School-Supervised Use of a Once-Daily Inhaled Corticosteroid Regimen: A Cluster Randomized Trial

Publication date: Available online 14 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Joe K. Gerald, Julia M. Fisher, Mark A. Brown, Conrad J. Clemens, Melissa A. Moore, Scott C. Carvajal, Donna Bryson, Nikki Stefan, Dean Billheimer, Lynn B. Gerald

Background

School-supervised use of a once-daily inhaled corticosteroid regimen (supervised therapy) can improve medication adherence and asthma control.

Objective

To evaluate the effectiveness of supervised therapy in a unique setting and population.

Methods

We conducted a cluster-randomized trial of supervised therapy in 20 elementary schools with a disproportionate enrollment of low income Latino students. Schools were purposively selected, matched, and randomized to receive 9-months of supervised therapy with mometasone furoate or usual care. All English- or Spanish-speaking students with self-reported asthma were eligible. The Asthma Control Questionnaire (ACQ) was interviewer-administered quarterly at school. Students in supervised therapy schools were hypothesized to have lower ACQ scores than students in usual care schools.

Results

Of 393 enrolled students, 189 immediate intervention and 143 delayed intervention students provided ≥1 ACQ data point, were between 6 - 10 years of age, and were included in the primary analysis. At baseline, 39% of students reported taking a controller medication and 24% had well-controlled asthma. Eighty percent of immediate intervention students were prescribed mometasone. Schools administered 98% of prescribed doses when students attended school. Absences, weekends, and holidays reduced calendar adherence to 53%. During the first year, the mean ACQ score for immediate and delayed intervention students was 1.55 (95% CI 1.41, 1.70) and 1.64 (95% CI 1.47, 1.80), respectively. The estimated treatment effect was -0.08 (95% CI -0.31, 0.14).

Discussion

Compared to usual care, supervised therapy did not improve asthma control among this population of Latino students. Additional research is warranted to confirm these results.

Graphical abstract

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