New Asthma Management Education Program Helps Children and Parents in Rural Areas

AUSTIN, TexasSchool-age children participating in a federally funded University of Texas at Austin asthma health education program improved significantly in their asthma self-management, skill at using an inhaler and had 50 percent fewer hospitalizations, study results show.

The four-year $1.5 million National Institutes of Health study at the School of Nursing began in 2003 and focused on rural familiesparents and school-age children. Most of the information about children and asthma in the past has come from studies in urban areas.

"Asthma is still the most common chronic health problem for childreneven for those who live in the country because they may be exposed to more allergens," said Dr. Sharon Horner, professor of nursing and lead investigator. Home management of asthma is a significant burden for these families in terms of health care costs, lost wages and concern over the need to travel to urban sites to receive health care, she said.

"This results in significant health disparities among rural people who already have lower incomes and fewer social and health care resources than urban dwellers," Horner said.

Through the family asthma education intervention, researchers hoped to improve asthma severity and, thus, improve quality of life.

The tri-ethnic study was composed of 173 families and 183 children in grades 2-5 in central Texas.

"Because school-age children spend much of their time away from home," Horner said, "the children need to be able to recognize early asthma warning signs, get help from other adults like teachers and coaches when they are having asthma symptoms and become more aware of asthma triggers and ways to avoid triggers."

During their school lunch breaks, children in the treatment group learned about asthma symptoms, how to measure and manage their symptoms, how to cope with them and how to deal with exacerbating situations, such as caring for animals or hard play outside. They practiced using teaching inhalers (which contained no medicine) and peak flow meters, a simple device that helps them measure airflow in the lungs. Another set of children, a comparison group, learned about general hygiene activities.

Home visits also were incorporated into the treatment study. Families were given a peak flow meter and were taught how to use it and interpret the scores. An informational booklet on asthmadesigned specifically for the projectalso was given to the families.

At the beginning of the study, researchers found that some of the children had no prescribed medications for asthma and 42 percent of the children had their medication only at home. Only 19 percent of the children had a peak flow meter to use.

"We also recognized that parents are their children's first and most important teachers," said Horner. "We wanted to focus on providing parents with tools and information they could use to help their children learn to manage their asthma."

Including parents in education program can aid continuity in care between the school and home settings, she said.

After the education self-management program, parents reported significant decreases in their children's asthma symptom frequency and severity and activity limitations. In addition to lower hospitalization rates, the children also missed less school after the program. Children with asthma symptoms missed (a group reduction of 13 percent less days) after participating in the study.

"This reduction in absences is significantan improvement that benefits the child, parents and the schools," said Horner. "Not only were the children better able to care for their asthma, but they can now do so in situations where adults are not around."

Asthma continues to increase among children 5-14 years of age and now 6.5 million people under the age of 18 have the chronic illness. Members of ethnic minority groups are disproportionately affected, with 13 percent of African American and 8.6 of Hispanic children having a diagnosis of asthma as compared to 8 percent of white children.

For more information contact: Nancy Neff, School of Nursing, 512-471-6504.