Allergen Screening and Telephone Coaching Interventions to Prevent School-Age Children at Risk of Developing Asthma

Purpose:

Asthma is the most common chronic health condition for children globally, and the prevalence is increasing in Taiwan. According to surveys by the Department of Health, Taipei City Government, the prevalence of asthma among first graders was 20.34% and 20.74% in 2007 and 2009 respectively. This project was aimed to have evidence-based intervention program for children at risk of asthma.

Methods:

During 2010 to 2012, an action research was conducted to deliver an overall allergen screening for the enrolled first-grade pupils and to provide telephone coaching interventions for the high-risk group in Taipei city, Taiwan. Dimensions of the interventions consisted of providing telephone coaching and parenting group, establishing the document of the coaching process and feedback, disseminating the asthma education materials and website resources. Before the research project, a standard telephone coaching protocol was developed and achieved to consensuses. Ten telephone coachers were recruited then trained by a series of asthma in-service education; they had clinical nurse practices at least 5 years and had approval as qualified asthma educators by Taiwan Association of Asthma Education. The high risk first graders were screened by using the asthma symptoms screening questionnaire and confirmed by blood allergen test. Parents of blood test positive children were given telephone coaching asthma education first and then received follow-up care. In addition, they were invited to parenting group for further dynamic asthma care consultation and supports. Outcome evaluation included narrative feedback and structural questionnaire of asthma knowledge, asthma symptom control, adherence to asthma care, level of satisfaction to the interventions.

Results

A total of 5,463 were screened out of the 62,497 first-grade schoolchildren as high risk group for asthma. As receiving allergen blood test, 4267 schoolchildren were confirmed to have positive findings; positive rate was 78.11% (4267/5263). Ninety percent positive cases (3878/426=90.8%) were successfully recruited to have the interventions. Among them, house dust mites (dermatophagoides pteronyssinus & dermatophagoides farine), blomia tropicalis and hair of dogs/cats were reported to be the first three leading allergens for children. Mothers are the key recipients having the telephone coaching (68.5%). The major contents of the coaching included allergen prevention (70.8%), facets of allergy and asthma (60.4%), use of controller and rescue medicine (62.7%). Use of peak expiratory flow meter, prevention of exercise induced asthma and skills of using inhaler were insufficient for their self-management. Among the children, 5.3% experienced the ER visit in the past one year and 3.7% had school absences. Prevention of asthma exacerbation during sandstorm and cold wave were also discussed. In addition to adherence to asthma medicine, prevention of triggers, healthy eating and regular exercise were fully shared and reinforced during the process. The final follow-up evaluation showed a high degree of satisfaction of telephone coaching and parenting group among parents, statistical significant reductions in ER rate and days of absence among schoolchildren.

Conclusions

The interventions in the research support the “asthma control-oriented asthma care” advocated by the Global Initiative for Asthma (GINA). The findings indicate that developing partnership between parents/children with asthma, identifying the triggers and reducing exposure to risk factors, empowering the asthma self-monitor and self-management efficacy can enhance health outcomes and quality of life for children and their families.