Can an Asthma Self-Management Intervention Improve Quality of Life in Children Who Have Asthma?

Purpose:  Asthma is a major public health problem in childhood. Frequent symptomatic days requiring urgent management, disturbed sleep, and limitations in daily activities due to asthma contribute to worsening quality of life (QOL) in children who have asthma (Moreira et al., 2013). Asthma is a heavy burden on children who are members of racial/ethnic minority groups (Akinbami et al., 2012). A randomized controlled trial was conducted to test an asthma self-management intervention in comparison to an attention control intervention of general health promotion on school-aged (7-12 years) children’s QOL. The aims of this presentation are twofold: (1) To report results of the intervention on children’s asthma-related QOL. Hypothesis: Children in the treatment group will report significantly better asthma-related QOL than children in the attention control group. (2) Noting the heavier burden of asthma on members of ethnic/racial minority groups, we will also explore differences in QOL between Hispanic, Black, and non-Hispanic white children.

Methods:  Children were randomly assigned to the treatment or comparison group. The intervention was designed to improve children’s asthma self-management and included learning activities related to asthma trigger recognition, asthma symptom prevention and treatment, children’s problem-solving in common scenarios, self-monitoring and correct use of a metered dose inhaler (Horner & Brown, 2014; Raymond et al., 2012). All intervention and data collection materials were presented in English and Spanish-language versions. Data on QOL were collected from children at baseline and again at 12 months. The intervention was provided after study enrollment. QOL was measured with Juniper’s 23-item scale for children with 3 sub-scales (activity limitations, emotional functioning, and asthma symptoms). Higher scores on the QOL scale indicates worse asthma QOL. Repeated measures ANOVA were run to examine changes from baseline to 12 months (Field, 2013). Follow-up ANOVA were run to examine QOL by racial/ethnic group.

Results:

Sample:  A total of 257 children and their parental caregiver completed the 12-month study (88% retention) and included 163 boys (63.6%), 94 girls (36.4%); of which 58% were Hispanic, 21% were Black, and 19% were non-Hispanic white (white). The children’s mean age was 8.82 years (SD=1.2).

 Aim1. Examination of baseline demographics (gender, age, race/ethnicity) and QOL scores revealed no significant differences between the treatment groups. After the intervention, when compared to the attention-control group, QOL was significantly improved in the treatment group: QOL total score, F=7.53, p=.007; QOL emotional functioning, F=4.05, p=.02; and QOL asthma symptoms, F=3.28, p=.04. In terms of activity limitations due to asthma, there were no between treatment group differences – both groups had fewer days with limited activity.

Aim 2. When comparing racial/ethnic groups, additional information is revealed. There were significant differences at baseline in children’s QOL: QOL total score, F=7.05, p=.001; QOL activity limitations, F=5.89, p=.003; QOL emotional functioning, F=3.46, p = .03; and QOL asthma symptoms, F=8.21, p<.001. Black children reported significantly worse QOL than the other two ethnic/racial groups. The children’s QOL improved after the intervention, but there continued to be significant differences between racial/ethnic groups 12 months later: QOL total score, F=3.62, p=.03; QOL activity limitations, F=3.18, p = .04; QOL asthma symptoms, F=4.52, p=.01. Whereas, QOL emotional functioning, F=2.25, p=.11 was not significantly different.

When reviewing the descriptive findings (means & SD) for children’s total QOL scores at baseline: 62.30 (SD=19.28) for Blacks, 52.34 (SD=18.96) for Hispanics, and 48.86 for whites we find that Black children had worse total QOL than did Hispanic children, who in their turn had worse QOL than did the non-Hispanic white children. However, the total QOL scores 12-months later were: 48.56 (SD=16.91) for Blacks, 46.66 (SD=18.83) for Hispanics, and 39.86 (SD=15.18) for whites. The 12-month data shows improvements in their total QOL scores, but the between racial/ethnic group differences remained.

Conclusion: In terms of whether the intervention improved QOL in children with asthma, the hypothesis was supported. The treatment group had significantly better improvements in their QOL than did the comparison group. QOL is a patient-centered indicator of well-being and health. The intervention, which focused on symptom recognition, self-monitoring, problem-solving, and skill development, was an effective way to improve QOL in children with asthma. It is important to note that the treatment and comparison group were composed of equivalent groups in terms of gender and race/ethnicity. The further examination of QOL by racial/ethnic group did reveal significant differences in QOL for children who are members of racial/ethnic minority groups. Nevertheless, their scores also improved after the intervention. While this is a positive finding, the continued differences in QOL reported by children who are ethnic/racial minority group members should be noted. The secondary aim highlights the need for continued work to look carefully at ways to improve asthma self-management and thereby improve the QOL of children who have asthma (Sweet et al., 2014). Interventions may require tailoring to address specific issues of concern to parents and children with asthma who are members of racial/ethnic groups.