Promoting Children's Adherence to Asthma Self-management

The long-term objective of this randomized, controlled clinical trial is to improve pediatric asthma outcomes, a Healthy People 2010 objective, by enhancing adherence to recommended asthma self-management. Asthma affects 26.3 million Americans, including 8.6 million children. Recent statistics reveal an alarming increase in pediatric asthma morbidity and mortality. Peak expiratory flow rate (PEFR) monitoring is integral to asthma symptom management. However, there are no published studies regarding the efficacy of strategies to enhance children's adherence to daily PEFR monitoring. The specific aim is to evaluate the effect of an intervention combining a contingency management protocol with asthma education (based on the National Asthma Education and Prevention Program treatment guidelines, National Heart, Lung, and Blood Institute) on: adherence to PEFR monitoring; asthma quality of life, health care utilization for asthma problems, missed school days due to asthma; and number of asthma episodes. The contingency management protocol will include self-monitoring, a contingency contract, reinforcing, tailoring, and cueing. The sample (N = 86) of 7- through 11-year-old children with persistent asthma and their parents/guardians will be recruited primarily from physician practices in central Kentucky. They will be randomly assigned to the intervention or usual care group. Data will be collected electronically on the PEFR monitoring adherence using the AccuTrax Personal Diary Spirometer that records the date, time and PEFR value and includes a self-report symptom and medication diary. The intervention will be delivered Weeks 4 through 6. Adherence episodes will be measured throughout the 16-week study. Data on the other outcome variables will be collected at baseline, following the intervention, and 10 weeks post-intervention. This study will provide further evaluation and refinement of the intervention for the development of an R01 proposal for a randomized, controlled clinical trial of an asthma self-management program for children.