MedWire News: A telephone coaching program can improve
the quality of life (QoL) of parents with asthmatic children by
helping to improve disease management at home, US research
Writing in the Archives of Pediatrics and Adolescent
Medicine, Jane Garbutt (Washington University School of
Medicine, St Louis, Missouri, USA) and colleagues explain that
among children with asthma "care is often episodic, with underuse
of controller medications and inadequate home management of acute
They add: "Consequently, many children with asthma live with
frequent symptoms and activity limitations, and visits for urgent
care are common."
To investigate whether a telephone-based asthma management
coaching program benefits children with asthma and their parents,
the team enrolled the families of 362 children, aged 5-12 years,
with the respiratory condition who were randomly assigned to the
Telephone Asthma Program (TAP) (n=190) or a control group
TAP was a 12-month intervention designed to provide
telephone-based education and support for parents to help them with
the day-to-day management of their child's asthma. The program
targeted four key behaviors: using controller medications as
prescribed; administering albuterol at the first signs of an asthma
attack; having an up-to-date asthma action plan; and having a
collaborative relationship with the child's primary care provider
that included asthma planning visits at least every 6 months.
Disease-specific QoL was measured at the beginning and end of
the study period using the Pediatric Asthma QoL Questionnaire in
children and the Pediatric Asthma Caregiver's QoL Questionnaire in
parents. For both instruments, answers are expressed on a 7-point
scale, with a higher score indicating a better QoL and a change of
0.5 units considered clinically significant. Urgent visits for
asthma care were also recorded.
The researchers found that parental QoL scores in the TAP group
improved by an average of 0.67 units, from 5.75 to 6.47, during the
study period, compared with an improvement of 0.28 units, from 5.92
to 6.22, in the control group - a statistically significant
difference of 0.38 units.
There were no significant between-group differences in the
children's QoL at the end of the study period, or in the mean
number of urgent care events per year.
However, there were significantly greater reductions in levels
of very poorly controlled asthma among children in the TAP group
over the study period than among those in the control group, as
assessed using data on symptom frequency, use of albuterol, the
number of school days missed, and the number of courses of oral
Garbutt and team conclude: "Participation in the 12-month
telephone asthma coaching program resulted in an improvement in the
parents' QoL and improved the child's asthma control."
They add: "If the refined intervention proves to be
cost-effective, widespread implementation may be possible as it
would require minimal practice redesign and would not require
additional physician training."
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