The role of supervised school therapy in poorly controlled asthma in children

Muppala Raju; Malvika Sagar; Andrew Bush; Eugene Quaye; Shekhar Ghamande; Sonal Malhotra; Mercedes E Arroliga

doi:10.1080/08998280.2023.2204522

The role of supervised school therapy in poorly controlled asthma in children

Proc (Bayl Univ Med Cent). 2023 Apr 27;36(4):448-452. doi: 10.1080/08998280.2023.2204522. eCollection 2023.

Authors

Muppala Raju¹, Malvika Sagar², Andrew Bush³, Eugene Quaye⁴, Shekhar Ghamande⁴, Sonal Malhotra⁵, Mercedes E Arroliga⁶

Affiliations

¹ Department of Pediatrics, Baylor Research Institute, Temple, Texas.
² Division of Pediatric Pulmonology, Department of Pediatrics, Baylor Scott and White McLane Children's Medical Center, Temple, Texas.
³ Department of Paediatrics, Imperial College London, London, UK.
⁴ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Baylor Scott & White Medical Center - Temple, Temple, Texas.
⁵ Pulmonary and Sleep Medicine Services, Baylor College of Medicine, Houston, Texas.
⁶ Division of Allergy and Clinical Immunology, Department of Medicine, Baylor Scott and White Center for Diagnostic Medicine, Temple, Texas.

Abstract

Background: In children, nonadherence to inhaled corticosteroid (ICS) therapy leads to poor asthma control and complications.

Methods: We evaluated the benefit from initiation of ICS administration once daily at school. We retrospectively chose patients from our pediatric pulmonary clinic who had poorly controlled asthma and prescribed ICS daily. For the study period, we examined the number of corticosteroid courses, emergency room visits, hospital admissions, symptom history, and pulmonary function tests.

Results: Thirty-four patients who satisfied the inclusion criteria began the intervention. Preintervention, there were a mean number of 2.6 oral corticosteroid courses compared to 2 courses in the year following intervention (P = 0.8). Postintervention emergency department visits decreased from a mean of 1.4 to 1.0 (P = 0.71), and hospital admissions decreased from 1.23 to 0.57 (P = 0.04). There was also a significant increase in forced expiratory volume in 1 second (1.69 vs 1.4 L/sec, P = 0.02), a decrease in systemic steroid-free days in a year (96 vs 141 days, P = 0.03), and an increase in symptom-free days postintervention (28 vs 26 days, P = 0.325).

Conclusion: These findings suggest that ICS administration in schools may help reduce hospital admissions and improve lung function in patients with poorly controlled asthma.

Keywords: Asthma; hospitalizations; inhaled corticosteroids; lung function; oral corticosteroids; school therapy.