Trial aimed at improving inhaled steroid adherence and asthma outcomes
Published Online: June 27, 2011
In a recent issue of The Journal of Allergy and Clinical Immunology (JACI), Apter et al conducted an individualized randomized controlled trial to improve inhaled steroid adherence, monitored electronically, and asthma outcomes.
In adults with moderate/severe asthma recruited from practices serving inner-city neighborhoods, they compared Problem-Solving (PS) to standard asthma education (AE) over 6 months. PS consisted of defining specific barriers to adherence, proposing solutions, trying the best, assessing, and revising. 333 adults were randomized: 49+14 years, 72% female, 68% African American, 7% Latino, mean FEV1 66%+19%, 31% with hospitalizations and 52% with ED visits for asthma in the prior year.
There was no difference between groups in overall change of adherence or any asthma outcome. Mean adherence was good: 61% declining slightly over the observation period. Asthma control improved overall by 15%. In both groups, FEV1 and quality of life improved: 6% and 18%, respectively. However, the improvement in FEV1 only occurred during monitoring but not subsequently after randomization. Rates of ED visits and hospitalizations did not decrease. Thus, PS was not better than AE. Monitoring inhaled steroid use with provision of medications and attention, imposed on both groups, was associated with improvement in FEV1 and asthma control but did not reduce the rates of ED visits and hospitalizations.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.