Does school supervision of controller medication use improve asthma control?

Published online: August 14, 2018

The best way for children with asthma to manage their condition is to take an inhaled corticosteroid (ICS) every day. Unfortunately, few children take their medication consistently enough to control their asthma. Studies have shown that supervising ICS use at school (supervised therapy) can increase medication adherence and improve asthma control. However, few studies have used randomization to account for factors other than treatment that might affect asthma outcomes and few have included Latino children.

In a research article recently published in The Journal of Allergy & Clinical Immunology (JACI), Gerald and colleagues at the University of Arizona tested whether supervised therapy improved asthma control among students enrolled in elementary schools serving primarily Latino students from disadvantaged communities in Tucson, Arizona. Over a two-year period, they collected data on more than 300 students in the Supervised Asthma Medicine in Schools (SAMS) study.

In the first year, 10 schools were randomized to start supervised therapy immediately and 10 were randomized to wait until the second year. School health personnel supervised ICS use every day students were at school. When students did not attend, parents supervised medication use at home. Every three months, students were asked about their asthma symptoms, activity level and rescue medication use. Medication adherence at school, but not at home, was monitored by the researchers.

At baseline, only 39% of students reported taking a controller medication. After the first study visit, 80% of students in supervised therapy schools were prescribed ICS. During the study period, schools correctly supervised 98% of the prescribed doses when students were present. When the researchers compared asthma control among students in immediate intervention schools with those in delayed intervention schools, supervised therapy did not improve asthma control.

However, the author’s note that absences, weekends, and holidays meant that students were only in school and receiving ICS on 53% of the days during the school year. While students likely took some medication at home, it may not have been enough to improve asthma control. The authors caution applying these results to other settings owing to the unique population studied, the lack of home adherence measurement, and the absence of lung function measurement.

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.