Rita H. Brown

Mobile-based asthma action plans for adolescents

Abstract Purpose: To examine feasibility and utilization of a mobile asthma action plan (AAP) among adolescents. Methods: Adolescents (aged 12–17 years) with persistent asthma had their personalized AAP downloaded to a smartphone application. Teens were prompted by the mobile application to record either daily symptoms or peak flow measurements and to record medications. Once data were entered, the application provided immediate feedback based on the teen’s AAP instructions. Asthma Control Test (ACT®) and child asthma self-efficacy scores were examined pre- and post-intervention. Results: Adolescents utilized the mobile AAP a median 4.3 days/week. Participant satisfaction was high with 93% stating that they were better able to control asthma by utilizing the mobile AAP. For participants with uncontrolled asthma at baseline, median (interquartile range) ACT scores improved significantly from 16 (5) to 18 (8) [p = 0.03]. Median asthma attack prevention self-efficacy scores improved from 34 (3.5) to 36 (5.3) [p = 0.04]. Conclusions: Results suggest that personalized mobile-based AAPs are a feasible method to communicate AAP instructions to teens.

Uncontrolled asthma and factors related to morbidity in an impoverished, rural environment

BACKGROUND Asthma disproportionately affects children living in impoverished communities; however, factors related to asthma morbidity among impoverished rural children have not been adequately described. OBJECTIVE To examine factors associated with asthma morbidity among rural children living in the Arkansas Delta region. METHODS We performed a cross-sectional investigation of 109 rural children with asthma enrolled in public schools in the Arkansas Delta region. A questionnaire format and home inspection were used to examine participant, caregiver, and home characteristics. RESULTS The median age of the study participants was 9 years, 83% were African American, and 71% had an annual household income of

Results of an asthma education program delivered via telemedicine in rural schools

20,000 or less. Ninety-eight percent of participants were insured, and most fit the criteria for uncontrolled asthma, yet only 23% reported taking inhaled corticosteroids. Transportation problems were cited by 20%. In the past 4 weeks, more than 50% reported rescue medication use or exercise limitations of 2 or more days per week or nocturnal symptoms of more than 2 nights per month. Emergency department visits in the past 6 months were reported by 28%, and 43% reported an unscheduled physicians visits for asthma in the past 3 months. Sixty-four percent had 1 or more positive allergen skin test results, and allergic sensitization was associated with exposure to dust mite, dog, mouse, and cockroach allergens in the home. CONCLUSION Asthma morbidity was high among this cohort of atopic asthmatic children in the Arkansas Delta. Overuse of rescue medications and underuse of inhaled corticosteroids were prevalent even though the population was highly insured and had frequent health care use. Future asthma health initiatives should focus on the unique challenges associated with translating national guidelines-based care to rural pediatric populations. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00590304.

Smartphone-based vs paper-based asthma action plans for adolescents.

BACKGROUND Asthma morbidity is high in low-income children living in rural US regions, yet few interventions have been designed to decrease the asthma burden in rural populations. OBJECTIVE To examine the effect of a school-based asthma education program delivered by telemedicine in children living in an impoverished rural region. METHODS We conducted a cluster randomized trial with rural children 7 to 14 years old by comparing a school-based telemedicine asthma education intervention with usual care. The intervention provided comprehensive asthma education by telemedicine to participants and provided evidence-based treatment recommendations to primary care providers. RESULTS Of the 393 enrolled children, median age was 9.6 years, 81% were African American, and 47% lived in households with an annual income less than

Mouse and cockroach exposure in rural Arkansas Delta region homes

14,999. At enrollment, 88% of children reported uncontrolled asthma symptoms. At the end of the intervention, there were no statistically significant differences in reported symptom-free days (primary outcome) for the intervention or usual-care group. Participants in the intervention group reported significantly higher use of peak flow meters to monitor asthma and reported taking their asthma medications as prescribed more frequently compared with the usual-care group. There were no changes in other outcome measures, including quality of life, self-efficacy, asthma knowledge, or lung function, between groups. CONCLUSION Although there was some evidence of behavior change among intervention participants, these changes were inadequate to overcome the significant morbidity experienced by this highly symptomatic rural impoverished population. Future interventions should be designed with a multifaceted approach that considers caregiver engagement, distance barriers, and inadequate access to asthma providers in rural regions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01167855.