Evaluation of efficacy of a therapeutic-educational programme addressed to improve asthma control, in asthmatic children and adolescents

Key words: Childhood asthma, Anti-asthmatic drugs, Asthma control, Therapeutic education, Asthma management.

Aim - To evaluate whether the therapeutic-educational programme ‘Io e l’Asma’, addressed to asthmatic children/adolescents and their families would improve asthma control and implement asthma guidelines in an Italian setting in which the prevalence of asthma in 6-15 year-old children is 4.2%, and only 9% undergo a specialist visit.
Methods - Observational retrospective pre-post intervention study. The programme ‘Io e l’Asma’ included three visits and two educational courses (one individually-based and one for groups). Outcome measures were the degree of asthma control (not controlled, partially controlled and controlled) and the percentage of children who benefit from the intervention, defined as the improvement of the degree of control. Moreover, hospitalizations for asthma and school-missing days because of asthma were calculated.
Results - Between September 2007 and July 2010, 262 asthmatic children and adolescents aged between 6-15 underwent and completed the programme ‘Io e l’Asma’. The proportion of children with an asthma rated as ‘controlled’ increased from 44 to 79% (χ2M-H=66.8; p<0.0001). In all, 42% improved their asthma control and 38% maintained a good control as before the intervention. At the end 49% of cases did not need any controller therapy and 49% received fluticasone only, compared to 72 and 16%, respectively, at the beginning of the programme. 10% underwent hospitalization: 7% before, 2% during, and 1% after intervention (χ2M-H=15.4; p=0.0001). 20% missed school: 14% before, 4% during, and 2% after intervention (χ2M-H=24.4; p=0.0001).
Conclusions - The therapeutic-educational programme and the follow-up by the doctor led to clinical improvements as well as a reduction in, or more efficient use of, asthma medication. The efficacy of this programme suggests the inappropriateness of the therapeutic-educational level in asthma management.