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160. Randomized clinical trial of parental psychosocial stress management to improve asthma outcomes

Author

Teach, Stephen J., Shelef, Deborah Q., Fousheé, Naja, Horn, Ivor B., Yadav, Kabir, Yunfei Wang, Rand, Cynthia S., and Streisand, Randi

Abstract

Because higher parental psychosocial stress is associated with worsened asthma outcomes in children, we sought to determine if a parent-focused stress management intervention would improve outcomes among their at-risk African American children. We enrolled self-identified African American parent-child dyads (children aged 4-12 years old with persistent asthma, no co-morbidities, on Medicaid) in a prospective, single-blind, randomized clinical trial with follow-up at 3, 6, and 12 months. All children received care based on the guidelines of the National Institutes of Health. Developed with extensive local stakeholder engagement, the intervention consisted of four individual sessions with a community wellness coach (delivered over 3 months) supplemented with weekly text messaging and twice monthly group sessions (both delivered for 6 months). The main outcome was asthma symptom-free days in the prior 14 days by repeated measures at 3 and 6 months follow-up. We randomized 217 parent-child dyads and followed 196 (90.3%) for 12 months. Coaches completed 338/428 (79%) of all individual sessions. Symptom-free days increased significantly from baseline in both groups at 3, 6, and 12 months, but there were no significant differences between groups over the first 6 months. At 12 months, the intervention group sustained a significantly greater increase in symptom-free days from baseline [adjusted difference = 0.92 days, 95% confidence interval (0.04, 1.8)]. The intervention did not achieve its primary outcome. The efficacy of providing psychosocial stress management training to parents of at-risk African American children with persistent asthma in order to improve the children’s outcomes may be limited. NCT02374138

Published
2019
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167. Medications used by children with asthma living in the inner city

Author

Eggleston, Peyton A., Malveaux, Floyd J., Butz, Arlene M., Huss, Karen, Thompson, Lera, Kolodner, Ken, and Rand, Cynthia S.

Subjects
Asthma in children -- Drug therapy, African American children -- Health aspects, City children -- Drug use
Abstract

Many inner-city children with asthma may not receive appropriate and effective medical therapy. Researchers surveyed the families of 392 urban asthmatic children to determine which medications were used to treat and manage asthma. Twenty percent of children used no medications or only used over-the-counter medication. Many older children supervised their own medication use. Only 11% of children used an antiinflammatory drug every day, despite national guidelines which recommend it. Urban asthmatic children may be undermedicated, and they require more supervision of care., Objective. The purpose of the study was to examine medication use reported by families participating in an urban school-based community intervention program and to relate this use to other social and medical variables. Design. The design of the study was a cross-sectional questionnaire survey. Setting. Patients and their families recruited from elementary schools in a community setting were interviewed between December 1991 and January 1992. Participants. A total of 508 children with asthma were identified by school health records and teacher surveys. Their families confirmed the diagnosis and agreed to enter the study. Questionnaires were completed by 392 families. Intervention. The 392 families participated in a controlled trial of asthma education after providing the data that are the basis of this report. Results. More than half of the children took two or more medications for asthma. Thirty-one percent took theophylline alone or in combination with an adrenergic agent, 11% took some form of daily antiinflammatory medication, either cromolyn (8%) or inhaled steroids (3%). The pattern of medication use related to measures of severity and to regular visits to physicians or nurses. In general, however, children were undermedicated. A total of 78 children (20%) reported no medication or over-the-counter medication use, although 370% reported asthma severe enough to be associated with [is greater than or equal to] 20 days of school missed per month, and 37% had had an emergency room visit for asthma in the past 6 months. More than half of children [is greater than or equal to] 9 years old supervised their own medication. Conclusions. We concluded that undermedication is common in poor children with asthma living in urban areas. Antiinflammatory medications are used less commonly than in the general population, and theophylline is used more often. School children may be likely to supervise their own medication. Pediatrics 1998; 101:349-354; asthma, medications, minorities, epidemiology., Medication recommendations for the treatment of chronic asthma have changed a great deal in the past decade. Currently, national and international guidelines for asthma therapyl[1,2] include daily antiinflammatory medications such [...]

Published
1998

190. The Diagnostic Pathway to Sarcoidosis*

Author

Judson, Marc A., Thompson, Bruce W., Rabin, David L., Steimel, Joanne, Knattereud, Genell L., Lackland, Daniel T., Rose, Cecile, Rand, Cynthia S., Baughman, Robert P., and Teirstein, Alvin S.

Published
2003

197. Depression in Sarcoidosis

Author

CHANG, BETTY, STEIMEL, JOANNE, MOLLER, DAVID R., BAUGHMAN, ROBERT P., JUDSON, MARC A., YEAGER, HENRY, Jr., TEIRSTEIN, ALVIN S., ROSSMAN, MILTON D., and RAND, CYNTHIA S.

Published
2001
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