Asthma attacks, emergency department (ED) visits, and hospital admissions are much more common among African American (AA), Hispanic, and poor children living in cities than among other children with asthma. When parents are unable to follow asthma management plans, and particularly when they do not consistently give their children their daily inhaled controller medications, asthma outcomes are even worse. We have developed a unique program that follows national guidelines for asthma care and that focuses on urban youth with asthma who make frequent ED visits. While patients in the program take more daily controller medications than those not in the program, actual use remains just under 50%. The link between psychosocial stress ("life's daily hassles") and poor asthma outcomes is clear. Of note, stress may lower daily use of controller medications.
National experts and other stakeholders cite a pressing need to reduce parents' stress in order to increase their children's use of daily controller medications. However, few studies exist of interventions to manage stress among parents of youth with asthma. Of note, interventions using several approaches to asthma care at once may prove crucial to such efforts. For example, cell phones are now being used to help manage chronic diseases, including pediatric asthma. No studies have examined a parental stress management program using cell phones as a means to increase medication usage.
Our overall aim is therefore to work with parents and other stakeholders to develop and test a patient-centered and culturally-appropriate program targeting parents of at-risk urban youth with severe asthma. It will use several approaches to reduce stress and to increase medication use including a cell phone tool that allows the research team to track home medication use and to help when that use drops off. We will do this by: Stage 1: a. Developing and refining a program of highly individualized stress management for the parents of urban, AA, and/or Hispanic youth with uncontrolled asthma; b. Testing a cell phone tool that allows in-home tracking of controller medication use and real-time help when it falls. Stage 2: To conduct a research study comparing our current program of asthma care to our current program plus parental stress management with home tracking of controller medication use in a group of 250 AA and/or Hispanic youth aged 4-12 years.
We predict that the stress management program will increase the amount of daily controller medications taken. We will look at other outcomes including wheezing, cough, ED visits, hospitalizations, missed school days, parental/child stress, parental satisfaction, and parent/child quality of life. The potential for this research to determine if a stress management program plus home tracking of medication use can further improve guideline-based care in an at risk population is very important. It will give parents and doctors more choices in caring for children.
Waters DM, Olson AM, Fousheé N, et al., Perceptions of Stress, Coping, and Intervention Preferences among Caregivers of Disadvantaged Children with Asthma Journal of Child and Family Studies (March 2017).
Shelef DQ, Rand C, Streisand R, et al. Using Stakeholder Engagement to Develop a Patient-Centered Pediatric Asthma Intervention. Journal of Allergy and Clinical Immunology (December 2016).
Kramer CB, LeRoy L, Donahue S, et al. Enrolling African-American and Latino Patients with Asthma in Comparative Effectiveness Research: Lessons Learned From Eight Patient-Centered Studies. Journal of Allergy and Clinical Immunology (December 2016).