Asthma program doesn't benefit inner-city kids

NEW YORK, June 13 (Reuters) An intensified education effort, directed at inner-city children with asthma who used a nebuliser at home, had no effect on their asthma severity or health care use, Baltimore-based researchers report in the June issue of the Archives of Pediatrics and Adolescent Medicine.

Dr. Arlene M. Butz of The Johns Hopkins Medical Institutions, and colleagues assessed the value of an asthma education program that included six home visits and concentrated on the use of devices such as the nebuliser and the relief-inhaler. They compared the results of this educational program with a more generalized approach involving three home visits.

Two hundred twenty-one children were randomly assigned to the enhanced intervention or the ''control,'' or more generalised, intervention.

At the end of the 6-month study period, the researchers found no significant differences between the two groups in home nebuliser practice, asthma attacks, emergency department visits or hospitalisations.

The average number of non-urgent care visits over the previous 6 months fell from three at the start of the study to two at follow-up, but again there were no between-group differences.

Of the three deaths that occurred, two were in the intervention group, but one of these children died before the education sessions started.

The fatality rate (1.4 per cent), the investigators note, was higher in the control group than the national asthma fatality rate of 0.7 per 100,000 in children.

In addition, the use of quick-relief medication was high and corticosteroid use was low in both groups.

Commenting on the results, Dr. Butz told Reuters Health that ''over-reliance of young children with persistent asthma on quick-relief medication and undertreatment with preventive medications may be prevented by standard assessment of medication use by health care providers.'' In addition, she pointed out, ''Frequent review of pharmacy refill records and medication delivery technique may help identify children with 'uncontrolled' asthma.'' REUTERS KD PM0949