Multicomponent intervention for schoolchildren with asthma: Pilot cluster randomized controlled trial

Background

Physical activity (PA) is an important factor in asthma management. However, studies report low PA in children with asthma living in underserved communities.

Objective

We assessed preliminary effectiveness of a pilot multicomponent asthma intervention that includes classroom-based PA, asthma education to increase knowledge and reduce stigma, and care coordination to facilitate guideline-based care, on PA and symptom-free days (SFD) in urban, historically marginalized children with asthma.

Methods

Children aged 7-10 years with asthma and their caregivers were recruited from 4 Bronx, NY, schools. We randomly assigned 2 schools as intervention and 2 as control sites. Child PA (primary outcome) was measured by accelerometers at 4 time points, and caregivers completed surveys on asthma symptoms. Analyses used generalized linear mixed models with generalized estimating equation adjusting for clustering. Clinical Trial Registration: ClinicalTrials.gov NCT01873755.

Results

We included 107 children (53% male participants, 82% Hispanic, mean [standard deviation] age 9.0 [1.0] years, 76% with persistent or uncontrolled asthma). Children in the intervention group had a significantly greater increase in total moderate-to-vigorous PA and step counts at 12 months after intervention in the entire sample (β = 6.05, P < .0001; β = 579.11, P = .008, respectively) and in those with persistent or uncontrolled asthma compared to controls (β = 6.20, P < .001; β = 639.08, P = .004, respectively). Similar beneficial intervention effects were found in improvement in SFD over 2 weeks in the entire sample (β = 1.38, P = .018) and in children with persistent or uncontrolled asthma (β = 1.82, P = .011) compared to controls.

Conclusion

A pilot intervention addressing multiple barriers to PA, including stigma, teacher confidence in asthma management, access to PA, and in-school medication, improved PA levels and SFD in students with asthma.