title: Asthma in Head Start children: effects of the Breathmobile program and family communication on asthma outcomes.
abstract: BACKGROUND
  Asthma morbidity and mortality rates are high among young inner-city children. Lack of routine primary care provider visits, poor access to care, and poor patient-physician communication might be contributing factors.
  
  
  OBJECTIVE
  This study evaluated the effects of providing Breathmobile services only, a Facilitated Asthma Communication Intervention (FACI) only, or both Breathmobile plus FACI on asthma outcomes relative to standard care.
  
  
  METHODS
  Children with asthma (n = 322; mean age, 4 years; 53% male; 97% African American) were recruited from Head Start programs in Baltimore City and randomized into 4 groups. Outcome measures included symptom-free days (SFDs), urgent care use (emergency department visits and hospitalizations), and medication use (courses of oral steroids and proportion taking an asthma controller medication), as reported by caregivers at baseline, 6-month, and 12-month assessments. Generalized estimating equations models were conducted to examine the differential treatment effects of the Breathmobile and FACI compared with standard care.
  
  
  RESULTS
  Children in the combined treatment group (Breathmobile plus FACI) had an increase of 1.7 (6.6%) SFDs that was not maintained at 12 months. In intent-to-treat analyses the FACI-only group had an increase in the number of emergency department visits at 6 months, which was not present at 12 months or in the post hoc as-treated analyses. No significant differences were found between the intervention groups compared with those receiving standard care on all other outcome measures.
  
  
  CONCLUSIONS
  Other than a slight improvement in SFDs at 6 months in the Breathmobile plus FACI group, the intervention components did not result in any significant improvements in asthma management or asthma morbidity.
authors: Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA.
authors: Michelle N
authors: MN
authors: Eakin
authors: Cynthia S
authors: CS
authors: Rand
authors: Andrew
authors: A
authors: Bilderback
authors: Mary E
authors: ME
authors: Bollinger
authors: Arlene
authors: A
authors: Butz
authors: Veni
authors: V
authors: Kandasamy
authors: Kristin A
authors: KA
authors: Riekert
mesh_terms: D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D015142:Baltimore; D002675:Child, Preschool; D003142:Communication; D018572:Disease-Free Survival; D004363:Drug Utilization; D018479:Early Intervention, Educational; D004632:Emergency Medical Services; D005190:Family / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008952:Mobile Health Units / Q000706:statistics & numerical data; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D014505:Urban Population
chemical_list: D013256:Steroids