African-American adolescents undergoing comprehensive treatment who had been previously hospitalized or had undergone multiple emergency department visits for asthma had improved outcomes compared with control patients, according to the results of a new study published in Pediatrics.

Clinical measurements from African-American adolescents who had previously been hospitalized or had multiple emergency department visits for asthma were evaluated after treatment with either Multisystemic Therapy-Health Care, a comprehensive home- and community-based plan, or weekly family counseling control. Outcomes of interest were forced expiratory volume in 1 second (FEV1), medication adherence, symptom severity, and healthcare use over the course of 12 months.

Of the 399 patient medical records screened, 196 were contacted regarding eligibility. Ultimately, 170 participants (ages 12-16 years) were enrolled in the study and randomly assigned to either the comprehensive treatment (n=84) or the control group (n=86). At follow-up, 3 were excluded from analysis. In the primary study outcome of FEV1, the comprehensive treatment group improved from 2.05 at baseline to 2.25 at 7 months (a 9.8% improvement), and the comparison group changed from 2.21 at baseline to 2.31 at 7 months (a 4.5% improvement).


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Similar improvements were seen at the 12-month follow-up. Furthermore, both adherence and symptom frequency were significantly improved in the comprehensive treatment group compared with control participants. Changes in asthma symptom severity were not significantly different between the groups over time. In addition, there was a reduction in the number of hospitalizations, but not in the number of emergency department visits.

“A home- and community-based, individualized behavioral treatment significantly improved FEV1 as a measure of lung function in African-American adolescents with poorly controlled asthma,” the researchers wrote. “These findings are especially noteworthy because African American adolescents experience greater morbidity and mortality from asthma than white adolescents even when controlling for socioeconomic variables.”

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Reference

Naar S, Ellis D, Cunningham P, et al. Comprehensive community-based intervention and asthma outcomes in African American adolescents [published September 5, 2018]Pediatrics. doi:10.1542/peds.2017-3737