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Older adults with asthma treated with a self-management, customized support intervention had improved quality of life, more effective inhaler technique, greater medication compliance, and better control of their asthma, according to a study published in JAMA Internal Medicine. The intervention also significantly reduced the number of emergency department visits.
This randomized clinical trial included 391 adults aged ≥60 years (mean age, 67.8±7.4 years; 15.1% men) with uncontrolled, persistent asthma. Participants in the Supporting Asthma Self-Management Behaviors is Older Adults (SAMBA; ClinicalTrials.gov Identifier: NCT02316223) study were randomly assigned to intervention at home, in a clinic, or usual care (control). The study was conducted between 2014 and 2017, and participants were recruited from electronic medical records.
Barriers were identified by screening for cognitive, physical, psychosocial, and environmental factors affecting self-management and control of asthma. The study’s primary outcomes included the Asthma Control Test, Medication Adherence Rating Scale, Mini Asthma Quality of Life Questionnaire, number of asthma-related emergency department visits, and metered dose inhaler technique. Home- vs clinic-based outcomes were compared in subgroup analyses. All primary outcome measures were investigated using continuous repeated measures with random and fixed-effects hierarchical linear modeling.
The intervention groups had better scores on the Asthma Control Test than controls, with a 3-month difference of 1.2 (95% CI, 0.2-2.2; P =.02), a 6-month difference of 1.0 (95% CI, 0.0-2.1; P =.049), and a 12-month difference of 0.6 (95% CI, -0.5 to 1.8; P =.28), resulting in an overall chi-squared value of 13.4 (P =.01). At 12 months, 6.2% of the patients in the intervention groups visited the emergency department compared with 12.7% of controls (P =.03), yielding an adjusted odds ratio of 0.8 (95% CI, 0.60-0.99; P =.03).
The intervention groups also reported significant improvements in asthma quality of life compared with controls (chi-squared value, 10.5 with 4 degrees of freedom; P =.03), as well as improvements in inhaler technique at 12 months (75% vs 58%) and compliance with medication (chi-squared value, 9.5 with 4 degrees of freedom; P =.049). There was no significant difference in outcomes for patients who received the intervention at home vs in a clinic.
Study limitations included a smaller than intended sample size, a low retention rate in the treatment groups, limited generalizability due to specific demographic characteristics, and a lack of blinding among research assistants. In addition, researchers noted improvements in some outcomes in patients in the control group, which means that secular effects may have also contributed to improvements in patients in the intervention group.
“The SAMBA intervention is a promising model of self-management support and disease control for older adults with asthma, and possibly other chronic diseases, though because of lower retention of intervention patients and diminished intervention effects over time, the model should undergo additional refinement and testing before it is widely adopted,” the researchers wrote.
Disclosures: Drs Wolf and Wisnivesky report financial associations with pharmaceutical companies outside of the submitted work.
Reference
Federman AD, O’Conor R, Mindlis I, et al. Effect of a self-management support intervention on asthma outcomes in older adults: the SAMBA study randomized clinical trial [published online June 10, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2019.1201
