Peer-led asthma self-management education for adolescents in urban areas outperformed adult-led programs in enhancing asthma outcomes. These and other findings were described in a randomized clinical trial published in Journal of the American Medical Association.

The potential for peer-led asthma self-management programs to improve asthma outcomes in urban adolescents has yet to be elucidated. Researchers assessed the long-term effects of such a program in participants with persistent asthma aged between 12 and 17 years in 3 US metropolitan areas: Buffalo, New York; Baltimore, Maryland; and Memphis, Tennessee.  The experimental group received instruction from peers, whereas those in the control group received adult-led instruction. The investigators recruited participants via clinical practices and schools.

The primary endpoint was quality of life measured by the Pediatric Asthma Quality of Life Questionnaire. This tool reflects asthma symptoms, activity limitations, and emotional functioning during the preceding 2 weeks.


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In total, results from 320 participants were gathered (52.5% boys; 78.4% African American). Response rates topped 80%, and the peer-led group had better improvements vs the adult-let group, with adjusted mean differences (AMDs) between baseline and 15 months of 0.75 vs 0.37 for quality of life (between-group AMD, 0.38; 95% CI, 0.07-0.63) and −0.59 vs −0.31 for asthma control (between-group AMD, −0.28; 95% CI, −0.51 to −0.01).

Peer leaders completed bimonthly contacts every other month using a standardized script for continuous support/encouragement for 1 year. Asthma educators and nurse practitioners, who served as adult leaders, delivered the same content as the peer leaders, with research staff conducting bimonthly contacts for 1 year to match the bimonthly attention of the peer-led groups.

The control group received an average number of 4.60 bimonthly contacts vs 2.60 in the control group, although this difference did not result in significant differences in results.

Limitations of the current study include impaired generalizability secondary to nonprobability sampling. Specifically, it may be hard to extrapolate findings to White or Hispanic individuals. Additionally, self-reported outcomes were prone to response bias. Another limitation was that the study duration may be too short to assess the impact on asthma control outcomes.

“These findings suggest that a peer-led asthma self-management program should be considered in addressing the disproportionate asthma burden in racial and ethnic minority adolescents living in urban communities,” wrote the authors.

Reference

Rhee H, Love T, Wicks MN, et al. Long-term effectiveness of a peer-led asthma self-management program on asthma outcomes in adolescents living in urban areas. JAMA Network Open. 2021;4(12):e2137492. doi:10.1001/jamanetworkopen.2021.37492