School-based telemedicine enhances asthma management in children

Originally Published By 2 Minute Medicine®. Reused on Pulmonology Advisor with permission.
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1. A school-based telemedicine program with directly observed preventive therapy, when compared to enhanced usual care, led to more symptom-free days and fewer emergency department visits or hospitalizations.

2. Particularly in impoverished communities, incorporating school-based telemedicine has the potential to lower barriers in preventive asthma care, including poor adherence and lack of follow-up care.

Evidence Rating Level: 1 (Excellent)   

Study Rundown: Many children with persistent asthma do not have well-controlled symptoms, in part due to poor adherence and a lack of follow-up care. In this study, the authors randomized children with persistent asthma to school-based telemedicine (with directly observed therapy) or enhanced usual care. They found that children in the school-based telemedicine group had more symptom-free days (SFDs) and fewer emergency department visits or hospitalizations for asthma, when compared to children assigned to enhanced usual care. Furthermore, they also had a greater decline in fractional exhaled nitric oxide (FeNO), a measure of airway inflammation, and the quality of life of their caregivers was improved, though the difference was not statistically significant.

Though the increase in the number of symptom-free days was small, the reduction in emergency department visits or hospitalization, contributions to improved quality of life, and general satisfaction with school-based telemedicine support the implementation of telemedicine in schools for the management of asthma. However, because the study did not directly compare telemedicine with directly observed therapy to directly observed therapy alone, the results do not support the superiority of telemedicine over other formats.

Click to read the study in JAMA Pediatrics

Relevant Reading: Randomized controlled trial to improve care for urban children with asthma: results of the School-Based Asthma Therapy trial.

In-Depth [randomized controlled study]: This study randomized 400 children aged 3 to 10 years with persistent or poorly controlled asthma from various schools in Rochester, New York to either School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) or enhanced usual care (eUC). The SB-TEAM group underwent a telemedicine visit for an initial asthma assessment and prescription of preventive medication, and received daily directly observed therapy at school, as well as follow-up telemedicine assessments every 4-6 weeks. The eUC group received a symptom assessment, medication recommendations, and educational materials. The authors found that children assigned to SB-TEAM, compared to eUC, had more symptom-free days (11.6 vs. 10.97 per 2 weeks, p = 0.01), fewer emergency department visits or hospitalization for asthma (7% vs. 15%; 95% CI, 0.32 to 0.84), and a greater decline in FeNO level (mean difference, -5.54; 95% CI, -9.8 to -1.3). The quality of life for caretakers was also improved in the SB-TEAM group, though the difference was not statistically significant. Caregivers were highly satisfied with the program, with more endorsing improved understanding of asthma medications and improved communication and comfort with the school nurse in the SB-TEAM group vs. the eUC group.

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