EVALUATION OF A COMMUNITY-BASED ASTHMA MANAGEMENT PROGRAM IN A POPULATION-SAMPLE OF SCHOOLCHILDREN

Objective: To assess the eff ect of a community-based management progr am, incorporating both education and treatment directed at children, p arents, doctors, pharmacists, community nurses and school teachers. De sign: The effect of this intervention in a population sample of 65 chi ldren with a wide range of morbidity due to asthma was compared with a control group of 55 children living in a different area. Both groups were re-evaluated concurrently after three and six months. Main outcom e measures: Forced expiratory volume in one second (FEV1); bronchial r esponsiveness to histamine measured as the provoking dose causing a 20 % fall in FEV1 (PD20FEV1) and as dose-response ratio (DRR); Airflomete r variability; symptom frequency; and knowledge of asthma. Morbidity w as measured by parents using a self-administered questionnaire and inc luded days absent from school and unscheduled doctor or emergency room visits. Results: At three months, the intervention group had a signif icant improvement in knowledge of asthma compared with both their base line and the control group's change in knowledge. Also, FEV1 improved in this group and symptoms which limit activity decreased significantl y. However, the largest improvements were recorded at the six-month fo llow up. In the intervention group, bronchial responsiveness and night cough were reduced significantly and FEV1 was improved, compared with both baseline measurements and the control group. Knowledge of asthma also improved significantly from baseline, and unscheduled doctor or emergency room visits were reduced. Conclusion: These improvements in this group of children, many of whom had mild asthma, verify that comm unity-based management programs can be effective in treating childhood asthma.