Asthma education and quality of life in the community: a randomised controlled study to evaluate the impact on white European and Indian subcontinentethnic groups from socioeconomically deprived areas in Birmingham, UK

Background-Whether asthma morbidity in minority groups can be reduced by pr eventative health care measures delivered in the relevant ethnic dialects r equires further evaluation. This study reports clinical outcomes and qualit y of life from a community based project investigating white European (WIE) and Indian subcontinent (ISC) ethnic groups with asthma living in deprived inner city areas of Birmingham, UK. Methods-Six hundred and eighty nine asthmatic subjects (345 WIE, 344 ISC) o f mean (SD) age 34.5 (15) years (range 11-59) and mean forced expiratory vo lume in one second (FEV1) of 80% predicted were interviewed in English, Pun jabi, Hindi, or Urdu. Subjects randomised to the active limb of a prospecti ve, open, randomised, controlled, parallel group, 12 month follow up study underwent individually based asthma education and optimisation of drug ther apy with four monthly follow up (active intervention). Control groups were seen only at the beginning and end of the study. Urgent or emergency intera ctions with primary and secondary health care (clinical outcomes) and both cross sectional and longitudinal data from an Asthma Quality of Life Questi onnaire (AQLQ) were analysed. Results-Clinical outcomes were available for 593 subjects. Fewer of the act ive intervention group consulted their GP (41.8% versus 57.8%, odds ratio ( OR) 0.52 (95% CI 0.37 to 0.74)) or were prescribed antibiotics (34.9% versu s 51.2%, OR 0.51 (95% CI 0.36 to 0.72)), but by ethnicity statistically sig nificant changes occurred only in the W/E group with fewer also attending A &E departments and requiring urgent home visits. Active intervention reduce d the number of hospital admissions (10 versus 30), GP consultations (341 v ersus 476), prescriptions of rescue oral steroids (92 versus 177), and anti biotics (220 versus 340), but again significant improvements by ethnicity o nly occurred in the active WIE group. AQLQ scores were negatively skewed to the higher values; regression analysis showed that lower values were assoc iated with ISC ethnicity. Longitudinal changes (for 522 subjects) in the me an AQLQ scores were small but statistically significant for both ethnic gro ups, with scores improving in the active and worsening in the control group s. Conclusions-Active intervention only improved clinical outcomes in the WIE group. AQLQ scores, although lower in the ISC group, were improved by activ e intervention in both ethnic groups.