- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00516633
Intervention Study to Improve Adherence in Asthma
Does Improved Information in the Form of Group Discussions With Parents of Newly Diagnosed Asth-Matic Children Lead to a Better Quality of Life for the Families, an Improved Adherence and Better Devel-Opment of the Lung Function of the Children?
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Poor adherence to the prescribed regimen of medication is one of the major obstacles to successful treatment of many chronic diseases, in the case of both grown-ups and children. In 1998 we initiated a randomized, prospective intervention study with per protocol design involving 60 young children re-cently diagnosed as having asthma and with a high risk that this condition would persist.
The parents of the children in the intervention group received extra support and information in the form of group discussions, whereas the control patients were treated in a routine manner. All children 0-6 years of age who fulfilled at least one of the criteria for risk of persistent asthma among the 9410 children in our catchments area were evaluated at our out-patient clinic during a period of 1.5 years beginning in 1998. Of the 66 patients thus identified the parents of 6 declined to participate and the remaining 60 children were randomized consecutively in groups of four by a nurse to either the inter-vention or the control group. The groups turned out to be well-matched.
All of the children received the usual management and care, including individual oral and written information concerning how to deal with their asthma. The intervention consisted of additional infor-mation and support in a group setting, with three 1.5-hour meetings soon after inclusion in the study (with 70% participation, no gender difference) and a fourth meeting 6 months later (with 40% partici-pation). The three nurses, three pediatricians and two psychologists who performed this investigation were also in charge of the intervention, i.e. the study was not blinded.
The initial examination included a clinical examination, spirometry, chest x-ray, examination of the patients' records and questionnaires concerning issues of adherence, burden of asthma and quality of life (Pediatric Caregiver's Quality of Life Questionnaire, PACQLQ). This Questionnaire was filled out separately by the fathers and the mothers and a change of > 0.5 units on a 7-point scale was considered to be clinically important. The blood and urine were analyzed for inflammatory parameters. Skin prick tests were performed being considered positive if the mean diameter of the wheal was >3 mm. The al-lergen extracts used were Soluprick® (ALK-Albello A/S, Denmark) and included egg, birch, timothy, mugwort, dog, cat, horse and Dermatophagoides pteronyssinus. RAST® testing (Pharmacia Diagnos-tics & Upjohn AB) with the same allergens (considered positive when the IgE-level was >0.7 kU/l) and Phadiatop® testing (Pharmacia Diagnostics & Upjohn AB) (considered positive if the value > 1.0 kU/l) were also performed.
The children made regular visits to their own pediatrician and nurse during the subsequent years and their medical records have been continuously updated and computerized. The examination after 6 years was performed during 2005. In this context each child was examined and interviewed, in the company of one or both parents and the examination being the same as earlier, except that no chest x-ray or objective assessment of adherence was carried out.
This time separate questionnaires addressed to the child (the Pediatric Asthma Quality of Life Questionnaire) and to the child and parent together (the Asthma Control Questionnaire) were included, with a value of < 0.75 considered as being an indicator of good asthma control. Furthermore exhaled NO was measured with the help of the NIOXMINO® Airway Inflammation Monitor (Aerocrine AB, Solna, Sweden), utilizing a 10-sec expiration at a constant flow rate of 0.05 l/s. In addition, we per-formed dry-air tests (Aiolos AB, Karlstad, Sweden), in connection with which a fall in FEV1 of > 10% was considered pathological.
During the follow-up parents and doctors estimated adherence on a visual analogue scale (VAS). The children were told to begin taking high doses of ICS (0.2 mgx4) as soon as they caught a cold, even before they had any asthmatic symptoms, and to subsequently reduce the dose gradually during the first week, stopping medication when they no longer had any symptoms. When symptoms of asthma developed they were instructed to continue ICS for one month and, if they had experienced three or more exacerbations during a12-month period, to continue this treatment for another six months.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Karlstad, Sweden, 651 12
- Barn-ungdomsmedicinska mottagningen VC Gripen
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Clinical diagnosis of asthma and fullfilling the criteria utilized to indicate high risk for persistent asthma: the presence of atopic disease among close relatives, confirmed allergy, symptoms of another atopic disease or asthma that appeared between bouts of the common cold.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: CG
The control group had regular individual information and support in connection with ordinary clinical follow-ups
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Experimental: IG
The intervention group had extra support and information in the form of four group discussions with parents
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Four group discussions with parents in close connection to diagnosing the children
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Adherence
Time Frame: 18 months and 6 years
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18 months and 6 years
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Burden of asthma on the individual and on the health care system
Time Frame: 18 months and 6 years
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18 months and 6 years
|
Collaborators and Investigators
Sponsor
Investigators
- Study Chair: Gunilla Hedlin, Professor, Karolinska Institutet, Stockholm, Sweden
Publications and helpful links
General Publications
- Hederos CA, Janson S, Hedlin G. Group discussions with parents have long-term positive effects on the management of asthma with good cost-benefit. Acta Paediatr. 2005 May;94(5):602-8. doi: 10.1111/j.1651-2227.2005.tb01946.x.
- Hederos CA. Neuropsychologic changes and inhaled corticosteroids. J Allergy Clin Immunol. 2004 Aug;114(2):451-2. doi: 10.1016/j.jaci.2004.03.045. No abstract available.
- Hederos CA, Janson S, Andersson H, Hedlin G. Chest X-ray investigation in newly discovered asthma. Pediatr Allergy Immunol. 2004 Apr;15(2):163-5. doi: 10.1046/j.1399-3038.2003.00098.x.
Study record dates
Study Major Dates
Study Start
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- LIVFOU-8215
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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