- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03986177
Asthma Implementation Research Trial (AIRE)
May 28, 2020 updated by: Johns Hopkins University
Implementation of a Community Intervention to Improve Asthma Self-Management Practices in Peru
Asthma is the most common chronic disease among children worldwide, with 80% of asthma related deaths occurring in low- and middle-income countries (LMICs), such as Peru.
While evidence-based guidelines exist for asthma treatment and management, adherence to guideline-based practices is low in high-income country (HIC) and LMIC settings alike.
There a clear need for effective, locally-tailored solutions to address the asthma treatment gap in low-income communities in LMICs, such as Peru.
This study aims to develop and test a locally-adapted intervention package to improve adoption of self-management practices and utilization of preventive health services for asthma among children in Lima.
There is a paucity of research regarding the development and testing of interventions to improve asthma self-management in LMIC settings, which experience unique or exacerbated barriers to receiving evidence-based care.
To the investigators' knowledge, no studies have systematically developed and evaluated an asthma management program in Peru.
Therefore, the long-term goal of this study is to disseminate locally appropriate asthma management strategies to reduce asthma-related emergency department visits and improve service utilization in LMIC settings.
For the current study, the investigators will carry out a randomized controlled trial to test the effectiveness of the intervention package in a group of 110 children with asthma who will be randomized to the intervention (55 children) or no intervention (55 children) arm.
Participants in the intervention group will receive case management from a designated nurse manager, who will provide ongoing educational, social, and self-management support during monthly follow-up home visits and text-message based communication.
Participants will be followed up every month for data collection over a six-month period.
Throughout the follow-up period, the investigators will collect data on asthma control, healthcare utilization, medication adherence, quality of life of children with asthma and the children's caregivers, caregiver mental health, fidelity to the intervention, and acceptability and feasibility.
Ultimately, this study will inform the scientific community about effective strategies and treatment programs for asthma in low-income settings.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
110
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Lima, Peru
- Hospital Nacional Cayetano Heredia
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
5 years to 17 years (CHILD)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Currently living in Lima, Peru
- 5-17 years of age
- Has a physician diagnosis of asthma
- Has attended the emergency room or urgent care for asthma, or has been hospitalized for asthma at least once in the previous 12 months
Exclusion Criteria:
- Family plans to move out of the study community within the next 12 months
- Co-occurring chronic respiratory or cardiovascular disorders other than asthma
- Active tuberculosis or are currently taking tuberculosis medications
- Diagnosis of HIV/AIDS
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: HEALTH_SERVICES_RESEARCH
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: DOUBLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Intervention
The intervention arm will receive a multi-faceted self-management intervention package.
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Children will receive basic asthma education, based on the National Heart, Lung, and Blood Institute "A Breath of Life" asthma education program. Children/caregivers in the intervention arm will also be assigned a designated nurse case manager who will provide home visits and be available via text message and phone-based support throughout follow-up. Intervention components:
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NO_INTERVENTION: Enhanced care
The control arm will receive usual care plus basic asthma education from a trained nurse educator.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Asthma Control as assessed by Childhood Asthma Control Test (cACT) Score
Time Frame: Baseline, then monthly up to 6 months
|
cACT (5-11 years of age) will be administered at baseline and monthly during the follow-up period.
The cACT is scored by summing the scores for all items.
Overall scores ranges from 0 to 27.
Lower scores indicate poorer asthma control and higher scores indicate better asthma control.
Scores 19 and below suggest impaired asthma control.
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Baseline, then monthly up to 6 months
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Change in Asthma Control as assessed by Asthma Control Test (ACT) Score
Time Frame: Baseline, then monthly up to 6 months
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ACT (12-17 years of age) will be administered at baseline and monthly during the follow-up period.
The ACT is scored by summing the scores for all items.
Overall score ranges from 5 to 25. Lower scores indicate poorer asthma control and higher scores indicate better asthma control.
Scores 19 and below suggest impaired asthma control.
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Baseline, then monthly up to 6 months
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Number of participants with at least one asthma-related ED or urgent care visit during the six-month follow-up period
Time Frame: 6 months
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Number with asthma-related emergency department (ED) or urgent care visits will be used to assess healthcare utilization.
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6 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Adherence to Refills and Medications Scale-7 (ARMS-7) score
Time Frame: Baseline, then monthly up to 6 months
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ARMS-7 will administered at baseline and monthly during the follow-up period.
Score is calculated by summing the scores for all items.
Overall score ranges between 7 and 28.
Lower scores indicate better adherence.
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Baseline, then monthly up to 6 months
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Medication adherence as assessed by Dose counter-measured medication use
Time Frame: 6 months
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Number of puffs used divided by the number of puffs indicated to be used over monthly follow-up period.
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6 months
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Quality of life as assessed by Pediatric Asthma Quality of Life Questionnaire (PAQLQ)-Mini
Time Frame: 6 months
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Measures disease-specific quality of life in children and adolescents with asthma.
The PAQLQ-mini has 13 items, each scored on a 7-point Likert scale with "1" indicating severe impairment and "7" indicating no impairment.
Score is calculated by taking the average of scores for each item.
Higher scores indicate better quality of life.
Range: [1 to 7].
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6 months
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Quality of life in caregivers of children and adolescents with asthma as assessed by Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ)
Time Frame: 6 months
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Measures quality of life in caregivers of children and adolescents with asthma.
The PACQLQ has 13 items, each scored on a 7-point Likert scale with "1" indicating severe impairment and "7" indicating no impairment.
Score is calculated by taking the average of scores for each item.
Higher scores indicate better quality of life.
Range: [1 to 7].
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6 months
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Depression as assessed by Patient Health Questionnaire-9 (PHQ-9)
Time Frame: 6 months
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Measures depressive symptoms.
Will be administered to caregivers of children and adolescents with asthma.
The PHQ-9 has nine items, each scored on a Likert scale from 0 to 3. Higher scores indicate more evidence of depressive disorder of greater severity of disorder.
Scores are calculated by summing the scores for all items.
Range: [0 to 27].
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6 months
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Number of participants with asthma-related hospitalizations
Time Frame: 6 months
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Count of participants (children) with at least one asthma-related hospitalization during six-month follow-up period.
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6 months
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Number of participants with all-cause emergency department (ED) or urgent care visits
Time Frame: 6 months
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Count of participants with at least one all-cause ED or urgent care visit during the six-month follow-up period.
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6 months
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Number of participants who attend two or more outpatient appointments with healthcare provider for asthma.
Time Frame: 6 months
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Count of participants who attend two or more outpatient appointments with healthcare provider for asthma over six-month follow-up period.
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6 months
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Suzanne Pollard, PhD, Johns Hopkins University
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (ACTUAL)
June 3, 2019
Primary Completion (ACTUAL)
March 30, 2020
Study Completion (ACTUAL)
March 30, 2020
Study Registration Dates
First Submitted
June 11, 2019
First Submitted That Met QC Criteria
June 11, 2019
First Posted (ACTUAL)
June 14, 2019
Study Record Updates
Last Update Posted (ACTUAL)
May 29, 2020
Last Update Submitted That Met QC Criteria
May 28, 2020
Last Verified
May 1, 2020
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- IRB00170462
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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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