Randomized trial of the feasibility of ED-initiated school-based asthma medication supervision (ED-SAMS)

Lynn B Gerald, Joe K Gerald, John M VanBuren, Ashley Lowe, Cecilia C Guthrie, Eileen J Klein, Andrea Morrison, Emily Startup, Kurt Denninghoff, Lynn B Gerald, Joe K Gerald, John M VanBuren, Ashley Lowe, Cecilia C Guthrie, Eileen J Klein, Andrea Morrison, Emily Startup, Kurt Denninghoff

Abstract

Background: While using an inhaled corticosteroid (ICS) in the weeks after an ED visit reduces repeat visits, few children receive a needed prescription. Because a prescription may not be filled or used, dispensing ICS at discharge and supervising its use at school could overcome both barriers until follow-up care is established. To assess the feasibility of such an intervention, we conducted a pilot study among elementary-age school children with persistent asthma who were discharged from the ED following an asthma exacerbation.

Methods: Eligible children were randomly assigned to ED-dispensing of ICS with home supervision or ED-dispensing of ICS with home and school supervision. The primary outcomes were ability to recruit and retain participants, ability to initiate school-supervised medication administration within 5 days of discharge, and participant satisfaction.

Results: Despite identifying 437 potentially eligible children, only 13 (3%) were enrolled with 6 being randomized to the intervention group and 7 to the control group. Eleven (85%) randomized participants completed the 90-day interview (primary outcome) and 8 (62%) completed the 120-day interview (safety endpoint). Four (67%) intervention participants started their school regimen within 5 business days and 2 started within 6 business days.

Conclusion: While our pilot study did not meet its recruitment goal, it did achieve its primary purpose of assessing feasibility before undertaking a larger, more intensive study. Several major recruitment barriers need to be mitigated before EDs can successfully partner with schools to establish supervised ICS treatment.

Trial registration: ClinicalTrials.gov , NCT03952286 . Registered 16 May 2019.

Keywords: Asthma; Pediatric; Pediatric emergency medicine; Schools.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

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Fig. 1
ED-SAMS Consort Diagram 1Patients could be ineligible due to more than one exclusion reason

References

    1. Akinbami L. The state of childhood asthma, United States, 1980-2005. Adv Data. 2006(381):1–24.
    1. Cloutier MM, Baptist AP, Blake KV, et al. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020;146(6):1217–1270. doi: 10.1016/j.jaci.2020.10.003.
    1. National Heart L, and Blood Institute,. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda (MD): National Institutes of Health; 2007.
    1. Gerald LB, McClure LA, Mangan JM, et al. Increasing adherence to inhaled steroid therapy among schoolchildren: randomized, controlled trial of school-based supervised asthma therapy. Pediatrics. 2009;123(2):466–474. doi: 10.1542/peds.2008-0499.
    1. Gerald JK, Grad R, Bailey WC, Gerald LB. Cost-effectiveness of school-based asthma screening in an urban setting. J Allergy Clin Immunol. 2010;125(3):643–650. doi: 10.1016/j.jaci.2009.12.984.
    1. Sin DD, Man SF. Low-dose inhaled corticosteroid therapy and risk of emergency department visits for asthma. Arch Intern Med. 2002;162(14):1591–1595. doi: 10.1001/archinte.162.14.1591.
    1. Rowe BH, Bota GW, Fabris L, Therrien SA, Milner RA, Jacono J. Inhaled budesonide in addition to oral corticosteroids to prevent asthma relapse following discharge from the emergency department: a randomized controlled trial. JAMA. 1999;281(22):2119–2126. doi: 10.1001/jama.281.22.2119.
    1. Alpern ER, Stanley RM, Gorelick MH, Donaldson A, Knight S, Teach SJ, Singh T, Mahajan P, Goepp JG, Kuppermann N, Dean JM, Chamberlain JM, Pediatric Emergency Care Applied Research Network Epidemiology of a pediatric emergency medicine research network: the PECARN Core Data Project. Pediatr Emerg Care. 2006;22(10):689–699. doi: 10.1097/01.pec.0000236830.39194.c0.
    1. McCarthy AM, Kelly MW, Reed D. Medication administration practices of school nurses. J Sch Health. 2000;70(9):371–376. doi: 10.1111/j.1746-1561.2000.tb07277.x.
    1. Weiss CH, Krishnan JA, Au DH, Bender BG, Carson SS, Cattamanchi A, Cloutier MM, Cooke CR, Erickson K, George M, Gerald JK, Gerald LB, Goss CH, Gould MK, Hyzy R, Kahn JM, Mittman BS, Moseson EM, Mularski RA, Parthasarathy S, Patel SR, Rand CS, Redeker NS, Reiss TF, Riekert KA, Rubenfeld GD, Tate JA, Wilson KC, Thomson CC. An Official American Thoracic Society Research Statement: Implementation Science In Pulmonary, Criticial Care and Sleep Medicine. Am J Respir Crit Care Med. 2016;194(8):1015–1025. doi: 10.1164/rccm.201608-1690ST.
    1. Gerald JK, Fisher JM, Brown MA, Clemens CJ, Moore MA, Carvajal SC, Bryson D, Stefan N, Billheimer D, Gerald LB. School-supervised use of a once-daily inhaled corticosteroid regimen: A cluster randomized trial. J Allerg Clin Immunol. 2019;143(2):755–764. doi: 10.1016/j.jaci.2018.06.048.

Source: PubMed

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