The following is the summary of “Improving Adherence in Urban Youth With Asthma: Role of Community Health Workers” published in the December 2022 issue of Allergy and Clinical Immunology by Pappalardo, et al.

To determine which intervention is more effective in helping low-income minority children with asthma, the Asthma Action at Erie Trial compared the services of community health workers (CHWs) vs. certified asthma educators (AE-Cs). Examine the possession, adherence, method, and triggers of asthma medication in children who were given either an asthma CHW or an AE-C intervention.

 Uncontrolled asthma in children was addressed by randomly assigning them to either 10 CHW home visits or 2 AE-C clinic sessions over the course of a year. Self-report, dose counters, and electronic monitors were used to assess adherence, and participants were monitored for possession of asthma medicine and proper inhaler use. Self-reporting, direct observation, and objective measurement were all used to collect data on the environment’s role in triggering reactions. Mixed effects linear and logistic regression models were generated to estimate models for continuous and binary outcomes. The children (n=223) ranged in age from 5 to 16 and were predominantly Hispanic (85%). Almost all inhalers were recorded, including those used for quick relief (82%), spacers (72%), and inhaled corticosteroids (ICS) (44%). There were 205 people with uncontrolled asthma, and 35% of them did not have a prescription for an ICS. At 12 months, children in the CHW group were more likely to be prescribed ICS (odds ratio 2.39; 95% CI 0.99-5.79).

At 6 months, the CHW group saw a 9.8 percentage point increase in inhaler technique (95% CI 4.20-15.32). At 12 months, there was a significant improvement in ICS adherence in the CHW arm by 16.0% (95% CI 2.3-29.7; P=.02). No significant differences in trigger exposure over time were found across groups. When comparing CHW services to AE-C services, better ICS adherence and inhaler technique were seen among patients who received CHW services. To identify the optimal dose of the intervention required to maintain adherence, further data is required.

Source: sciencedirect.com/science/article/abs/pii/S2213219822008662