Asthma coaching can reduce hospitalizations in some children

Working with an asthma coach helps to significantly reduce hospitalizations of low-income, African-American children with asthma, results of a new, two-year study show.

Researchers at Washington University School of Medicine in St. Louis and the University of North Carolina at Chapel Hill worked with nearly 200 parents of children between 2-8 years old on Medicaid who had been hospitalized for asthma at St. Louis Children's Hospital.

Children were randomly assigned to an asthma coach or to usual care following discharge from the hospital, which included asthma education, an asthma management plan and a suggested follow-up appointment with the child's pediatrician within one week of discharge.

"Compliance with asthma care can often be a challenge," said Robert C. Strunk, M.D., a Washington University asthma specialist at St. Louis Children's Hospital. "The asthma coach provided support for parents dealing with the unrelenting demands of their child's illness."

During the two years the coach was available to parents, 35 of the 96 patients (36.5 percent) in the coaching group were hospitalized at least once, compared with 55 of the 93 patients (59 percent) in the usual-care group.

The asthma coaches were African-American women living in the same general St. Louis neighborhoods as the participants.

"They had experience with asthma personally or with a family member, so they understood what these families were dealing with," said Strunk, the Donald Strominger Professor of Pediatrics at the School of Medicine. "Because they shared community and life experiences with the families, they quickly established a trusting relationship."

Each coach completed a training program that covered the asthma disease process, ways to manage asthma and reduce triggers, communication techniques, social support and strategies to change behavior.

Coaches contacted parents to offer help and scheduled visits with the family. In each visit or phone call, the coaches discussed at least one aspect of an asthma action plan, which included information about asthma medications, physician visits and the need to reduce exposure to second-hand smoke and cockroach allergen.

Coaches also discussed general stressors, including changes in housing or employment, illness or other issues. Over the 24 months of the study, coaches averaged 21 visits with each parent.

"Beyond the good news it provides for asthma care, the asthma coach sets an important model for treating a variety of chronic diseases in children and adults," said Edwin B. Fisher, Ph.D., professor of health behavior and health education at the University of North Carolina at Chapel Hill, co-author of the paper and global director of Peers for Progress, a program to promote peer support in chronic disease. "These kinds of programs help people put into practice in their daily lives the plans they agree to in the doctor's office. That's going to be an increasingly important part of health care as more people have problems like asthma and diabetes."

With the success of the asthma coach program in this population, St. Louis Children's Hospital offers a coach to children with severe asthma who are at high risk for multiple hospitalizations. Funded by the St. Louis Children's Hospital Foundation, the coach works with the families of children hospitalized for asthma to encourage them to see an asthma specialist in addition to a pediatrician.

"We hope the coach increases clinic visits and decreases hospitalizations in these kids," Strunk said.

Results of the study are published in the March 2009 issue of Archives of Pediatrics and Adolescent Medicine.