Effectiveness of a preschool asthma education programme, compared to usual care, on the frequency of acute asthma events: a community-based cluster randomised trial.

AIM: To determine whether an asthma intervention delivered within preschools can improve asthma outcomes in children aged 2-5 years with asthma or a high probability of asthma. METHODS: Between 2011 and 2013, we undertook a pragmatic, single-blind, cluster randomised trial in Auckland, New Zealand. We randomly assigned (1:1 ratio) preschools, and their children aged 2-5 years with asthma or a high probability of asthma, to receive an asthma intervention (a 12-month respiratory nurse-led asthma assessment using an evidence-based, web-based tool and a class-based asthma education programme for four months), or a control intervention (a class-based science education programme for four months). Both groups received standard asthma management by their primary care physician. The primary outcome was the proportion of children that had at least one unscheduled ("urgent") medical or ED attendance for asthma over 12 months. RESULTS: We randomised 171 preschools, 85 to the intervention (341 children) and 86 to the control (334 children). We found no difference in the primary outcome (intervention: 216/341, 63% vs control: 181/334, 54%: adjusted Odds Ratio=1.36, 95% Confidence Interval=0.95-1.94, p=0.095). However, compared with the control group, the intervention group had improved and sustained asthma control and fewer asthma symptoms over 12 months. CONCLUSIONS: Combining asthma education with a nurse-led, evidence-based asthma assessment and education intervention led to sustained improvements in asthma control in this preschool population, but its effect on acute events remains unclear.

Giving Asthma Support to Patients (GASP): a novel online asthma education, monitoring, assessment and management tool.

BACKGROUND AND CONTEXT: Giving Asthma Support to Patients (GASP) is a unique online tool developed to provide asthma education at point of care, and to provide health care professionals in primary care with skills and knowledge to undertake a structured asthma assessment. ASSESSMENT OF PROBLEM: A retrospective cohort study was undertaken to evaluate the effectiveness of GASP. Data for patients aged 5-64 years seen in primary care (Waitemata region of Auckland) with uncontrolled asthma who had completed a minimum of two GASP assessments between 1 November 2008 and 17 April 2011 were extracted from a secure, self-populating database. Outcome measures were compared between each patient's visit 1 and 2 assessments. RESULTS: A total of 761 patients provided data using GASP. There was a significant reduction between GASP assessments in the risk of exacerbations, hospital admissions, emergency department presentations, requirement for corticosteroids, and bronchodilator reliance. STRATEGIES FOR IMPROVEMENT: Results from this retrospective cohort study are promising. A randomised controlled trial of the use of GASP in primary care is warranted to confirm these findings. The effectiveness of the GASP tool also needs to be further investigated in Maori and Pacific populations. LESSONS: The findings of this study of GASP show its potential and support its use in the primary care setting.