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Children With Asthma: Discussion

We found that an educational intervention that emphasized reduction in ETS exposure and that used a variety of motivational, instructional, and other aides to promote behavior change was associated with significantly lower odds of having more than one acute medical visit for asthma (OR, 0.32; p = 0.03 [after controlling for baseline visits]) and also with a nonsignificant trend toward lower odds of hospitalization (OR, 0.34; p = 0.14). Using statistical bootstrap procedures, we confirmed that these logistic regression results were not a statistical artifact of the inherent tendency for the level of health-care utilization to be correlated from 1 year to the next.
This result is both statistically and clinically significant, especially for a population of very low-income, ETS-exposed, minority children with a history of acute exacerbations. One fourth of the children had been hospitalized for asthma in the preceding year. The population also was composed entirely of nonvolunteer families, that is, families who were not in the process of seeking assistance with exposure reduction, smoking cessation, or asthma control when they were recruited. Individuals in the intervention and control groups were comparable in terms of their pharmacologic regimens and were provided with comparable medical management throughout the study, yet comparable reductions in health-care utilization were not observed among participants in the control group. buy Tofranil online

In this medical setting, a small-group asthma education program was being offered on a regular basis to the community. Six control group families and two intervention group families enrolled in this program over the course of the study, which potentially could have tended to reduce the differences between the two groups. That program mentions the need to avoid ETS exposure but does not emphasize it or provide additional assistance in accomplishing that goal. Nevertheless, the ETS reduction intervention was associated with health-care utilization benefits substantially exceeding those of the control group. To our knowledge, this is the first report of an educational intervention that explicitly targets ETS reduction in exposed children that has demonstrated a reduction in the number of acute visits for asthma under controlled conditions. Although we have not carried out a formal cost-benefit analysis, the reduction in the numbers of acute visits appears to justify the modest cost in nursing time, and the possible reduction in inpatient care, if confirmed, would provide further economic justification.