OCTOBER 01, 2006

Asthma Higher Among Special Education Students

A new study has shed light on the prevalence of asthma in special education students. Statistics indicated that 1 in 3 special education students in New York City public schools have asthma, compared with 1 in 5 students in the general population, according to a study reported in the American Journal of Public Health (September 2006).

To investigate a possible correlation between having the condition and being in special education, the researchers surveyed 24 randomly selected New York City public schools using parent questionnaires. The responses showed that 34% of students in special education classes had asthma, compared with 19% of students in the general school population. The investigators calculated that children with asthma faced a 60% increased risk of being in special education, compared with children without asthma.

The findings also indicated that children with asthma who were in special education were more prone to be from low-income families and 3 times more apt to be hospitalized for asthma in the past year. Furthermore, this population was 50% less likely to use a peak flow meter and 15% less likely to use a spacer.

Asthma Care Differs Among Ethnic Groups

Racial disparity appears to play a role in the asthma care of Puerto Rican children and African American children, and the reasons for the difference are unclear. The study looked at the data from >6500 children from inner-city Hartford, Conn, who were screened for the condition.

The researchers found that Puerto Rican children with asthma make 30% more outpatient clinic visits, compared with black children with the same disease severity. On the flip side, black children spend 3 times more days in the hospital for asthma treatment, compared with Puerto Rican children. Furthermore, the study showed that, overall, 18% of children with unrelenting asthma filled prescriptions for preventive medications. Puerto Rican families were more likely to fill those prescriptions than black families.

Lead investigator Robyn Cohen, MD, said more research is needed to determine why the differences exist. "The Puerto Rican children had greater asthma severity, so it was interesting that the African American children ended up spending more days in the hospital," she said. "Is that because Puerto Rican children get more care early in their lives? Are we not reaching out enough to make all families feel comfortable coming to the clinic? Are we not teaching families to recognize symptoms? We don't know." (The findings were reported in Chest, August 2006.)

Research Supports Dual Therapy

A Swedish study backed the use of combined asthma therapy using inhaled corticosteroids and antileukotriene for patients with persistent asthma. The study of 13 patients looked at whether the inhaled corticosteroid treatment fluticasone propionate reduced bronchial responsiveness to leukotriene D4.

The patients participated in an inhalation challenge with methacholine and leukotriene D4 on consecutive days, before and after 2 weeks of twice-daily treatment with fluticasone. The fluticasone therapy showed a dramatic reduction in methacholine sensitivity—a measure of airway hyperresponsiveness—and in exhaled nitric oxide.

Reporting in the Journal of Allergy and Clinical Immunology (July 2006), the researchers found, however, that the fluticasone treatment did not have any effect in preventing the bronchoconstriction that happened when leukotrienes were inhaled by the patients. The treatment also did not impact the production of leukotrienes, as measured in the patients' urine.

Pediatric Asthma Care Gets Boost

The National Association of Chain Drug Stores Foundation recently awarded a $100,000 research grant potentially totaling $300,000 over 3 years to the Children's National Medical Center (CNMC) in Washington, DC. The grant supports community pharmacists' intervention in "Improving Pediatric Asthma Care in the District of Columbia" (IMPACT DC).

The CNMC and community pharmacy will develop and execute a model program of "enhanced pharmacy care." It will allow patients and families in disadvantaged minority areas of Washington, DC, to be referred to specifically trained pharmacists in participating pharmacies. The goal of the initiative is to improve medical and functional outcomes in patients with asthma 12 months to 12 years old in underserved areas of the Washington, DC, region.

The CNMC Asthma Clinic will create the training program for participating community pharmacies (Rite Aid and CVS) selected by CNMC. The pharmacists will receive prescriptions for patients with asthma directly from the clinic and will provide them with asthma drugs, devices, and education. In addition, pharmacists will provide patients and their families with realtime, targeted education around the purpose and use of new and refilled asthma medication. The education will include device teaching, dosage review, and medication compliance.

Staff from IMPACT DC will assess the success of the program through participant and pharmacist reports, collecting refill data from each pharmacy monthly, and conducting follow-up interviews with participants at 1, 3, and 6 months after their clinic visit.