Table 1.

Summary of selected intervention studies for children with asthma and social disadvantage

Study	Type	Target population	Description of interventions	Outcomes
National Cooperative Inner-City Asthma Study1	RCT	Inner-city children with asthma, multiple sites, USA	Improve communication with PCP Asthma education (caregivers and children) Ensuring children had PCP and AAP Provision of mattress/pillow covers Counselling on environmental exposures, provision of bedding cover Pest control for cockroach-sensitized children	Reduced maximum symptom days over previous 2 weeks Trend towards fewer hospitalizations No difference in unscheduled acute care visits for asthma
Inner-City Asthma Study2	RCT	Inner city children with atopic asthma, 7 cities, USA	Comprehensive environmental remediation in the home, tailored to child’s sensitization and exposures Asthma education Provision of supplies for remediation	Reduced asthma symptom days during intervention and follow-up year Reduced missed school Reduced healthcare utilization No effect on lung function Reduced home allergen levels
Allies Against Asthma Initiative3,4	Comparison group cohort	Children with asthma from low-income communities of colour, 7 regions, USA	Policy and system changes such as funding asthma coordinator at hospital, asthma care coordination, smoking ban in restaurants, prohibiting idling of diesel trucks in neighbourhoods, legislation to protect childrens’ right to take asthma medication in school	Reduced daytime and night-time symptoms over previous 2 weeks Parental sense of empowerment3 Reduced healthcare utilization4
La Red de Asma Infantil5	Case study	Children with moderate - severe asthma living in 2 housing projects, San Juan, Puerto Rico, USA	Team approach with physician, community nurse/coordinator, and CHW Asthma education Risk assesments (allergen skin testing) Home evaluations Clinic and telephone follow-up	Reduction in asthma symptoms Reduction in healthcare utilization and simulated costs Reduced rescue medication/Increased controller medication use Improved access to provider Improved knowledge and equipment for asthma care
Children’s Hospital Boston Community Asthma Initiative6	Controlled trial	Urban children with high risk asthma, underserved community, Boston, MA, USA	Case management Home visits for asthma education, environmental assessment, and remediation materials (HEPA vacuum, bedding encasements, IPM materials, if needed) Referral to IPM exterminator as needed	Reductions in asthma morbidity Reduced healthcare utilization and cost Return on investment of 1.46 due to reduced hospitalizations and ED visits
Neighborhood Asthma Coalition7	Controlled trial	African American children with high risk asthma, two predominantly low-income African American neighbourhoods, St Louis, Missouri, USA	Asthma education in school and neighbourhood settings Involvement of residents in planning programs Training neighbourhood residents to act as neighborhood health workers via the Change Asthma With Social Support (CASS) program	Reduced acute care rates in both intervention and control groups (no difference between groups) Improved parental views that asthma can be managed No difference in “Index of Asthma Management” to assess timely response of parents to child’s symptoms
The East London Randomised Controlled Trial for High Risk Asthma (ELECTRA)8	RCT	Children and adults with history of acute asthma, 44 general practices in London boroughs which served deprived, multi-ethnic population, UK	Provider level asthma education regarding asthma management guidelines Specialty Nurse provided education and supplies for asthma self-management to patients	Reduced unscheduled asthma care but not admissions or ED Delayed time to first unscheduled asthma care in the year after intervention No difference in self-management behaviour, quality of life, or rescue OCS

AC, asthma counsellor; AAP, asthma action plan; CHW, community health worker; ED, emergency department; IPM, integrated pest management; OCS, oral corticosteroids; PCP, primary care physician, RCT, Randomized Controlled Trial

¹Evans R, 3rd, Gergen PJ, Mitchell H, et al. A randomized clinical trial to reduce asthma morbidity among inner-city children: results of the National Cooperative Inner-City Asthma Study. The Journal of pediatrics 1999;135: 332–338.

²Morgan WJ, Crain EF, Gruchalla RS, et al. Results of a home-based environmental intervention among urban children with asthma. The New England journal of medicine 2004;351: 1068–1080.

³Clark NM, Lachance L, Doctor LJ, et al. Policy and system change and community coalitions: outcomes from allies against asthma. American journal of public health 2010;100: 904–912.

⁴Clark NM, Lachance LL, Benedict MB, et al. Improvements in health care use associated with community coalitions: long-term results of the allies against asthma initiative. American journal of public health 2013;103: 1124–1127.

⁵Lara M, Ramos-Valencia G, Gonzalez-Gavillan JA, et al. Reducing quality-of-care disparities in childhood asthma: La Red de Asma Infantil intervention in San Juan, Puerto Rico. Pediatrics 2013;131 Suppl 1: S26–37.

⁶Woods ER, Bhaumik U, Sommer SJ, et al. Community asthma initiative: evaluation of a quality improvement program for comprehensive asthma care. Pediatrics 2012;129: 465–472.

⁷Fisher EB, Strunk RC, Sussman LK, Sykes RK, Walker MS. Community organization to reduce the need for acute care for asthma among African American children in low-income neighborhoods: the Neighborhood Asthma Coalition. Pediatrics 2004;114: 116–123.

⁸Griffiths C, Foster G, Barnes N, et al. Specialist nurse intervention to reduce unscheduled asthma care in a deprived multiethnic area: the east London randomised controlled trial for high risk asthma (ELECTRA). BMJ 2004;328: 144.