Table 1.
Study characteristics and intervention components
| Study | Study design | Sample size | US study location | Population and demographics | Intervention components |
|---|---|---|---|---|---|
| Halterman et al,15 2004 | RCT | 184 | Rochester,NY | African-American (59%) Hispanic (32%) Medicaid (75%) Smokers in home (44%) |
School-based care group was provided with 2 metered dose inhalers of fluticasone propionate and a spacer, and children in this group received a single dose (2 puffs) of fluticasone propionate each school day, administered by the school nurse. The second inhaler was given to the family to administer at home, when the child was not in school. |
| Millard et al,18 2003 | RCT | 50 | Dallas, TX | African-American communities | Children were randomly assigned to 1 of 4 arms: 1) school-based delivery of inhaled steroids, 2) home-based delivery of inhaled steroids, 3) home-based delivery of inhaled steroids with school-based asthma education, and 4) control group with no change in current therapy. Students in the treatment arms received beclomethasone twice a day, either at school (upon arrival and before leaving) or at home. |
| Gerald et al,17 2009 | RCT | 290 | Birmingham, AL | African-American (91%) Smokers in home (29%) |
Children were prescribed and provided with budesonide once daily to facilitate adherence. For children randomized to the supervised therapy arm, use of ICSs was supervised by study staff at school each day. If a child was observed using their inhaler incorrectly, staff provided education with the aid of a placebo inhaler. Children were also provided with an AAP and 2 peak flow meters (for home and school). |
| Halterman et al,14 2011 | RCT | 530 | Rochester, NY | African-American (63%) Hispanic (28%) Medicaid (73%) Smokers in home (54%) |
Single dose of fluticasone was administered by school nurses, with dose adjustment based on NHLBI guidelines to the treatment group. A home-based environmental tobacco smoke reduction program for smoke-exposed children in treatment group was provided as well, using motivational interviewing. |
| Halterman et al,13 2011 | Pilot, pre- and-post | 30 | Rochester, NY | African-American (53%) Hispanic (33%) |
Teens were provided with a start-up preventive inhaler as authorized and prescribed by their physician. A second inhaler was delivered to the school nurse for single-dose DOT of preventive medication. Teens also received 3 MI counseling sessions (1 in-home and 2 via telephone) exploring attitudes about asthma management, building motivation for medication adherence, and supporting transition to independent preventive medication use. |
| Halterman et al,11 2012 | Pilot, RCT | 100 | Rochester, NY | African-American (57%) Hispanic (26%) Medicaid (69%) Smokers in home (58%) |
DOT of preventive asthma medications in school was facilitated by web-based technology. Web-based technology was also used for systematic symptom screening, electronic report generation, and medication authorization from providers. One dose of medication was given at school during the school day (if more frequent dosing was needed, additional doses were taken at home). |
| Trivedi et al,10 2017 | Retrospective | 84 | Central Massachusetts | African-American (19%) Hispanic (67%) Medicaid (95%) |
Providers determined medication dosing (once vs twice daily dosing) based on each child’s requirement. All children in the program started the school day by going to the school nurse office for supervised preventive asthma medication/ICS. For a child receiving twice-daily dosing at school, the nurse would administer the second dose at the end of the school day. |
| Harrington et al,16 2018 | Pilot, RCT | 48 | Washington, DC | African-American (I: 95%) (C: 88%) Medicaid (100%) Smokers in home (I: 14%) (C: 28%) |
Clinician in clinic provided a specific order for the school nurse to administer ICS every day that school was in session, and prescribed ICS for administration at home every evening on school days and every morning and evening on weekends and holidays. |
| Halterman et al,12 2018 | RCT | 400 | Rochester, NY | African-American (58%) Hispanic (32%) Medicaid (76%) Smokers in home (48%) |
Supervised administration of preventive asthma medication at school as well as 3 school-based telemedicine visits to ensure appropriate assessment, preventive medication prescription, and follow-up care was done in intervention group. Most children received once-daily dosing to allow for medication administration during school hours but if more frequent dosing was needed, additional doses were given at home. |
Abbreviations: RCT, randomized controlled trial; ICS, inhaled corticosteroids; AAP, asthma action plan; NHLBI, National Heart, Lung, and Blood Institute; DOT, directly observed therapy; MI, motivational interviewing; C, control; I, intervention.