Long Term Effect of A self-Regulation

Education on Inhaled Anti-

Inflammatory Medicines and Short-
Acting Bronchodilator
Noreen Clark, PhD
Molly Gong, MD
Julie Dodge, MS
Sijian Wang, M.S.
Xihong Lin, PhD
William Bria, MD
Timothy Johnson, MD

University of Michigan
School of Public Health
Supported by NHLBI grant 1 R18 HL60884
BACKGROUD

Inhaled anti-inflammatory
medicines are suggested for
disease control in asthma
patients (NAEPP).
Increasing use of short-acting
bronchodilators indicates
inadequate control of the disease
(NAEPP).
PURPOSE

To examine and evaluate the

effectiveness of a self-
regulation telephone counseling
intervention for women with
asthma on medication use in a
randomized clinical trail.
 METHODS
Recruitment
 Women 18 years and older
 Physician diagnosis

 Attending University of Michigan Asthma &

Airways Clinic and University of Michigan
Health System
Data Collection
Telephone interview
 Demographics

 Asthma symptoms
 Health care utilization

 Gender-related management

 Peak flow meter use

Study Sample
Baseline 808

Follow up I* 608

Follow up II** 580

• One year subsequent to baseline data collection

• One year subsequent to follow up I data collection
 Demographics: Age
7% 9%

13%

21% 18-30
31-40
41-50
51-60
24%
61-70
>71
26%
Demographics: Education

4%
21%

26%
< High School

High School

2-year College

4-year College

29% Post Grad

20%
 Demographics: Income

11% 7%
7% <10,000
10,001-20,000
15% 13% 20,001-40,000
40,001-60,000
60,001-80,000

13% 80,000-100,000
18% >100,000
Not reported
16%
 Demographics: Race/Ethnicity

84%
2% Caucasian/White

1% African American/Black
2%
Asian/Pacific Islander
2%
Hispanic/Latino
11% Native American

Other
Intervention

 Subsequent to baseline data collection,

women were randomly assigned to
either the control or the intervention
group.
 Women in the intervention group
received the self-regulation telephone
counseling intervention: Women Breathe
Free.
 Data Analyses
To examine:
1. Relationships between demographics vs.
Medication use at baseline: Frequencies
with Odds Ratio
2. Program effects on medication use:
Generalized Estimating Equations (GEE)
with logit link using entire sample (intent-to-
treat)
 FINDINGS
Asthma Severity
Percent of Women
Mild intermittent 52%

Mild persistent 15%

Moderate persistent 20%

Severe persistent 13%

Classified by NAEPP criteria, Guidelines and Diagnosis and Treatment of Asthma, 1997
Demographics and Lower Use of
Inhaled Anti-Inflammatory
Medications

OR P-value

Age <50 years 13.8 <.002

Lower education 3.9 <.05

Minority 7.9 <.005

 Program Effects
on Medication Use

1.Inhaled non-steroid use increased

more in the 12 month follow up
perceived in the treatment group
(p=.09).
2. Significantly more reduction to
use short-acting bronchodilators
at 24 month follow up in
treatment group (p=.05)
 CONCLUSIONS
A. Women of lower education and
younger age used less inhaled
anti inflammatory medicine
B. The intervention improved
medicine use over the
evaluation period