Long term effect of self-regulation education on use of inhaled anti-inflammatories and

short-acting bronchodilators
Clark, NM, Gong, M, Wang, S, Lin, X, Bria, W, Johnson, T
University of Michigan School of Public Health and University of Michigan Health System - Supported by NHLBI grant 1 R18 HL60884

ABSTRACT METHODS FINDINGS

Inhaled anti-inflammatory medicines (IAI) are suggested for disease control in Enrollment Criteria Intervention Asthma Severity Demographics Associated with Use of
asthma patients, while increasing use of short-acting bronchodilators (SAB) Women 18 years and older  Subsequent to baseline data collection, women were randomly assigned to
Physician diagnosis of asthma either the control or the intervention group. Percent of Women
Inhaled Anti-Inflammatory Medications
indicates inadequate control of the disease. The purpose of this investigation, a
sub study of a randomized clinical trial, was to examine and evaluate the Attending University of Michigan Clinics  Women in the intervention group received the woman focused self- Mild intermittent 52% OR p-value
effectiveness of a self-regulation telephone counseling intervention for women regulation telephone counseling intervention: Women Breathe Free.
Age <50 years 13.8 <0.002
 Control group women received usual asthma treatment and education. Mild persistent 15%
with asthma on medication use. Data Collection Lower education 3.9 <0.05
A total of 808 women with asthma provided baseline data. Study women were Telephone interview Moderate persistent 20%
on average 48 years of age. Just over 16% were women of color, 14% were Minority 7.9 <0.005
Demographics
classified as low income (<$20,000/year), and 30% had a high school level Asthma symptoms Severe persistent 13%
Minority women, and women of lower education
education or less. Over half of the participants (52%) had mild intermittent, 15% Medicine use Data Analyses level, and younger age were less likely to use inhaled
mild, 20% moderate, and 13% severe persistent asthma at baseline. Lower IAI To examine: Classified by NAEPP criteria, Guidelines and Diagnosis and Treatment of Asthma, 1997
use was significantly correlated with minority race/ethnic origin (OR=7.9, anti-inflammatory medications.
 Relationships between demographics vs. Medication use at baseline:
p<.005), lower education level (OR=3.9, p<.05), and younger age than 50 years Study Sample Frequencies with Odds Ratio
(or=13.8, p<.002). Subsequent to baseline data collection women were Baseline 808
randomly assigned to either the control or the intervention group. Data were Follow up I* 608
 Program effects on medication use: Program Effects on Medication Use
Generalized Estimating Equations (GEE) with logit link using entire sample
available at follow up one for 608 women, and 580 women at follow up two. Follow up II** 580
(intent-to-treat) Age Baseline BMI Baseline FU1 FU2 Treat Treat x FU1 Treat x FU2
The results of the Generalized Estimating Equations models (GEE) with logit Persistence
One year subsequent to baseline data collection
link intent to treat analyses controlling for disease severity, weight, and age One year subsequent to follow up I data collection Inhaled Non-steroidal Est.: -0.005 -0.07 -0.05 -0.07 -0.01 0.04 0.62 -0.28
showed that 12 months subsequent to baseline, IAI use increased more (p=.09) Anti-inflammatory P-Value: 0.71 0.01 0.84 0.78 0.97 0.93 0.09 0.58
and SAB use reduced more (p=.05) at the 24 month follow up period in the Short acting inhaled Est.: -0.02 0.03 0.48 0.08 0.37 0.31 0.02 -0.59
treatment group. Conclusion: the program was effective over time in producing DEMOGRAPHICS bronchodilators P-Value: 0.001 0.02 0.004 0.65 0.09 0.18 0.95 0.05

more appropriate medication use.

7% 1. A trend toward increased use of inhaled non-steroid anti-inflammatories was noted at the
11%
BACKGROUND
7% 9%
Age 7% Income <10,000 12 month follow up perceived in the treatment group (p=.09) versus controls.
13%
10,001-20,000
Although women comprise the majority of adults patients with asthma, few studies have 21% 18-30 15% 13% 20,001-40,000
2. No significant difference was seen in the use of inhaled corticosteroids.
specifically examined management of asthma by them. 31-40 40,001-60,000
41-50 3. A significant reduction in use of short-acting bronchodilators at the 24 month follow up was noted
Inhaled anti-inflammatory medicines are suggested for disease control in asthma 60,001-80,000 in the treatment group (p=.05) versus controls.
51-60
patients (NAEPP). Increasing use of short-acting bronchodilators indicates inadequate 24% 13% 80,000-100,000
61-70
control of the disease (NAEPP). 18% >100,000
>71
26%
16%
Not reported CONCLUSIONS
PURPOSE 4%
Education Race/Ethnicity
21% Younger, less educated, and minority women were less
Effect of Self-Regulatory Education on Women with Asthma is a 5-year research 82%
evaluation of an asthma education program for women with asthma. The study assesses 26%
2% Caucasian/White likely to report use of anti-inflammatory medicine.
< High School
the impact of an innovative asthma management program – ‘Women Breathe Free’ – 1% African American/Black
based on principles of self-regulation and tailored to the unique needs of women with High School 2%
2-year College 2%
Asian/Pacific Islander The intervention produced some increase use of non-
asthma.
4-year College 11%
Hispanic/Latino steroidal anti-inflammatories and a significant
Native American
A randomized controlled trial to identify demographic influences on reported medicine 29% Post Grad decrease in use of short acting bronchodilators.
use by women with asthma to examine the effect of a self-regulation telephone 20% Other
counseling intervention on medication use.