Targeting Barriers to Self-Care Benefits Seniors With Asthma

An intervention designed to address barriers to asthma self-management improves asthma outcomes among older adults, according to a study published in JAMA Internal Medicine.

Alex D. Federman, M.D., M.P.H., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues conducted a three-arm clinical trial at primary care practices and personal residences in New York City. Adults aged 60 years and older with persistent, uncontrolled asthma were identified; 406 met the eligibility criteria and were randomly assigned to home-based intervention, clinic-based intervention, or control, and 391 patients were treated. The intervention included screening for barriers to asthma control and self-management and actions to address these barriers.

The researchers found that scores on the asthma control test were better in the intervention groups versus the control group (difference-in-differences at three months, 1.2 [95 percent confidence interval (CI), 0.2 to 2.2]; six months, 1.0 [95 percent CI, 0.0 to 2.1]; 12 months, 0.6 [95 percent CI, −0.5 to 1.8]; overall, Χ² = 13.4 with 4 degrees of freedom). Compared with the control group, the intervention groups had fewer emergency department visits at 12 months (6.2 versus 12.7 percent; adjusted odds ratio, 0.8; 95 percent CI, 0.6 to 0.99). The intervention versus control patients had statistically significant improvements in quality of life, medication adherence, and inhaler technique. There were no significant differences for patients receiving the intervention in their homes versus the practice setting.

"Identification of barriers to asthma self-management with targeted support is an effective method for improving proper asthma self-care, control, and quality of life among older adults," the authors write.

Two authors disclosed financial ties to the pharmaceutical and medical technology industries.

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