Utilizing peer leaders to improve asthma management in teens living in urban areas

Asthma is one of the most common chronic health conditions among children and adolescents. A variety of effective treatments are available to control symptoms, but roughly 60% of children and teenagers are still reported to have uncontrolled symptoms.¹ An investigation examines whether teenagers living in an urban environment responded better to a peer-led asthma program than a one that was led by adults.²

Investigators ran a parallel-group, randomized clinical trial from 2015 to 2019 in 3 cities in the United States: Buffalo, New York; Baltimore, Maryland; and Memphis, Tennessee. Clinical practices and schools were used to recruit participants aged 12 to 17 years who had persistent asthma. The participants were followed-up for 15 months following receipt of either the intervention or the control program. Following randomization, participants attended a day camp where a manualized self-management for asthma was run with peer leaders for the intervention and adult leaders, such as nurse practitioners, for the control group. Following the camp, participants would have bimonthly contact with the camp leaders, who used a standardized script for each interaction. The scripts were identical for both the intervention and control groups.

A total of 320 adolescents with an average age of 14.3 years participated. Nearly three-quarters of them utilized public health insurance and 251 were Black teenagers. Over the course of 15 months, the response rate for the contact was 80% or higher. The investigators found that the peer-led group had better improvement in outcomes versus the adult-led group. The adjusted mean difference between baseline and 15 months for quality of life was 0.75 versus 0.37 for quality of life (between-group adjusted mean difference, 0.38; 95% CI, 0.07 to 0.63). Asthma control had adjusted mean difference of 0.59 versus −0.31 for asthma control (between-group adjusted mean difference, −0.28; 95% CI, −0.51 to −0.01). The differences between both groups was particularly notable for shortness of breath, wheezing, short-acting β-agonist use, and daily activity. The noted outcomes were not found to be affected by the bimonthly contact doses.

The investigators concluded that using a peer leader with a self-management education program had more efficacy than a program led by an adult elder. Furthermore, these improvements were maintained for at least 15 months.

Reference

1. SullivanPW, GhushchyanV, NavaratnamP, et al.National prevalence of poor asthma control and associated outcomes among school-aged children in the United States. J Allergy Clin Immunol Pract. 2018;6(2):536-544.e1. doi:10.1016/j.jaip.2017.06.039

2. Rhee H, Love T, Wicks M. Long-term effectiveness of a peer-led asthma self-management program on asthma outcomes in adolescents living in urban areas: a randomized clinical trial. JAMA Netw Open. 2021;4(12):e2137492. doi:10.1001/jamanetworkopen.2021.37492