Evaluation of an asthma management program for Chinese children with mild-to-moderate asthma in Hong Kong

Salmeterol/Fluticasone Propionate in a Single Inhaler is Superior to Budesonide Alone in Control of Chinese Asthmatic Adults : An Open-Label, Randomised, 6-Week Study

OBJECTIVE AND DESIGN

There is comparatively little information on asthma management in China. A multicentre, randomised, open-label, parallel-group, 6-week treatment study was conducted to evaluate the efficacy and safety of salmeterol/fluticasone propionate combination treatment in Chinese adult asthmatic patients.

SETTING AND PATIENTS

398 patients with a documented history of moderate-to-severe asthma were randomised to treatment.

INTERVENTIONS

Salmeterol 50mug/fluticasone propionate 100mug twice daily for 6 weeks via Accuhaler((R)) (Diskustrade mark) inhaler and budesonide 400mug twice daily for 6 weeks via Turbuhaler((R)) inhaler.

MAIN OUTCOME MEASURES AND RESULTS

Morning peak expiratory flow (PEF) was investigated as the primary efficacy endpoint; evening PEF, use of salbutamol (albuterol) as rescue medication, and day- and night-time asthma symptom scores were secondary efficacy endpoints. Safety was assessed according to adverse events recorded. Over the 6-week treatment period, salmeterol/fluticasone propionate led to a significantly greater increase in morning (p < 0.0001) and evening (p = 0.0066) PEF compared with budesonide. Moreover, the significant benefit of salmeterol/fluticasone propionate was evident from the first week. Similarly, salmeterol/fluticasone propionate led to significantly greater improvements in the use of rescue medication and day- and night-time asthma symptom scores, compared with budesonide. Both treatments were well tolerated, with a similar incidence (23%) of adverse events in both treatment groups and no serious adverse events.

CONCLUSIONS

Salmeterol/fluticasone propionate 50mug /100mug twice daily was significantly more effective than budesonide 400mug twice daily in improving lung function and reducing symptoms and use of rescue medication in Chinese asthmatic patients who were poorly controlled on low-dose inhaled corticosteroids. This confirms the findings of superior efficacy of this combination product over budesonide in other populations.

Incorporating family therapy into asthma group intervention: a randomized waitlist-controlled trial

Asthma psychoeducational programs have been found to be effective in terms of symptom-related outcome. They are mostly illness-focused, and pay minimal attention to systemic/familial factors. This study evaluated a novel asthma psychoeducation program that adopted a parallel group design and incorporated family therapy. A randomized waitlist-controlled crossover clinical trial design was adopted. Children with stable asthma and their parents were recruited from a pediatric chest clinic. Outcome measures included, for the patients: exhaled nitric oxide (eNO), spirometry, and adjustment to asthma; and for the parents: perceived efficacy in asthma management, Hospital Anxiety and Depression Scale anxiety subscale, Body Mind Spirit Well-being Inventory emotion subscale, and Short Form 12 health-related quality of life scale. Forty-six patients participated in the study. Attrition rates were 13.0% and 26.0% for the active and control groups, respectively. Repeated-measures ANOVA revealed a significant decrease in airway inflammation, as indicated by eNO levels, and an increase in patient's adjustment to asthma and parents' perceived efficacy in asthma management. Serial trend analysis revealed that most psychosocial measures continued to progress steadily after intervention. Significant improvements in both symptom-related measures and mental health and relationship measures were observed. The findings supported the value of incorporating family therapy into asthma psychoeducation programs.

Intervenções educativas em asma na infância: uma revisão analítica da literatura

Foi realizada uma revisão analítica da literatura visando avaliar as internações educativas para asmáticos de 0 a 18 anos, no período de 1992 a 2002, e identificar características relacionadas com sua eficácia. Foram utilizados diversas bases de dados. Realizou-se também pesquisa manual, entre as referências bibliográficas dos trabalhos selecionados. Foram incluídos 39 trabalhos (27 controlados), tendo sido encontrados resultados variáveis, que, no entanto, permitiram vislumbrar a validade da educação no controle da asma pediátrica. Os parâmetros de avaliação usados pelos estudos foram: variáveis de morbidade, uso de serviços de saúde, qualidade de vida, função pulmonar, conhecimento sobre a doença e habilidades de automanejo. Em 32 estudos (82%), relatou-se benefício sobre uma ou mais variáveis. Entre os 27 estudos controlados, 85,7% produziram melhora nas habilidades de automanejo, 83,3% no conhecimento, 80% nos sintomas diurnos ou noturnos, 71,4% nas visitas médicas não programadas, 66,6% na capacidade para atividades físicas, 54,5% nas hospitalizações, 50% nas visitas à emergência, 50% na função pulmonar, 22,2% no absenteísmo escolar e 20% na qualidade de vida. O número de itens de conteúdo foi a única característica dos programas educativos revisados associada ao nível de eficácia. Técnicas educativas sofisticadas não contribuíram para melhores resultados. A educação de crianças e adolescentes asmáticos produz resultados benéficos, mas são necessários estudos com melhor controle de variáveis confundidoras, para uma avaliação mais precisa da sua eficácia.

Economic effectiveness of disease management programs: a meta-analysis

The economic effectiveness of disease management programs, which are designed to improve the clinical and economic outcomes for chronically ill individuals, has been evaluated extensively. A literature search was performed with MEDLINE and other published sources for the period covering January 1995 to September 2003. The search was limited to empirical articles that measured the direct economic outcomes for asthma, diabetes, and heart disease management programs. Of the 360 articles and presentations evaluated, only 67 met the selection criteria for meta-analysis, which included 32,041 subjects. Although some studies contained multiple measurements of direct economic outcomes, only one average effect size per study was included in the meta-analysis. Based on the studies included in the research, a meta-analysis provided a statistically significant answer to the question of whether disease management programs are economically effective. The magnitude of the observed average effect size for equally weighted studies was 0.311 (95% CI = 0.272-0.350). Statistically significant differences of effect sizes by study design, disease type and intensity of disease management program interventions were not found after a moderating variable, disease severity, was taken into consideration. The results suggest that disease management programs are more effective economically with severely ill enrollees and that chronic disease program interventions are most effective when coordinated with the overall level of disease severity. The findings can be generalized, which may assist health care policy makers and practitioners in addressing the issue of providing economically effective care for the growing number of individuals with chronic illness.