Medico-psychological interventions in male asthmatic children: an evaluation of physiological change. Improving the psychological status of children with asthma: a randomized controlled trial. The effects of a cognitive behavioural intervention in asthmatic patients. Incorporating family therapy into asthma group intervention: a randomized waitlist-controlled trial. Effects of a behavioral treatment program on children with asthma. Study of the effects of treatment with theophylline on the cognitive process and behaviour of children with bronchial asthma. Children with asthma and physical exercise: effects of an exercise programme. Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial. Evaluation of Community Action Against Asthma: a community health worker intervention to improve children's asthma-related health by reducing household environmental triggers for asthma. Home-based family intervention for low-income children with asthma: a randomized controlled pilot study.
The purpose of this study was systematically to evaluate the effectiveness of several modes of psychological intervention used with male asthmatic children being treated in the Allergy Outpatient Clinic. Therapeutic effectiveness was measured by large airway changes in respiratory function, and the number of recurrent asthmatic attacks. The psychotherapeutic modes used were Relaxation Training, Assertive Training, and combined Relaxation plus Assertive Training. All patients were administered medication by the responsible physician. The group psychotherapy experiences were controlled by using patients who received medication alone and by patients who received medication and met in a leaderless group. The effectiveness of the therapeutic interventions was determined by comparisons between pretreatment measures and measurements taken during and after the eight-week treatment program. Both Relaxation Training by itself and combined Relaxation plus Assertive Training increased respiratory functioning and reduced the number of attacks. Assertive Training alone failed to improve respiratory function and had a tendency to increase the frequency of asthmatic attacks. It was concluded that the most effective management in male asthmatic children was achieved by the combination of medical and psychological treatments. Children with asthma are at special risk for problems in psychological functioning, as are children with other chronic illnesses. We conducted a controlled trial of a combined education and stress management program among children ages 6 to 14 years with asthma. Eighty-one children were randomly assigned to an intervention or a control group; 56 children completed data collection, 29 intervention and 27 control. Psychological status was assessed by the Child Behavior Checklist (CBCL) before and after the intervention, as were children's knowledge of asthma, stress (as measured by children's life events), and functional status (as indicated by such activities as school attendance, time playing with friends, and daily chore performance). Children in the intervention group had a significant improvement in the total Behavior Problems score (p less than .04) and Internalizing scale (p less than .01) on the CBCL and a significant increase in daily chores (p less than .04) compared with the control group. Before intervention, the two groups had statistically significant positive relationships between negative life events and behavior problems scores. After intervention, children in the control group still demonstrated a significant relationship between negative life events and total and Internalizing Behavior Problem scores, although participation in the intervention group negated that relationship. Children in the intervention group whose knowledge of asthma increased were more likely to report an increase in daily chores (p less than .02). We conclude that the intervention had a beneficial effect on psychological status and on children's daily activities. The effect may have occurred in part by decreasing the likelihood that perceived stress from negative life events led to poorer adjustment. There is evidence that educational programmes may improve patient's compliance with asthma treatment and control symptoms. Whilst medical parameters have been thoroughly studied, few data are available concerning psychological intervention. The aim of our open pilot study was to verify whether any difference in perceived illness and response style to asthma existed in the patients enrolled in an Asthma Rehabilitation Group (ARG) and in a Control Group (CG). Forty consecutive asthmatics were randomly enrolled, all of whom were diagnosed, treated and followed-up according to the International Guidelines. Both groups underwent a psychological assessment at baseline and after one year. A battery of questionnaires was used to obtain data relating to baseline characteristics (anxiety, depression, psychophysiological disorders), emotional reactions to asthma attacks (panic-fear, etc,) and cognitive variables (external control, psychological stigma, internal beliefs, external chance, etc.) involved in the perceived illness. In addition, the Asthma Rehabilitation Group patients underwent an educational programme and a cognitive-behavioural intervention. In both groups, a reduction of anxiety and depression scores was observed, as well as a significant improvement of the medical parameters evaluated. Only the Asthma Rehabilitation Group reported lower scores on the Psychophysiological Questionnaire and on the External Control Subscale after 1 year. The Control Group reported higher score on the External Chance Scale. The data of our study seem to confirm the effectiveness of psychological intervention on the cognitive skills involved in the perception and management of asthma. Larger scale studies on this topic are suggested. 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. Twenty children with severe asthma using continual oral beta 2 agonists were randomized equally into either a behavioral intervention group or a control group. The behavioral intervention consisted of: symptom discrimination of asthma signals, self-management techniques of breathlessness, and contingency management of asthma-related behavior. The purpose of the study was to evaluate the effects of the behavioral treatment when superimposed on a regular medical treatment. The design consisted of a four-week baseline period, a four-week intervention period, and a four-week follow-up period. Results showed that the group receiving the behavioral intervention significantly reduced their use of beta 2 agonist spray doses and days of school absenteeism without increasing the number of asthma symptoms compared with the control group. It was concluded that children with severe asthma may benefit substantially from a behavioral program in addition to their regular medical treatment. The effects of theophylline (T) on cognitive and emotional aspects were evaluated in nine children with mild bronchial asthma (7-14 years). The study was double blind crossover against placebo (P) for a period of 30 days for each. The children admitted to the study had an average IQ (80-101) and were able to perform pulmonary function studies (PFS). On days 0, 30 and 60 patients were evaluated by psychological tests (Wisc, Bender, Complex Figure A. Rey and Miss Goodenough/Machouver). PPS an T serum levels were performed on days 15 and 45. During the T period all patients had T serum levels greater than 5 mcg/ml (5 to 22). The final evaluation showed no changes in the psychological tests. Behaviour alterations were not reported by the parents. In conclusion, in this group of patients there was no influence of T on the asthmatic children's behavior. These results are in agreement with the recent data published by Schlieper et al. (J. Pediatr. 118: 449-455, 1991). To evaluate the effects of a physical exercise programme for children with asthma on an outpatient basis.
                Intervention study: a randomized pretest-post-test control group design.
                Forty-seven children with clinically diagnosed asthma participated in the intervention study, including 34 boys and 13 girls, from 8 to 13 years of age (mean age 10.6).
                The physical exercise programme consisted of regular group exercises and home exercises for a period of three months. It was based on a theoretical model describing the relationships between physical competence (condition), perceived physical competence, self-esteem and coping behaviour.
                Maximum incremental exercise test, endurance test, the Self-Perception Profile for Children (CBSK), the Asthma Coping Test (ACBT), lung function and exercise-induced bronchoconstriction.
                The results showed significant effects of the intervention programme on physical condition. There was a significant improvement of 15 W on the maximal workload (Wmax) (p < 0.001), of 7% on VO2max (oxygen uptake) (p = 0.002) and a significant decrease on heart rate submaximal of 6% (p = 0.001). There was also a significant improvement of 50% in running time measured with the endurance test (p = 0.021). Furthermore, a significant effect of the intervention was seen on coping with asthma (p = 0.003).
                It was concluded that participation in the physical exercise programme not only enhanced physical fitness, but also improved coping behaviour with asthma. Childhood asthma is common in Cape Town, a province of South Africa, but is underdiagnosed by general practitioners. Medications are often prescribed inappropriately, and care is episodic. The objective of this study is to assess the impact of educational outreach to general practitioners on asthma symptoms of children in their practice.
                This is a cluster randomised trial with general practices as the unit of intervention, randomisation, and analysis. The setting is Mitchells Plain (population 300,000), a dormitory town near Cape Town. Solo general practitioners, without nurse support, operate from storefront practices. Caregiver-reported symptom data were collected for 318 eligible children (2 to 17 years) with moderate to severe asthma, who were attending general practitioners in Mitchells Plain. One year post-intervention follow-up data were collected for 271 (85%) of these children in all 43 practices. Practices randomised to intervention (21) received two 30-minute educational outreach visits by a trained pharmacist who left materials describing key interventions to improve asthma care. Intervention and control practices received the national childhood asthma guideline. Asthma severity was measured in a parent-completed survey administered through schools using a symptom frequency and severity scale. We compared intervention and control group children on the change in score from pre-to one-year post-intervention.
                Symptom scores declined an additional 0.84 points in the intervention vs. control group (on a nine-point scale. p = 0.03). For every 12 children with asthma exposed to a doctor allocated to the intervention, one extra child will have substantially reduced symptoms.
                Educational outreach was accepted by general practitioners and was effective. It could be applied to other health care quality problems in this setting. This article describes the evaluation of a community-based participatory research (CBPR) community health worker (CHW) intervention to improve children's asthma-related health by reducing household environmental triggers for asthma. After randomization to an intervention or control group, 298 households in Detroit, Michigan, with a child, aged 7 to 11, with persistent asthma symptoms participated. The intervention was effective in increasing some of the measures of lung function (daily nadir Forced Expiratory Volume at one second [p = .03] and daily nadir Peak Flow [p = .02]), reducing the frequency of two symptoms ("cough that won't go away," "coughing with exercise"), reducing the proportion of children requiring unscheduled medical visits and reporting inadequate use of asthma controller medication, reducing caregiver report of depressive symptoms, reducing concentrations of dog allergen in the dust, and increasing some behaviors related to reducing indoor environmental triggers. The results suggest a CHW environmental intervention can improve children's asthma-related health, although the pathway for improvement is complex. Low-income African American children have disproportionately higher asthma morbidity and mortality. Education alone may not address barriers to asthma management due to psychosocial stress. This study evaluated the efficacy of a home-based family intervention integrating asthma education and strategies to address stress using a community-based participatory research model. Children age 8 to 13 with poorly controlled asthma and their caregivers were recruited from an urban hospital and an asthma camp. Caregivers with elevated scores on a stress measure were enrolled. Forty-three families were randomized to the 4- to 6-session Home Based Family Intervention (HBFI) or the single session of Enhanced Treatment as Usual (ETAU). All families received an asthma action plan and dust mite covers; children performed spirometry and demonstrated MDI/spacer technique at each home visit. The HBFI addressed family-selected goals targeting asthma management and stressors. Asthma management, morbidity, family functioning, and caregiver stress were assessed at baseline, postintervention, and 6 months after the intervention. ED visits and hospitalizations were ascertained by medical record review for a year after intervention completion. Only one child (5%) in HBFI had an asthma-related hospitalization compared to 7 patients (35%) in ETAU in the year following intervention. Participants in both groups demonstrated improved asthma management and family functioning, and reduced ED visits, symptom days, missed school days, and caregiver stress, but there were no differential treatment effects. The results suggest that a home-based intervention addressing medical and psychosocial needs may prevent hospitalizations for children with poorly controlled asthma and caregivers under stress.
                (c) 2012 APA, all rights reserved.
This review was unable to draw firm conclusions for the role of psychological interventions for children with asthma. This review demonstrates the absence of an adequate evidence base and highlights the need for well-conducted and reported randomised trials in this area.