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Controlled Studies of Childhood Asthma Self-Management in Italy Using the "Open Airways" and "Living with Asthma" Programs: A Preliminary Report

IV Cattedra di Clinica Pediatrica, Universita' di Roma, "La Sapienza", Roma, Italia

Fabio Midulla

IV Cattedra di Clinica Pediatrica, Universitá di Roma, "La Sapienza", Roma, Italia

Michele Hindi-Alexander

Allergy Division, University at Buffalo, State University of New York, NY

Enea Bonci

IV Cattedra di Clinica Pediatrica, Universitá di Roma, "La Sapienza", Roma, Italia

Gian Carlo Tancredi

IV Cattedra di Clinica Pediatrica, Universitá di Roma, "La Sapienza", Roma, Italia

Renato Cutrera

IV Cattedra di Clinica Pediatrica, Universitá di Roma, "La Sapienza", Roma, Italia

Anna Maria Zicari

IV Cattedra di Clinica Pediatrica, Universitá di Roma, "La Sapienza", Roma, Italia

David Evans

Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY

Roberto Ronchetti

IV Cattedra di Clinica Pediatrica, Universitá di Roma, "La Sapienza", Roma, Italia

The concept of self-management for childhood asthma was introduced to Italy through a scientific exchange agreement with the United States. Two self-management programs, Living with Asthma (LWA) and Open Airways (OA), are being evaluated in three studies, two of which (Pilot and Atri-Viterbo) were conducted by the Respira tory Service of the Pediatric Department of the University "La Sapienza" in Rome and one by 14 Italian university pediatric respiratory centers (Project Italia).

In October 1985, 20 children and their 40 parents were enrolled in the Pilot Study. One hundred percent of the mothers and children and 70% of the fathers attended all of the sessions. Theoretical knowledge about asthma and knowledge of asthma self- management behavior were assessed three times by a questionnaire: at the beginning of the program, at the end of the program and one year later. Significant improvements in knowledge of asthma and in knowledge of asthma self-management behavior were demonstrated by both parents and children at the end of the program and one year later. Analysis of clinical symptoms and drug consumption indicated a statistically nonsignificant trend towards a reduction of asthma severity in the year after the program.

In the Atri-Viterbo study 8229 children were initially screened by a questionnaire. One hundred eighty-two children with asthma (2.4%) were identified and invited to participate in a self-management program. Open Airways was used in a shortened version. Only 29 families in Atri (22% of the eligible families) and 24 families in Viterbo (50%) ultimately agreed to participate in the program. A comparison of these families with those who did not participate showed that higher social status (p < 0.001) and more severe asthma (p < 0.05) were significantly associated with partici pation. Attendance by mothers and children was 78% in Atri and 61% in Viterbo. Only 5% of the fathers regularly attended the program. Parents who received the pro gram registered a statistically significant increase in knowledge of asthma and knowl edge of asthma self-management behavior relative to controls (+13% versus -4%; p < 0.05).

Fourteen university-based pediatric respiratory centers participated in Project Italia, in which the LWA and OA programs were compared in both full length and shortened versions (8 versus 4 h). Four hundred children and their families were en rolled in the study. Subsequently, 54% of the fathers, 75% of the mothers and 94% of the children attended 75% or more of the sessions. Experiences of many centers, how ever, suggest that one of the main problems is enrollment: Thus a remaining challenge is to find more effective methods of identifying, recruiting and educating those fami lies who most need education for childhood asthma. In general, results show that large epidemiological studies are necessary to better understand (1) how effective educa tional programs for asthma can be, and (2) how to increase their acceptability for those families who need them most.

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