Long term effect of self-regulation education on use of inhaled anti-inflammatories and short-acting bronchodilators Clark, NM, Gong, M, Wang, S, Lin, X, Bria, W, Johnson, T University of Michigan School of Public Health and University of Michigan Health System - Supported by NHLBI grant 1 R18 HL60884 Younger, less educated, and minority women were less likely to report use of anti-inflammatory medicine. The intervention produced some increase use of non-steroidal anti- inflammatories and a significant decrease in use of short acting bronchodilators. Enrollment Criteria   Women 18 years and older   Physician diagnosis of asthma   Attending University of Michigan Clinics Data Collection Telephone interview   Demographics   Asthma symptoms   Medicine use Study Sample Baseline 808 Follow up I* 608 Follow up II**580 One year subsequent to baseline data collection One year subsequent to follow up I data collection Although women comprise the majority of adults patients with asthma, few studies have specifically examined management of asthma by them. Inhaled anti-inflammatory medicines are suggested for disease control in asthma patients (NAEPP). Increasing use of short-acting bronchodilators indicates inadequate control of the disease (NAEPP). ABSTRACT BACKGROUND METHODS FINDINGS CONCLUSIONS ORp-value Age <50 years13.8<0.002 Lower education3.9<0.05 Minority7.9<0.005 Asthma Severity Inhaled anti-inflammatory medicines (IAI) are suggested for disease control in asthma patients, while increasing use of short-acting bronchodilators (SAB) indicates inadequate control of the disease. The purpose of this investigation, a sub study of a randomized clinical trial, was to examine and evaluate the effectiveness of a self-regulation telephone counseling intervention for women with asthma on medication use. A total of 808 women with asthma provided baseline data. Study women were on average 48 years of age. Just over 16% were women of color, 14% were classified as low income (<$20,000/year), and 30% had a high school level education or less. Over half of the participants (52%) had mild intermittent, 15% mild, 20% moderate, and 13% severe persistent asthma at baseline. Lower IAI use was significantly correlated with minority race/ethnic origin (OR=7.9, p<.005), lower education level (OR=3.9, p<.05), and younger age than 50 years (or=13.8, p<.002). Subsequent to baseline data collection women were randomly assigned to either the control or the intervention group. Data were available at follow up one for 608 women, and 580 women at follow up two. The results of the Generalized Estimating Equations models (GEE) with logit link intent to treat analyses controlling for disease severity, weight, and age showed that 12 months subsequent to baseline, IAI use increased more (p=.09) and SAB use reduced more (p=.05) at the 24 month follow up period in the treatment group. Conclusion: the program was effective over time in producing more appropriate medication use. PURPOSE Effect of Self-Regulatory Education on Women with Asthma is a 5-year research evaluation of an asthma education program for women with asthma. The study assesses the impact of an innovative asthma management program – ‘Women Breathe Free’ – based on principles of self-regulation and tailored to the unique needs of women with asthma. A randomized controlled trial to identify demographic influences on reported medicine use by women with asthma to examine the effect of a self-regulation telephone counseling intervention on medication use. Intervention   Subsequent to baseline data collection, women were randomly assigned to either the control or the intervention group.   Women in the intervention group received the woman focused self- regulation telephone counseling intervention: Women Breathe Free.   Control group women received usual asthma treatment and education. Data Analyses To examine:   Relationships between demographics vs. Medication use at baseline: Frequencies with Odds Ratio   Program effects on medication use: Generalized Estimating Equations (GEE) with logit link using entire sample (intent-to-treat) DEMOGRAPHICS Demographics Associated with Use of Inhaled Anti-Inflammatory Medications Age Education Income Race/Ethnicity 18% 16% 13% 15% 11% 13% 7% <10,000 10,001-20,000 20,001-40,000 40,001-60,000 60,001-80,000 80, ,000 >100,000 Not reported 21% 4% 26% 20% 29% < High School High School 2-year College 4-year College Post Grad 2% 1% 2% 11% 2% 82% Caucasian/White African American/Black Asian/Pacific Islander Hispanic/Latino Native American Other Classified by NAEPP criteria, Guidelines and Diagnosis and Treatment of Asthma, 1997 Minority women, and women of lower education level, and younger age were less likely to use inhaled anti-inflammatory medications. Program Effects on Medication Use 1. 1.A trend toward increased use of inhaled non-steroid anti-inflammatories was noted at the 12 month follow up perceived in the treatment group (p=.09) versus controls. 2. No significant difference was seen in the use of inhaled corticosteroids. 3. A significant reduction in use of short-acting bronchodilators at the 24 month follow up was noted in the treatment group (p=.05) versus controls. Percent of Women Mild intermittent52% Mild persistent15% Moderate persistent20% Severe persistent13% AgeBaseline BMIBaseline Persistence FU1FU2TreatTreat x FU1Treat x FU2 Inhaled Non-steroidal Anti-inflammatory Est.: P-Value: Short acting inhaled bronchodilators Est.: P-Value: % 7% 9% 21% 26% 24% >71