1. Is school based DOT always effective. “The good, the bad and the Ugly
Susan Frost, Joanna Bennett, Teresa Evans, Sarah Stone and Prasad Nagakumar

2. Why? Inhaled steroids reduce asthma related symptoms (Wennergren,1996)
Adherence to inhaled steroids is often <50% (Chan,2015)
School based directly observed therapy (DOT) shown to be effective in improving asthma control (Halterman,2012)
Chann et al (2015) The Effect of an electronic monitoring device with audivisual reminder function on adherence to inhaled corticosteroids and school attendance in children with asthma; a randomised controlled trial
Halterman et al (2012) The school based preventative asthma care trial; results of a pilot studyhttps://
Wennergren G, Kristjansson S, Strannegard I (1996) Decrease in hospitalisation for treatment of childhood asthma with increased use of
anti-inflammatory treatment, despite an increase in prevalence of asthma. J.allergy Clinical Immunology. March

3. How?
Retrospective study - looking at evidence over a 3 year period (June )
A decision to start DOT made following a Difficult asthma assessment (all patients being on high dose asthma therapy and were being considered for alternative therapies)
Evidence was taken from medical and nursing notes

4. During the 3 years: DOT was decided for 8 patients in a 3 year period
3/8 started - 5 not started due to lack of resources at school (n= 3) and parental refusal (n=2).
3 patients started were male ages 10

5. Of the 3…..
One was on DOT for 4 months and his asthma control was not improved (admissions, exacerbations, asthma control tests, school absences).
dot
HOSP
Hosp

6. Patient number 2 …
DOT for 12 months, his asthma control improved until the school holidays
dot
Aug
Jan.
Aug.

7. Patient number 3
Third patient - on it for 2 years pre DOT had 5 asthma admissions, pred 10mg alternate day, school attendance 70%. Since DOT- no admissions, stopped alt day pred and school attendance 99%
Aug.
dot

8. Conclusion:
DOT can work, whether it is used to discover if there are true adherence issues or to improve adherence.
However it takes a lot of collaborative working. Schools need a great deal of support ( teaching, Health care plans ) and this needs regular planned reviews.
Alternative plans for school holidays will need to be considered.