Thorax 2000;55:177-183 ( March )

Asthma education and quality of life in the community: a randomised controlled study to evaluate the impact on white European and Indian subcontinent ethnic groups from socioeconomically deprived areas in Birmingham, UK

H Moudgil^a, T Marshall^b, D Honeybourne^a

^a Department of Thoracic Medicine, City Hospital NHS Trust, Birmingham, UK, ^b Department of Public Health and Epidemiology, The University of Birmingham Medical School, Birmingham, UK

Correspondence to: Dr H Moudgil, Princess Royal Hospital, Apley Castle, Telford TF6 6TF, Shropshire, UK

Received 8 March 1999; Returned to authors 21 May 1999; Revised version received 7 December 1999; Accepted for publication 13 December 1999

BACKGROUNDWhether asthma morbidity in minority groups can be reduced by preventative health care measures delivered in the relevant ethnic dialects requires further evaluation. This study reports clinical outcomes and quality of life from a community based project investigating white European (W/E) and Indian subcontinent (ISC) ethnic groups with asthma living in deprived inner city areas of Birmingham, UK.
METHODSSix hundred and eighty nine asthmatic subjects (345 W/E, 344 ISC) of mean (SD) age 34.5 (15) years (range 11-59) and mean forced expiratory volume in one second (FEV₁) of 80% predicted were interviewed in English, Punjabi, Hindi, or Urdu. Subjects randomised to the active limb of a prospective, open, randomised, controlled, parallel group, 12 month follow up study underwent individually based asthma education and optimisation of drug therapy with four monthly follow up (active intervention). Control groups were seen only at the beginning and end of the study. Urgent or emergency interactions with primary and secondary health care (clinical outcomes) and both cross sectional and longitudinal data from an Asthma Quality of Life Questionnaire (AQLQ) were analysed.
RESULTSClinical outcomes were available for 593 subjects. Fewer of the active intervention group consulted their GP (41.8% versus 57.8%, odds ratio (OR) 0.52 (95% CI 0.37 to 0.74)) or were prescribed antibiotics (34.9% versus 51.2%, OR 0.51 (95% CI 0.36 to 0.72)), but by ethnicity statistically significant changes occurred only in the W/E group with fewer also attending A&E departments and requiring urgent home visits. Active intervention reduced the number of hospital admissions (10 versus 30), GP consultations (341 versus 476), prescriptions of rescue oral steroids (92 versus 177), and antibiotics (220 versus 340), but again significant improvements by ethnicity only occurred in the active W/E group. AQLQ scores were negatively skewed to the higher values; regression analysis showed that lower values were associated with ISC ethnicity. Longitudinal changes (for 522 subjects) in the mean AQLQ scores were small but statistically significant for both ethnic groups, with scores improving in the active and worsening in the control groups.
CONCLUSIONSActive intervention only improved clinical outcomes in the W/E group. AQLQ scores, although lower in the ISC group, were improved by active intervention in both ethnic groups.


Keywords: asthma; quality of life; ethnicity

---

© 2000 by Thorax
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Smeeton, N. C, Rona, R. J, Gregory, J., White, P., Morgan, M. (2007). Parental attitudes towards the management of asthma in ethnic minorities. Arch. Dis. Child. 92: 1082-1087 [Abstract] [Full Text]  
• Loh, L.C., Teh, P.N., Seth, K.D., Raman, S., Vijayasingham, P., Thayaparan, T. (2006). Ethnicity as a Determinant of Asthma-Related Quality of Life in a Multiracial Country. Asia Pac J Public Health 18: 49-55  
• (2005). Action plans in asthma. DTB 43: 91-94 [Abstract] [Full Text]  
• Goyder, E C, Blank, L, Ellis, E, Furber, A, Peters, J, Sartain, K, Massey, C (2005). Reducing inequalities in access to health care: developing a toolkit through action research. Qual Saf Health Care 14: 336-339 [Abstract] [Full Text]  
• Lozano, P., Finkelstein, J. A., Carey, V. J., Wagner, E. H., Inui, T. S., Fuhlbrigge, A. L., Soumerai, S. B., Sullivan, S. D., Weiss, S. T., Weiss, K. B. (2004). A Multisite Randomized Trial of the Effects of Physician Education and Organizational Change in Chronic-Asthma Care: Health Outcomes of the Pediatric Asthma Care Patient Outcomes Research Team II Study. Arch Pediatr Adolesc Med 158: 875-883 [Abstract] [Full Text]  
• Gibson, P G, Powell, H (2004). Written action plans for asthma: an evidence-based review of the key components. Thorax 59: 94-99 [Abstract] [Full Text]  
• Griffiths, C., Foster, G., Barnes, N., Eldridge, S., Tate, H., Begum, S., Wiggins, M., Dawson, C., Livingstone, A. E., Chambers, M., Coats, T., Harris, R., Feder, G. S (2004). Specialist nurse intervention to reduce unscheduled asthma care in a deprived multiethnic area: the east London randomised controlled trial for high risk asthma (ELECTRA). BMJ 328: 144- [Abstract] [Full Text]  
• Barbanel, D, Eldridge, S, Griffiths, C (2003). Can a self-management programme delivered by a community pharmacist improve asthma control? A randomised trial. Thorax 58: 851-854 [Abstract] [Full Text]  
• Kumar, S. (2003). Representation of South Asian people in randomised trials: Study results are interesting but not final word. BMJ 327: 394-394 [Full Text]  
• Glauber, J. H., Fuhlbrigge, A. L., Finkelstein, J. A., Homer, C. J., Weiss, S. T. (2001). Relationship Between Asthma Medication and Antibiotic Use. Chest 120: 1485-1492 [Abstract] [Full Text]  
• Griffiths, C., Kaur, G., Gantley, M., Feder, G., Hillier, S., Goddard, J., Packe, G. (2001). Influences on hospital admission for asthma in south Asian and white adults: qualitative interview study. BMJ 323: 962-962 [Abstract] [Full Text]  
• PARTRIDGE, M R (2000). In what way may race, ethnicity or culture influence asthma outcomes?. Thorax 55: 175-176 [Full Text]