ROARING ADVENTURES OF PUFF RAP PROGRAM REDUCES ASTHMA MORBIDITY E Wong, S McGhan, H Wells, P A Hesse

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ROARING ADVENTURES OF PUFF (RAP) PROGRAM REDUCES
ASTHMA MORBIDITYE Wong, S McGhan, H Wells, P A
Hessel, P Mundane, V Boechler, D Befus, C
MajaesicAlberta Asthma Centre, University of
Alberta, Edmonton, AB, Canada

• Abstract
• Rationale There is still ongoing debate as to
  the impact of asthma education on quality of
  life, level of control and health-care
  utilization. We hypothesized that children with
  asthma who receive an education program will
  improve their quality of life, level of asthma
  control, asthma management behaviour and will
  have reduced health-care utilization compared to
  children in the control group. Methods 34
  schools from three health regions in Alberta,
  Canada, were randomized to receive either the RAP
  program or usual care. The RAP program is a
  six-week childhood asthma education program
  administered by health professionals in the
  schools. Outcomes were measured from both the
  parent and child prior to the intervention and at
  six and 12 months using the Me and My Asthma
  Questionnaire, Parent Asthma Questionnaire, and
  the Pediatric Quality of Life Questionnaire.
  Results 130 children enrolled in the
  intervention group, and 165 children enrolled in
  the control group. Improvements following the RAP
  program were significantly greater (pthe intervention group in the following areas
  missed school days, unscheduled doctor visits,
  limitations in the kind of play, changing
  medication due to worsening asthma, smoke
  exposure in the home, use of peak flow meter, and
  avoidance of triggers. Discussion Our results
  showed that the most significant impact of asthma
  education was seen in asthma management
  behaviour. Concurrently, we noted an improvement
  in quality of life with less limitation in
  activity and fewer missed school days.
  Conclusion Our study suggests that a
  multi-level, comprehensive, school-based asthma
  education program is feasible and effective in
  improving health outcomes.
• Background
• Prevalence of childhood asthma is increasing.
• Asthma is not optimally controlled.
• Studies show that few families receive individual
  or group asthma education
• Education needs to be accessible, comprehensive
  and effective
• Accessing children at school has shown to be a
  feasible approach.
• Hypothesis
• We hypothesized that school-aged children with
  asthma who participated in the Roaring Adventures
  of Puff (RAP) program will exhibit greater asthma
  self-management behaviour, will have reduced
  symptoms and health care utilization.
• Study Procedure
• Urban and Rural Schools randomly selected (n 34)
• School Health Survey Administered
• (n 3986)

• RAP Intervention Phases
• Inform primary care physician and obtain written
  action plan
• Provide letter outlining the program
• Invite input and suggestions
• Provide sources of asthma guidelines
• Request a specific, written asthma action plan
• 2. Educate parents and school staff
• Obtain input on needs
• Provide overview on asthma management
• Agree on process to address school asthma
  guidelines
• Provide overview of the education program
• Outline how the parents and staff support
  children with asthma
• 3. Teach six one-hour RAP sessions at school to
  children with asthma
• Facilitate group interaction and team work
• Encourage goals setting
• Use interactive games and learning activities
• Teach self-monitoring and action plan use
• Discuss triggers and avoidance measures

• Access to action plans improved for the RAP group
  in the first 6 months.
• The use of peak flow meters statistically
  increased in the RAP group.
• Improvements in avoidance of triggers was
  significantly different from baseline at both 6
  and 12 months in the RAP group.

• Discussion
• The RAP group showed an overall improvement in
  outcome measures.
• Results suggest that RAP could help reduce health
  care utilization.
• The program generated enormous interest and
  positive feedback from parents and schools.
• Factors that may have influenced the impact of
  the program include low parent attendance, few
  physician generated action plans, and mild
  asthma.
• Other outcome measures (quality of life, child
  behaviour) were assessed but not reported in this
  poster.
• Conclusions
• A study of the Roaring Adventures of Puff (RAP)
  asthma education program using randomly selected
  and assigned schools demonstrated positive
  outcomes.
• Improved outcomes included
• Unscheduled physician visits
• Missed schools days
• Limitations in kind of play
• Frequency in use of bronchodilators
• Frequency of medication adjustment
• Smoke in the home

Activity limitation improved for both the control
and the RAP group

• The RAP group improved in reducing smoking in the
  home at 6 months
• Cats or other animals in the home remained
  relatively unchanged

Both groups showed an reducing trend in
unscheduled visits to the physician and
emergency, and in missed school days.

• Six month improvements were the most dramatic for
  the RAP group.
• Parents of the RAP group indicated a higher level
  of improvement in their understanding and ability
  to control and cope with asthma during the
  intervention phase of the study then the control
  group.
• Sub-groups
• The same analysis was done for the following sub
  groups
• Ages 8-10
• 1 unscheduled physician visit
• Past asthma education
• Non-smokers
• Few to no changes in significance was seen.

Appropriate use of medication improved more with
the RAP group.