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Customized, self-managed asthma intervention improves outcomes in older adults

Older adults with asthma who received interventions specific to their needs and barriers experienced improvements in asthma outcomes, quality of life and self-management behaviors compared with patients who received standard care, according to study results published in JAMA Internal Medicine.

“Older adults are prone to poor asthma outcomes owing in part to difficulties with self-management, like daily use of inhaled corticosteroids and proper inhaler technique,” Alex D. Federman, MD, MPH, of the division of general medicine in the Icahn School of Medicine at Mount Sinai, and colleagues wrote. “These difficulties arise because of varied psychosocial, cognitive, physical and mental health issues.”

To determine if asthma interventions tailored to individual patient needs improved outcomes, researchers created the Supporting Asthma Self-Management Behaviors in Older Adults, or SAMBA, to screen older adult patients for self-management barriers and target and support the identified barriers.

The researchers conducted a pragmatic randomized clinical control trial of SAMBA from Feb. 1, 2014, to Dec. 31, 2017. Patients aged older than 60 years with uncontrolled, moderate or severe persistent asthma were identified through electronic medical records and called to screen for eligibility. After a baseline interview was conducted, patients were randomized to home-based SAMBA intervention, clinic-based SAMBA intervention or usual care. Analysts and study investigators were blinded to participant assignments.

After barriers were identified and targeted actions were determined, SAMBA interventions were delivered by asthma care coaches at home or in primary care clinics. Asthma care coaches received training on basic asthma pathophysiology, self-management support, communication strategies and SAMBA protocol.

Researchers assessed 1,349 patients for eligibility. Of those, 391 patients with a mean age of 67.8 years were eligible, consented to participate, were randomized and received treatment.

Asthma control test scores were better in the intervention group compared with the control group after 3 months, (difference-in-differences[DD] = 1.2; 95% CI, 0.2-2.2), 6 months (DD = 1; 95% CI, 0-2.1), and 12 months (DD = 0.6; 95% CI, –0.5 to 1.8).

After 12 months, ED visits were lower in the intervention group (16 [6.2%]; P = .03) than the control group (17 [12.7%]; P = .03), with an overall adjusted OR of 0.8 (95% CI, 0.6-0.99).

Those in the intervention group experienced statistically significant improvement compared with the control group in quality of life (overall effect: ² =10.5, with 4 degrees of freedom; P = .01), medication adherence (overall effect: ² =9.5, with 4 degrees of freedom; P =.049) and inhaler technique (median: 75% vs 58%).

There was no significant difference in outcome in those who received intervention at home or in a primary care practice.

“The SAMBA intervention is a promising model of self-management support and disease control for older adults with asthma, and possibly other chronic diseases, though because of lower retention of intervention patients and diminished intervention effects over time, the model should undergo additional refinement and testing before it is widely adopted,” Federman and colleagues wrote. – by Erin Michael

Disclosures: Federman reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.