The prevalence of asthma among children living in rural settings may be as high as 13%, and many of these children and their families have limited access to health care and a poor understanding of asthma medications or preventive strategies. To assess the impact of an asthma-education program, researchers randomized 221 elementary school children living in rural Maryland into either a standard asthma-education program (consisting of a newsletter and, at the end of the study, a resource guide) or an interactive intervention program.

All children and parents completed baseline assessments; data gathered included their knowledge of asthma, scores on self-efficacy and quality-of-life scales, and reports of symptoms and use of health care and medication. Children in the intervention group (n = 130) received instruction from an asthma educator, including information about anatomy, medications, warning signs of an attack, using a peak flow meter and a metered dose inhaler, and environmental factors that could trigger or exacerbate an attack. The children also received an asthma coloring book. Their parents attended a similar program.

At the end of the school year, retesting showed that children in the education program had a significant decline in asthma symptoms and an increase in self-efficacy from baseline, and the younger children also displayed greater knowledge of asthma, as did parents, especially in the use of medications and peak flow meter.

The study's lead author, Arlene Butz, says that "two-thirds of children experienced frequent coughing," yet their parents reported that the quality of their lives was better. She says that may mean that "quality of life" has different meanings in rural settings. "Rural families may perceive health as the ability to work, because their primary focus may be independence and self-reliance," she adds. "Consequently, asthma symptoms in children may be tolerated for a longer period in rural families-as long as the child can work or attend school."

Butz A, et al. J Asthma 2005;42(10):813-21.