ABSTRACT
We examined the effects of a combined education and token system intervention to improve adherence to inhaled corticosteroids for an 8-year-old girl and a 10-year-old boy with asthma. Adherence was measured by an electronic chronolog monitor, and disease outcome was assessed by repeated pulmonary function testing. A withdrawal design demonstrated improved adherence and, for 1 child, an associated improvement in pulmonary function occurred. Methodological and clinical implications are discussed, including variables other than adherence that may affect disease outcome.
Subject(s)
Asthma/drug therapy , Behavior Therapy , Child Behavior , Patient Compliance/psychology , Patient Education as Topic/methods , Token Economy , Behavior Therapy/methods , Behavior Therapy/standards , Child , Female , Humans , Longitudinal Studies , Male , Respiratory Function Tests , Self Administration/methods , Self Administration/psychology , Treatment OutcomeABSTRACT
Rush Immunotherapy (IT) was given to 13 children with asthma, positive skin tests (ST), bronchial provocation tests (BPT) and compatible histories. ST was done by prick or intradermal technique, using commercially available antigens (Ag). BPT was done after an eight-hour medication hold for oral bronchodilators (BD) and four hours for inhaled BD. A Fisons/Vaponephrine nebulizer with an air compressor was used to deliver the Ag. A persistent 25% decrease in peak expiratory flow rate was considered a positive test. Rush IT consisted of four Ag dilutions: 10, 100, 1000 and 5000 pnu/ml. The maintenance dose of 0.5 ml of the 5000 pnu/ml solution was achieved in from seven to 18 weeks (mean 12 weeks). The total cumulative dose of Ag ranged from 3000--14000 pnu (mean 7200 pnu) when the BPT was repeated. Two patients had mild wheezing post-injections and rush IT was discontinued; one of these was later restarted and tolerated the IT well. Three were discharged from the Center prior to repeat BPT. Nine completed the protocol to a total of 14 Ags. One had increased bronchial sensitivity (BS) to both Ags tested. One had no change in BS. Seven subjects had decreased BS on 11 post-rush IT BPTs, four by an unknown degree as the BPT was negative on re-challenge. The mean pre-rush IT BPT was positive at 900 pnu (range 190--2200 pnu); the mean post-RI BPT was positive at 2600 pnu (range 20--7200 pnu). Five patients who had repeat BPT's to the same Ag without IT served as controls. The results showed that (1) Rush IT is a safe and effective method of IT and (2) a marked change in BS can be achieved rapidly and after a relatively low administered dose of Ag in a majority of patients.
