Multi-Systemic Therapy Improves High-Risk Asthma Management

Sylvie Naar, PhD

Multi-systemic therapy (MST), a comprehensive family and community-based treatment program, is capable of improving asthma symptoms and lowering hospitalizations in African-American adolescents, according to a recent study.

African-American youth are at greater risk for morbidity and mortality from asthma. This statistic holds even when compared with other minority groups, and increases as socioeconomic status decreases.

Probable contributors include families having fewer resources (particularly in the inner-city), which can result in difficulty handling environmental triggers and asthma management, said lead author, Sylvie Naar, PhD, professor of Behavioral Sciences and Social Medicine and director of the Center for Translational Behavioral Research at Florida State University.

“For this reason, we focused exclusively on African-American teenagers with moderate to severe persistent asthma who experienced inpatient hospitalization or multiple emergency department visits in the previous years,” she said.

MST is an approach that views certain behaviors, such as poor illness management, as a reciprocal exchange between the individual and their environment, such as family dynamics, family-healthcare provider relations, and family-school relations.

“Therapists work with everybody and anybody that the family is involved with around asthma; schools, providers, family, friends, peers,” Naar said.

Subjects for this study included 167 African-American adolescents between 12-16 years with moderate to severe persistent asthma, that had more than 1 inpatient hospitalization or more than 2 emergency department visits in the previous 12 months. They were randomized into 2 groups: those receiving MST and those receiving in-home family support.

Medication adherence was evaluated using the Medication Adherence subscale of the Family Asthma Management System Scale (FAMSS) and the Daily Phone Diary (DPD).

For the MST group, the baseline FEV₁ of 2.05 increased to 2.75 at the 7-month mark, compared to a change from 2.21 to 2.31 for the in-home support group. At 12 months, numbers for MST group showed greater improvement, at 2.37, compared to 2.33 for the in-home support group.

FAMSS adherence scores improved from 4.19 to 5.24 for the MST group and 4.61 to 4.72 in the in-home support group. DPD adherence scores increased from a mean of .33 at baseline to .69 for the MST group, while very little changed for the in-home support group, going from .43 to .46.

The same trend was maintained for the number of hospitalizations and emergency department visits. The MST group had lower hospitalizations in the 12 months post-baseline compared with the in-home support group (β = -0.882; P = .04; incidence rate ratio = 0.414; 95% CI; .175 - .978).

“Pediatricians can advocate for families who are at highest need for access to these kinds of treatment programs so that therapists or community health workers can go into the home and really work with the multiple systems that effect asthma management,” Naar said.

Limitations in this study included a focus only on controller medications when measuring adherence and lack of incorporating environmental controls.

“What we need to do next is evaluate the cost-effectiveness of this intervention and use a more objective measure of asthma management to improve on the study,” Naar said.

The study, “Comprehensive Community-Based Intervention and Asthma Outcomes in African-American Adolescents,” was published online in Pediatrics.