Noreen Clark, PhD Molly Gong, MD Julie Dodge, MS Sijian Wang, M.S. Xihong Lin, PhD William Bria, MD Timothy Johnson, MD University of Michigan School of Public Health Supported by NHLBI grant 1 R18 HL60884 Long Term Effect of A self-Regulation Education on Inhaled Anti- Inflammatory Medicines and Short- Acting Bronchodilator

BACKGROUD Inhaled anti-inflammatory medicines are suggested for disease control in asthma patients (NAEPP). Increasing use of short-acting bronchodilators indicates inadequate control of the disease (NAEPP).

PURPOSE To examine and evaluate the effectiveness of a self- regulation telephone counseling intervention for women with asthma on medication use in a randomized clinical trail.

METHODS Recruitment Women 18 years and older Physician diagnosis Attending University of Michigan Asthma & Airways Clinic and University of Michigan Health System

Data Collection Telephone interview Demographics Asthma symptoms Health care utilization Gender-related management Peak flow meter use

Study Sample Baseline 808 Follow up I* 608 Follow up II**580 One year subsequent to baseline data collection One year subsequent to follow up I data collection

Demographics: Age

Demographics: Education

Demographics: Income

Demographics: Race/Ethnicity

Intervention  Subsequent to baseline data collection, women were randomly assigned to either the control or the intervention group.  Women in the intervention group received the self-regulation telephone counseling intervention: Women Breathe Free.

Data Analyses To examine: 1. Relationships between demographics vs. Medication use at baseline: Frequencies with Odds Ratio 2. Program effects on medication use: Generalized Estimating Equations (GEE) with logit link using entire sample (intent-to-treat)

FINDINGS Asthma Severity Classified by NAEPP criteria, Guidelines and Diagnosis and Treatment of Asthma, 1997 Percent of Women Mild intermittent52% Mild persistent15% Moderate persistent20% Severe persistent13%

Demographics and Lower Use of Inhaled Anti-Inflammatory Medications ORP-value Age <50 years13.8<.002 Lower education3.9<.05 Minority7.9<.005

Program Effects on Medication Use 1.Inhaled non-steroid use increased more in the 12 month follow up perceived in the treatment group (p=.09).

2. Significantly more reduction to use short-acting bronchodilators at 24 month follow up in treatment group (p=.05)

CONCLUSIONS A. Women of lower education and younger age used less inhaled anti inflammatory medicine B. The intervention improved medicine use over the evaluation period