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Evidence-Based Journal Club
May 2004

Interpreting Subgroup Analyses: Is a School-Based Asthma Treatment Program's Effect Modified by Secondhand Smoke Exposure?

Author Affiliations


Arch Pediatr Adolesc Med. 2004;158(5):469-471. doi:10.1001/archpedi.158.5.469

Halterman et al1 present a randomized controlled trial (RCT) of a school-based asthma treatment program in this issue of the ARCHIVES. The authors enrolled 184 children with asthma 3 to 7 years of age from 1 school district. Children were identified via a school health form and were eligible for enrollment if at least mild persistent asthma was confirmed and the primary care physician (PCP) agreed with the need for daily inhaled steroids. After obtaining consent from the family and PCP and completing a baseline assessment, eligible children were randomized to the school-based intervention or control group. In both groups, parents and PCPs were notified of the child's asthma severity. On weekdays, school nurses administered study-provided inhaled steroids to the intervention group children; a second steroid inhaler was given to families for home use on nonschool days. Inhaled steroids were recommended but neither provided nor directly administered in the control group. Family report of the number of symptom-free days during the previous 2 weeks was the primary outcome measure. Halterman et al1 found no difference between the intervention and control groups in the primary outcome but did find statistically significant differences in 2 secondary outcomes. Stratification by secondhand smoke exposure resulted in statistically significant differences on multiple measures, all favoring the intervention.