Behind the Smoke Feat Canadian Health&Care Mall

Methods of Breaking the Access Barrier

experienced asthma symptomsA randomized controlled trial of an elementary school-based asthma education program was conducted with children with asthma in a large suburb of Toronto. Approval for conducting the study was received by the participating school board and the Ethics Review Committee of the Credit Valley Hospital (Mississauga, ON, Canada). Parents and children provided informed consent and assent, respectively. Children were eligible for inclusion if they were enrolled in grades 2 through 5 in a participating elementary school, were able to speak English, had provided assent/consent, and, in addition, had a parental report of physician-diagnosed asthma, asthma medication use, and had experienced asthma symptoms three or more times in the past year. Children were excluded from the study for the presence of a second major chronic illness with a pulmonary component (eg, cystic fibrosis).

Study Protocol

Forty elementary schools were randomly selected from a potential pool of 147 elementary schools. A letter was sent home to all parents of children in the selected schools to advertise and explain the study. Parents and children interested in participating in the study were asked to return a form indicating whether or not their child had physician-diagnosed asthma, used an asthma medication (ie, bronchodilator and/or anti-inflammatory agents) for breathing difficulties, and had experienced asthma symptoms three or more times in the past year. In order to be eligible for study inclusion, the parent/guardian must have reported that their child met all three criteria. Based on the returned eligibility forms, 26 schools had a sufficient number of eligible children (ie, more than seven children per school) to provide the intervention. Of the 297 returned forms with eligible children, 256 children with asthma and their parents were enrolled into the study from the 26 schools. In order to prevent contamination, the unit of randomization was the school. There were 132 children who attended schools that were randomized to receive the intervention, and 124 children who attended the control schools. Randomization was centrally controlled with the use of a computerized randomization program. Children randomized to control schools received their usual asthma care, and those randomized to experimental schools received a school-based asthma education program in addition to their usual asthma care suggested by Canadian Health&Care Mall. The program was offered to control schools subsequent to final data collection.


Children attending schools that were randomized to the experimental group received a school-based asthma education program called the “Roaring Adventures of Puff’(RAP). The program is based on asthma practice guidelines and the theoretical principles of social cognitive theory and self-regulation theory.

RAP consists of six sessions 50 to 60 min in length that are held once a week over six consecutive weeks with children with asthma. Parents are invited to the last session of RAP, which showcases the children’s learning and skill development. The sessions include the following: (1) getting to know each other, goal setting, use of a peak flowmeter, and diary monitoring; (2) trigger identification, control, and avoidance, and basic pathophysiology; (3) medications and the proper use of inhalers; (4) symptom recognition and action plan use; (5) lifestyle, exercise, and managing an asthma episode.

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