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Effect of peer led programme for asthma education in adolescents: cluster randomised controlled trial

BMJ 2001; 322 doi: (Published 10 March 2001) Cite this as: BMJ 2001;322:583
  1. Smita Shah (Smita_Shah{at}, directora,
  2. Jennifer K Peat, associate professorb,
  3. Evalynn J Mazurski, research and evaluation officera,
  4. Han Wang, statisticiana,
  5. Doungkamol Sindhusake, statisticianc,
  6. Colleen Bruce, research and evaluation officera,
  7. Richard L Henry, professord,
  8. Peter G Gibson, senior staff specialiste
  1. a Primary Health Care Education and Research Unit, Auburn Hospital and Community Health Services, Auburn, NSW 2144, Australia
  2. b Children's Hospital at Westmead, Westmead, NSW 2145, Australia
  3. c Department of Public Health and Community Medicine, Westmead Hospital
  4. d School of Paediatrics, University of New South Wales, Randwick, NSW 2031, Australia
  5. e Airway Research Centre, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW 2310, Australia
  1. Correspondence to: S Shah, Department of Public Health and Community Medicine, Westmead Hospital, Westmead, NSW 2145, Australia
  • Accepted 1 December 2000


Objective: To determine the effect of a peer led programme for asthma education on quality of life and related morbidity in adolescents with asthma.

Design: Cluster randomised controlled trial.

Setting: Six high schools in rural Australia.

Participants: 272 students with recent wheeze, recruited from a cohort of 1515 students from two school years (mean age 12.5 and 15.5 years); 251 (92.3%) completed the study.

Intervention: A structured education programme for peers comprising three steps (the “Triple A Program”).

Main outcome measures: Quality of life, school absenteeism, asthma attacks, and lung function.

Results: When adjusted for year and sex, mean total quality of life scores showed significant improvement in the intervention than control group. Clinically important improvement in quality of life (>0.5 units) occurred in 25% of students with asthma in the intervention group compared with 12% in the control group (P=0.01). The number needed to treat was 8 (95% confidence interval 4.5 to 35.7). The effect of the intervention was greatest in students in year 10 and in females. Significant improvements occurred in the activities domain (41% v 28%) and in the emotions domain (39% v 19%) in males in the intervention group. School absenteeism significantly decreased in the intervention group only. Asthma attacks at school increased in the control group only.

Conclusion: The triple A programme leads to a clinically relevant improvement in quality of life and related morbidity in students with asthma. Wider dissemination of this programme in schools could play an important part in reducing the burden of asthma in adolescents


  • Funding The Commonwealth Department of Health and Aged Care and Asthma NSW funded this study.

  • Competing interests None declared.

  • Accepted 1 December 2000
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