Jun 21, 2011


The Behavior Treatment Program for Children with Asthma teaches children skills to discriminate asthma signals and use self-management techniques to address asthma symptoms. It is designed to reduce subjective experiences of asthma symptoms and resulting medication use and school absenteeism. An experimental evaluation of the program using a small sample of children with severe asthma found that it significantly reduced children’s use of beta2 agonist spray and number of absentee days from school, but not the number of days asthma was subjectively experienced. No significant differences were found for objective measures of lung function (PEFR and exhalation frequency) between treatment and control groups.


Target population: Children with asthma

The Behavior Treatment Program is designed to be tailored to each individual child based on an evaluation of the child’s asthma related experiences. The treatment takes place in four one-hour sessions held either in the child’s home or school and is provided in addition to regular medical care. The program involves five components: discrimination training of asthma signals, self-management techniques of breathlessness, counterconditioning of learned fear responses, contingency management of asthma-related behavior, and compliance training.

Discrimination training of asthma signals uses a biofeedback approach to help children discriminate objective asthma symptoms from subjective asthma feelings. This is accomplished by eliciting slight asthma symptoms and having the child blow into a peak expiratory flow rate (PEFR) apparatus to measure airflow obstruction.

The self-control techniques for managing breathlessness taught to children include progressive relaxation, abdominal breathing exercises, and distraction techniques. Children are taught to apply the coping techniques to real-life situations through role-plays and homework assignments.

Counterconditioning of fear responses is accomplished through systematic desensitization of asthma-related stimuli. Children are gradually exposed to fear-inducing stimuli, such as pictures of allergic materials or imitations of social situations. Children who experience social anxiety are provided with social skills training that consists of role-playing, self-control techniques, and assertiveness training.

The contingency-management aspect of the program is designed for children who are “overusers” of hospital facilities in order to gain attention or avoid school. These children are allowed to be admitted as usual, but once admitted are not allowed to leave their rooms, have access to television or comic books, or have social visits from anyone other than their parents. The child also receives all of their missed homework from school. Parents and children are taught to check the PEFR when a child complains of asthma symptoms in the morning and send the child to school if the PEFR shows normal airflow values.

Children are also trained to use appropriate compliance techniques for using spray medications. Compliance training is provided in a step-by-step action program and teaches children to rely on self-control techniques first and to use spray medication as a secondary measure. This training is designed to counteract psychological dependence on spray medication. Children are also desensitized to anxiety-provoking situations relevant to spray medication through imagination techniques, such as imagining the child is stranded on an island without his or her medication.


Daul, J., Gustafsson, D., Melin, L. (1990). Effects of a behavioral treatment program on children with asthma. Journal of Asthma, 27(1), 41-46.

Evaluated population: Twenty children with severe asthma currently using beta2 agonist spray participated in the study. The sample had a mean age of 12 years and consisted of 11 boys and 6 girls.

Approach: All participants were observed during a four-week baseline period. The baseline period measurements included questionnaires on asthma experiences, family characteristics, and school situations; records of medication use, health care consumption, and hospital visits; and daily charts of exhalation frequency, PEFR ratings, daily activities influenced by asthma, subjective experience of asthma symptoms, global rating of general experience, absent days from school, medication use, and other illnesses.

After the four-week baseline, participants were randomly assigned to treatment or control groups. The intervention phase lasted four weeks. Treatment group participants participated in four one-hour treatment sessions tailored to their individual needs. Control group participants maintained care-as-usual. After the four-week intervention period, participants were observed for a four-week follow-up period.

Results: The behavioral treatment program had a statistically significant impact on reducing the number of medication spray doses per day and the number of absentee days from school. There was not a significant difference in the number of days asthma was subjectively experienced between groups and no significant differences were found for objective measures of lung function (PEFR and exhalation frequency).



Daul, J., Gustafsson, D., Melin, L. (1990). Effects of a behavioral treatment program on children with asthma. Journal of Asthma, 27(1), 41-46.

KEYWORDS: Children, Adolescents, Middle School, Males and Females (co-ed), School-based, Home-based, Counseling/Therapy, Health Status/Conditions, Other Physical Health, Attendance

Program information last updated on 6/21/2011.