Taking Asthma Care to School: Improving Treatment, Reducing Hospital Visits, and Closing Health Disparities Gaps

Millions of American children live with asthma, a condition in which inflamed airways make breathing hard. Daily preventive inhalers, called controller medicines, work well and most insurance plans cover them, yet many children are undertreated. Missed doses, poor inhaler technique, ongoing exposure to triggers and infrequent follow-up care leave their asthma poorly controlled. These problems fall hardest on children from historically marginalized communities, and schools can play a crucial role in helping.

Professor Kimberly Arcoleo of Michigan State University evaluated a school-based asthma therapy program in everyday practice. She worked with Musmulyono Musmulyono and Alli Walsh, also of Michigan State University; Dr. Colleen McGovern of the University of North Carolina Greensboro; Dr. Elizabeth Allen and Dr. Mary Kay Irwin of The Ohio State University and Nationwide Children’s Hospital; Ian Dela Cruz of Nationwide Children’s Hospital; Dr. Katia Noyes of the University at Buffalo; Dr. Peter Veazie, Dr. Holly McGregor and Dr. Jill Halterman of the University of Rochester; and Dr. Samantha Harden of Virginia Tech. The work is published in the peer-reviewed journal, Journal of Allergy and Clinical Immunology: Global.

Under the program, which runs in Columbus, Ohio, a school nurse gives children with persistent asthma their daily controller medicine in person, a practice called directly observed therapy. A dedicated program nurse links school nurses, families, pharmacies and the child’s doctor. Professor Arcoleo’s team reviewed the medical records of hundreds of children from the city’s largest school districts, comparing each child’s year before enrollment with the year after. Asthma control was rated through a standard questionnaire and by health care providers, and asthma-related emergency and clinic visits, hospital stays and intensive care admissions were tallied.

Well-controlled asthma became significantly more common on both measures. Emergency visits and hospital stays each fell by about half, urgent care and office visits also declined significantly, and intensive care admissions dropped even more steeply. Better control and fewer emergency visits were seen in every age group and in both boys and girls.

Professor Arcoleo’s study is the first real-world evaluation of the program to examine results by age, sex, race and ethnicity. Before enrollment, the questionnaire showed Black and Latino children were less likely than White children to have well-controlled asthma. Afterwards, every group improved, Black and Latino children showed the largest gains in asthma control, and Black children had significant drops in every type of visit and admission measured. “Our results indicate that the program is highly effective in improving children’s asthma outcomes in a real-world setting, and we demonstrated progress in narrowing the health disparities gap for historically marginalized children with asthma,” explained Professor Arcoleo.

To confirm that the program, rather than other hospital initiatives, drove these changes, the researchers compared enrolled children with a matched group from the same hospital who never took part. Only children in the program showed significant decreases in emergency visits and intensive care admissions. Early cost estimates also suggest the program could significantly reduce overall health care costs.

Professor Arcoleo pointed to the setting as key. “The program has the potential to be high impact because school-based programs can reach children at highest risk for asthma illness and optimize their care in the setting where they spend most of their week, regardless of their contact with the health care system,” she said. Earlier trials showed the approach works under research conditions; Professor Arcoleo’s study shows it also succeeds in everyday practice.

The program could serve as a model for improving asthma care, reducing illness and closing the health disparities gap for marginalized children, many of whom have limited contact with the health care system. Wider adoption will depend on giving schools, especially in low-resource communities, the training and support to offer it. “This model could be adapted to other pediatric chronic conditions to support optimal health and academic success for these children,” concluded Professor Arcoleo.