A pilot school-based health center intervention to improve asthma chronic care in high-poverty schools
Lucy C Holmes, Heather Orom, Heather K Lehman, Stacie Lampkin, Jill S Halterman, Vanessa Akiki, Alicia A Supernault-Sarker, Susan B Butler, Denise Piechowski, Patricia M Sorrentino, Ziqiang Chen, Gregory E Wilding, Lucy C Holmes, Heather Orom, Heather K Lehman, Stacie Lampkin, Jill S Halterman, Vanessa Akiki, Alicia A Supernault-Sarker, Susan B Butler, Denise Piechowski, Patricia M Sorrentino, Ziqiang Chen, Gregory E Wilding
Abstract
Objective: To test the feasibility and effectiveness of a multifaceted intervention administered through school-based health centers (SBHCs) to improve asthma control for children in high-poverty schools with not well controlled asthma.
Methods: Students 4-14 years old with persistent asthma were enrolled from three SBHCs. The centers' advanced practice providers received training on evidence-based asthma guidelines. Students randomized to the intervention received directly observed therapy of their asthma controller medication, medication adjustments as needed by the centers' providers, and daily self-management support. Students randomized to usual care were referred back to their primary care provider (PCP) for routine asthma care.
Results: We enrolled 29 students. Students in the intervention group received their controller medication 92% of days they were in school. Ninety-four percent of follow-up assessments were completed. During the study, 11 of 12 intervention students had a step-up in medication; 2 of 15 usual care students were stepped up by their PCP. Asthma Control Test scores did not differ between groups, although there were significant improvements from baseline to the 7 month follow-up within each group (both p < .01). Both FEV1% predicted and FEV1/FVC ratio significantly worsened in the usual care group (both p = .001), but did not change in the intervention group (p = .76 and .28 respectively).
Conclusions: Our pilot data suggest that a multifaceted intervention can be feasibly administered through SBHCs in communities with health disparities. Despite the small sample size, spirometry detected advantages in the intervention group. Further study is needed to optimize the intervention and evaluate outcomes.
Trial registration: clinicaltrials.gov Identifier: NCT03032744.
Keywords: Pediatrics; children; chronic care model; directly observed therapy; health disparities; health services research; medication adherence; national guidelines; prevention; pulmonary function test; spirometry; treatment.
Conflict of interest statement
Declaration of Interest: The authors report no conflicts of interest.
Figures
![Figure 1:](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8281495/bin/nihms-1710241-f0001.jpg)
![Figure 2.](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8281495/bin/nihms-1710241-f0002.jpg)
Figure 3.
Mean (95% CI) number of…
Figure 3.
Mean (95% CI) number of days per week with daytime asthma symptoms in…
Figure 4.
Mean (95% CI) number of…
Figure 4.
Mean (95% CI) number of nights per month with nighttime awakenings due to…
Figure 5.
Spirometry. Mean (95% CI) FEV…
Figure 5.
Spirometry. Mean (95% CI) FEV 1 % predicted. FEV 1 % predicted significantly…
Figure 6.
Spirometry. Mean (95% CI) FEV…
Figure 6.
Spirometry. Mean (95% CI) FEV 1 /FVC ratio. FEV 1 /FVC ratio significantly…
- School-supervised use of a once-daily inhaled corticosteroid regimen: A cluster randomized trial.Gerald JK, Fisher JM, Brown MA, Clemens CJ, Moore MA, Carvajal SC, Bryson D, Stefan N, Billheimer D, Gerald LB. Gerald JK, et al. J Allergy Clin Immunol. 2019 Feb;143(2):755-764. doi: 10.1016/j.jaci.2018.06.048. Epub 2018 Aug 14. J Allergy Clin Immunol. 2019. PMID: 30118728 Free PMC article. Clinical Trial.
- The effectiveness of school-based family asthma educational programs on the quality of life and number of asthma exacerbations of children aged five to 18 years diagnosed with asthma: a systematic review protocol.Walter H, Sadeque-Iqbal F, Ulysse R, Castillo D, Fitzpatrick A, Singleton J. Walter H, et al. JBI Database System Rev Implement Rep. 2015 Oct;13(10):69-81. doi: 10.11124/jbisrir-2015-2335. JBI Database System Rev Implement Rep. 2015. PMID: 26571284
- A pilot study to enhance preventive asthma care among urban adolescents with asthma.Halterman JS, Riekert K, Bayer A, Fagnano M, Tremblay P, Blaakman S, Borrelli B. Halterman JS, et al. J Asthma. 2011 Jun;48(5):523-30. doi: 10.3109/02770903.2011.576741. J Asthma. 2011. PMID: 21599562 Free PMC article. Clinical Trial.
- Suicidal Ideation.Harmer B, Lee S, Duong TVH, Saadabadi A. Harmer B, et al. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 33351435 Free Books & Documents.
- Development of School-Based Asthma Management Programs in Rochester, New York: Presented in Honor of Dr Robert Haggerty.Halterman JS, Tajon R, Tremblay P, Fagnano M, Butz A, Perry TT, McConnochie KM. Halterman JS, et al. Acad Pediatr. 2017 Aug;17(6):595-599. doi: 10.1016/j.acap.2017.04.008. Epub 2017 Apr 18. Acad Pediatr. 2017. PMID: 28434913 Free PMC article. Review.
- Updates in school-based asthma management.Lowe AA, Onge IS, Trivedi M. Lowe AA, et al. Curr Opin Allergy Clin Immunol. 2023 Apr 1;23(2):119-131. doi: 10.1097/ACI.0000000000000883. Epub 2022 Nov 24. Curr Opin Allergy Clin Immunol. 2023. PMID: 36730215 Review.
- Randomized Controlled Trial
- Research Support, N.I.H., Extramural
- Adolescent
- Asthma* / drug therapy
- Child
- Child, Preschool
- Humans
- Poverty
- School Health Services
- School Nursing*
- Schools
- Students
- ClinicalTrials.gov/NCT03032744
- Full Text Sources
- Other Literature Sources
- Medical
NCBI Literature Resources
The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.
National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
![Figure 3.](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8281495/bin/nihms-1710241-f0003.jpg)
Figure 4.
Mean (95% CI) number of…
Figure 4.
Mean (95% CI) number of nights per month with nighttime awakenings due to…
Figure 5.
Spirometry. Mean (95% CI) FEV…
Figure 5.
Spirometry. Mean (95% CI) FEV 1 % predicted. FEV 1 % predicted significantly…
Figure 6.
Spirometry. Mean (95% CI) FEV…
Figure 6.
Spirometry. Mean (95% CI) FEV 1 /FVC ratio. FEV 1 /FVC ratio significantly…
- School-supervised use of a once-daily inhaled corticosteroid regimen: A cluster randomized trial.Gerald JK, Fisher JM, Brown MA, Clemens CJ, Moore MA, Carvajal SC, Bryson D, Stefan N, Billheimer D, Gerald LB. Gerald JK, et al. J Allergy Clin Immunol. 2019 Feb;143(2):755-764. doi: 10.1016/j.jaci.2018.06.048. Epub 2018 Aug 14. J Allergy Clin Immunol. 2019. PMID: 30118728 Free PMC article. Clinical Trial.
- The effectiveness of school-based family asthma educational programs on the quality of life and number of asthma exacerbations of children aged five to 18 years diagnosed with asthma: a systematic review protocol.Walter H, Sadeque-Iqbal F, Ulysse R, Castillo D, Fitzpatrick A, Singleton J. Walter H, et al. JBI Database System Rev Implement Rep. 2015 Oct;13(10):69-81. doi: 10.11124/jbisrir-2015-2335. JBI Database System Rev Implement Rep. 2015. PMID: 26571284
- A pilot study to enhance preventive asthma care among urban adolescents with asthma.Halterman JS, Riekert K, Bayer A, Fagnano M, Tremblay P, Blaakman S, Borrelli B. Halterman JS, et al. J Asthma. 2011 Jun;48(5):523-30. doi: 10.3109/02770903.2011.576741. J Asthma. 2011. PMID: 21599562 Free PMC article. Clinical Trial.
- Suicidal Ideation.Harmer B, Lee S, Duong TVH, Saadabadi A. Harmer B, et al. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 33351435 Free Books & Documents.
- Development of School-Based Asthma Management Programs in Rochester, New York: Presented in Honor of Dr Robert Haggerty.Halterman JS, Tajon R, Tremblay P, Fagnano M, Butz A, Perry TT, McConnochie KM. Halterman JS, et al. Acad Pediatr. 2017 Aug;17(6):595-599. doi: 10.1016/j.acap.2017.04.008. Epub 2017 Apr 18. Acad Pediatr. 2017. PMID: 28434913 Free PMC article. Review.
- Updates in school-based asthma management.Lowe AA, Onge IS, Trivedi M. Lowe AA, et al. Curr Opin Allergy Clin Immunol. 2023 Apr 1;23(2):119-131. doi: 10.1097/ACI.0000000000000883. Epub 2022 Nov 24. Curr Opin Allergy Clin Immunol. 2023. PMID: 36730215 Review.
- Randomized Controlled Trial
- Research Support, N.I.H., Extramural
- Adolescent
- Asthma* / drug therapy
- Child
- Child, Preschool
- Humans
- Poverty
- School Health Services
- School Nursing*
- Schools
- Students
- ClinicalTrials.gov/NCT03032744
- Full Text Sources
- Other Literature Sources
- Medical
![Figure 4.](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8281495/bin/nihms-1710241-f0004.jpg)
Figure 5.
Spirometry. Mean (95% CI) FEV…
Figure 5.
Spirometry. Mean (95% CI) FEV 1 % predicted. FEV 1 % predicted significantly…
Figure 6.
Spirometry. Mean (95% CI) FEV…
Figure 6.
Spirometry. Mean (95% CI) FEV 1 /FVC ratio. FEV 1 /FVC ratio significantly…
![Figure 5.](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8281495/bin/nihms-1710241-f0005.jpg)
![Figure 6.](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8281495/bin/nihms-1710241-f0006.jpg)
Source: PubMed