Success of a Comprehensive School-Based Asthma Intervention on Clinical Markers and Resource Utilization for Inner-City Children with Asthma in Chicago: The Mobile C.A.R.E. Foundation's Asthma Management Program

Abstract

Children with asthma in low-income households in Chicago were participants in a school-based mobile van clinic, Mobile C.A.R.E. Our objective was to investigate whether long-term follow-up changed clinical markers and resource utilization. Children were evaluated by a pediatrician in a mobile allergy clinic and classified and treated based on National Asthma Education and Prevention Program (NAEPP) guidelines. Intervention consisted of assessment of allergic environment with avoidance recommendations, institution of appropriate controller therapy and inhaler technique, education on asthma and asthma management, and expectations for asthma control. Over 20,000 children were screened, 2041 were examined at least once, and 677 children had four follow-up visits. With follow-up, there was a decrease in hospitalizations and emergency room visits. Symptomatic markers (daytime and nighttime cough, wheezing, and dyspnea symptoms), frequency of rescue inhaler use, and a quality-of-life score improved from baseline. These findings suggest that ongoing school interventions may reduce resource utilization and improve clinical symptoms. Primary care physicians may be able to deliver specialized care to large numbers of inner-city children with asthma.

Achieving and maintaining asthma control in inner-city children

“…Despite significant improvement in asthma control from program enrollment, maintenance of WCA was highly variable and affected by several factors. [38][39][40][41][42][43][44][45] In our study, adherence to prescribed controller therapy was the most significant factor associated with maintenance of WCA. Comparable findings have been widely reported.…”

Asthma School Program in children and their parents

“…[9] A Chicago study on a school-based asthma intervention investigated long-term follow-up impact on clinical markers and resource utilization. [10] Their fi ndings suggested that in children who had four follow-up visits, clinical symptoms were improved and health care utilization was reduced to the highest degree. Comparisons of the intervention group and non-intervention group showed that the AEI resulted in improved self-esteem and disease control together with gaining better quality of life.…”

Developing, Implementing, and Evaluating a School-Centered Asthma Program: Step-Up Asthma Program

“…Many studies describe successful school-centered interventions, including education for students and parents, 15,16,[21][22][23][24][25][26][27][28] case management, 25,27 enhanced communication with providers, 15,21,26,27 access to providers in school-based health centers 27,29,30 or as consults, 31,32 provision of asthma action plans, 15,23 directly observed therapy, 32,33 and home visits. 27 These programs have shown improvements in asthma control and have different strengths, but many have small numbers and lack sustainability mechanisms.…”