The Breathmobile™: A Novel Comprehensive School-Based Mobile Asthma Care Clinic for Urban Underprivileged Children

Abstract

Urban minority children have higher rates of asthma morbidity due to multiple factors. Many school-based programs have been funded to improve asthma management, especially for these "high-risk" inner-city children with asthma. Here we report the outcomes of the Children's Hospital of Orange County Breathmobile program, which is a school-based asthma program that combines the use of a mobile clinic and a pediatric asthma specialist. Baseline evaluations included a detailed history and physical, skin prick test to common allergens, spirometry measurements, and asthma severity classification based on the current National Asthma Education and Prevention Program guidelines. From April 2002 to September 2005, a total of 1321 children were evaluated for asthma. Analysis of the 1112 (84%) children diagnosed with asthma showed a population mean age of 7.8 years, 81% Latino ethnicity, and 73% with persistent disease. At baseline, only 24% of children with persistent asthma were on daily anti-inflammatory medications, which increased to 78% by the first follow-up visit. In the year prior to entry into the program, 64% had school absenteeism related to asthma (38% >10 days), 45% had emergency room (ER) visits (28% >1), and 19% had hospitalizations (9% >1). There was a significant reduction (p < .001) in the annual rates of ER visits, hospitalizations, and school absenteeism when comparing pre- and postentry into the program. These data suggest that a mobile asthma van clinic at the school site with an asthma specialist could be an effective model in reducing morbidity in the underserved child with asthma. Further studies are necessary to determine whether this model is applicable to other inner-city settings.

School-based asthma programs

“…32 An alternative strategy has been to provide a mobile medical van that on a regular schedule brings health care providers, examination space, and medical supplies to the school so that students may receive diagnostic and treatment services with scheduled follow-up visits. Two studies have shown that comprehensive asthma care provided through mobile vans reduced hospitalizations and ED visits, 33,34 symptoms and rescue inhaler use, 33 and school absences. 34 Another strategy involves a partnership among school staff, health care providers, and parents to identify students who need daily therapy and have shown or are at risk for poor compliance, and provide supervised daily controller therapy at the school.…”

“…Two studies have shown that comprehensive asthma care provided through mobile vans reduced hospitalizations and ED visits, 33,34 symptoms and rescue inhaler use, 33 and school absences. 34 Another strategy involves a partnership among school staff, health care providers, and parents to identify students who need daily therapy and have shown or are at risk for poor compliance, and provide supervised daily controller therapy at the school. Because adherence to asthma treatment regimens is typically below 50%, it is an important factor in morbidity.…”

Community-Based Approaches to Controlling Childhood Asthma

“…Ongoing control, however, was not constant and varied significantly across all levels of asthma severity. Liao et al (61) showed that subsequent to receiving ongoing care in a mobile unit, participating children had significant declines in their annual rate of visits to an emergency department and/or hospitalization. School absences also declined.…”

Recurrent Chronic Cough, Wheeze and their Control without Corticosteroids in 1 to 5 Year-old Children

“…On the one hand, asthma at these ages is frequently overlooked and sometimes undertreated [2,3]. Wheezy patients often become in remission, however, the lung function in children with persistent wheeze becomes reduced by age 6 in several cases [1][2][3].…”

“…L-Carbocystein was also used for proper mucociliary clearance to prevent infectious processes, sinusitis and/or bronchitis [3].…”