Trivedi Michelle, Spano Michelle, Frisard Christine, Crawford Sybil, Ryan Grace, Goulding Melissa, Radu Sonia, Arenas Juliana, Becker Sarah, Al-Halbouni Layana, Alter Jordan, Byatt Nancy, Phipatanakul Wanda, Rosal Milagros C, Lemon Stephenie C, Gerald Lynn B, Pbert Lori
Division of Pulmonary Medicine, Department of Pediatrics, UMass Chan Medical School, UMass Memorial Children's Medical Center, Worcester, Mass; Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Mass; Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, UMass Memorial Children's Medical Center, Worcester, Mass.
Division of Pulmonary Medicine, Department of Pediatrics, UMass Chan Medical School, UMass Memorial Children's Medical Center, Worcester, Mass.
J Allergy Clin Immunol Pract. 2025 Aug 22. doi: 10.1016/j.jaip.2025.07.022.
Although school-supervised inhaled corticosteroid administration has potential to improve asthma morbidity, there has yet to be an evaluation of the pediatric practice as a setting to identify children with asthma and connect them to school-supervised asthma therapy.
Conduct a pragmatic pilot trial of Asthma Link, a model that connects children with asthma seen in pediatric practice to supervised asthma therapy in the school setting.
Four pediatric practices were pair-matched and randomized to (1) Asthma Link plus an asthma educational workbook or (2) Enhanced Usual Care, the same workbook alone. We recruited children 6 to 17 years old with poorly controlled asthma, prescribed a daily inhaled corticosteroid. Parent-child dyads completed surveys at baseline and 3, 6, and 12 months.
recruitment/retention of pediatric practices and parent-child dyads and intervention fidelity.
asthma symptoms, medication adherence, emergency room visits, hospital admissions, oral steroid use, missed schooldays.
Four pediatric practices and 66 parent-child dyads were recruited (average child age 9 y, 44% female, 65% Hispanic, 23% Black, 62% low income). All (4 of 4) practices were retained throughout the study and retention of parent-child dyads was 95%, 91%, and 89% at 3, 6, and 12 months, respectively. All (31 of 31) Asthma Link families brought their child's preventive inhaler into school; children received school health staff-supervised therapy on more than 95% of schooldays over 12 months. Children in the Asthma Link group had greater improvement in Asthma Control Test scores, longer time to first asthma exacerbation, less oral steroid use, and better medication adherence compared with the Enhanced Usual Care group.
Extending the reach of pediatric practices to facilitate the delivery of daily asthma prevention medication at school was feasible and improved pediatric asthma morbidity.
尽管学校监督下的吸入性糖皮质激素给药有可能改善哮喘发病率，但尚未对儿科诊所作为识别哮喘儿童并使其接受学校监督的哮喘治疗的场所进行评估。
对哮喘联系（Asthma Link）进行一项实用性试点试验，该模式将在儿科诊所就诊的哮喘儿童与学校环境中的监督哮喘治疗联系起来。
将四家儿科诊所配对并随机分为：（1）哮喘联系加一本哮喘教育工作手册，或（2）强化常规护理，即仅提供同一本工作手册。我们招募了6至17岁哮喘控制不佳且每日开具吸入性糖皮质激素处方的儿童。亲子二元组在基线、3个月、6个月和12个月时完成调查。
儿科诊所和亲子二元组的招募/留存情况以及干预保真度。
哮喘症状、药物依从性、急诊就诊、住院、口服类固醇使用、缺课天数。
招募了四家儿科诊所和66个亲子二元组（儿童平均年龄9岁，44%为女性，65%为西班牙裔，23%为黑人，62%为低收入）。在整个研究过程中，所有（4家诊所中的4家）诊所均被保留，亲子二元组在3个月、6个月和12个月时的留存率分别为95%、91%和89%。所有（31个哮喘联系家庭中的31个）家庭都将孩子的预防性吸入器带到了学校；在12个月的时间里，孩子们在超过95%的上学日接受了学校卫生人员监督的治疗。与强化常规护理组相比，哮喘联系组的儿童在哮喘控制测试分数上有更大改善，首次哮喘发作的时间更长，口服类固醇使用更少，药物依从性更好。
扩大儿科诊所的服务范围以促进在学校提供每日哮喘预防药物是可行的，并改善了儿科哮喘发病率。
