School-Based Asthma Care Research Articles

Addressing critical barriers for sustainability of asthma stock inhaler policy implementation and resultant programming

BackgroundAsthma is a prevalent health concern among Illinois (IL) children, and management is significantly influenced by social determinants. There were 17 states who have adopted stock inhaler laws, but implementation varies widely. ObjectiveTo assess critical barriers to implementation and address sustainability of stock inhaler programming in school-based asthma care in IL. MethodsSemistructured interviews were conducted with high asthma burden school districts in IL to assess barriers in implementing stock inhaler policies and resultant programming. Thematic analysis was performed using Atlas.ti (Scientific Software Development GmbH, Berlin, Germany) to identify and code “threats” to future sustainability. Data were synthesized and presented to stakeholders for barrier mitigation. A schematic flowchart outlining steps to support sustainability was created. ResultsA total of 18 interviews were conducted with key community partners across 8 IL school districts, representing rural, urban, and suburban areas. Analysis revealed 25 barriers, with several identified as “threats” to future sustainability, including liability concerns, follow-up care assurance, funding/resources, pharmacy dispensing practices, district-level readiness to change, and nurse staffing. Stakeholders formed a statewide coalition to address these barriers, increase awareness, plan evaluations, and advise on state funding allocation. A national stock inhaler toolkit tailored to school administrative needs was developed to support sustainability efforts. ConclusionStrategic stakeholder and community engagement are vital for establishing and sustaining stock inhaler programs that adhere to policy mandates. Many districts face challenges initiating and maintaining such programs without critical barrier mitigation and support. Collaborative solutions are necessary to ensure effective school-based asthma management and mitigate persistent pediatric asthma health disparities.

Adolescent Knowledge of When to Use Inhaled Asthma Medications: Implications for Management

PurposeIt is unclear how often adolescents with persistent asthma know when to use different inhaled medications (as-needed rescue vs. daily controller; ‘accurate use’), or whether this knowledge is associated with clinical asthma outcomes. This study aimed to characterize adolescent knowledge of accurate use; examine whether accurate use is associated with controller medication adherence, asthma symptoms, or exacerbations requiring acute health care services; and determine whether knowledge of accurate use improves following regular exposure to controller medications with school-based directly observed therapy (DOT). MethodsWe analyzed baseline and 7-month data from the School-Based Asthma Care for Teens trial. Adolescents (12–16 years) identified inhaled medications on a chart and stated when each is used. We compared accurate use with adolescent-reported adherence, recent symptoms, and asthma-related acute health care visits; and exposure to DOT. Analyses were limited to subjects with controller medication. ResultsOf 430 participants, 252 had controller medication at baseline. Knowledge of accurate use was described by 62%, and associated with adherence (odds ratio [OR]: 2.06, 95% confidence interval [CI]: 1.12–3.83). By 7 months, 313 adolescents had controller medication; 75% described accurate use, which was associated with adherence (OR: 3.46, 95% CI: 1.83–6.54), health care (OR: 0.39, 95% CI: 0.20–0.79), and DOT exposure (OR: 1.83, 95% CI: 1.10–3.32). Associations with adherence and health care at 7 months persisted in adjusted analyses. DiscussionAdolescent knowledge of accurate medication use was linked with greater adherence (baseline, 7 months), less acute health care (7 months), and exposure to in-school DOT. Interventions to support adolescents with persistent asthma should consider school-based care strategies and facilitate adolescent understanding of when to use different medications.

Analysis of school-based asthma screenings and need for care coordination in underserved urban communities

BackgroundAsthma is one of the most common chronic childhood disease states in the United States and continues to become more prevalent. Data suggest the incidence, morbidity, and mortality of asthma are higher among minority children of lower socioeconomic status living in urban settings. There is a lack of data evaluating the impact of mass school-based asthma screenings and care coordination in underserved communities. ObjectiveThis study aimed to determine whether a school-based asthma screening program is effective in identifying children who are at risk of undiagnosed and uncontrolled asthma and whether there is a need for care coordination. MethodsThis study is a retrospective review describing the outcomes of the 2021 school-based asthma screening program. Asthma screening data from 6 participating school districts (prekindergarten to twelfth grade) in the greater Pittsburgh area were included in this review. An asthma screening questionnaire was distributed school-wide and included questions about demographics, previous asthma diagnosis, repeated episodes of asthma, and frequency of symptoms. Based on caregiver-reported answers, children who screened positive for previously diagnosed asthma, uncontrolled asthma, or undiagnosed asthma received care coordination for follow-up care. ResultsThis study included asthma screening results for 561 participants. Approximately 13% of participants (n = 73) displayed asthma symptoms but did not have a diagnosis of asthma. Of those 73 participants, 9.6% (n = 54) were at risk of uncontrolled asthma. The screening tool also identified 5.6% of participants (n = 32) who had a diagnosis of asthma and were at risk of uncontrolled asthma. ConclusionsThe school-based asthma screening program was effective in identifying children at risk of undiagnosed and uncontrolled asthma. Pharmacists are well positioned to implement asthma screening programs in schools and throughout the community.

Self-Determination Theory and Preventive Medication Adherence: Motivational Considerations to Support Historically Marginalized Adolescents With Asthma

Using self-determination theory, we explored relationships between autonomous motivation (AM) and perceived competence (PC) with previously validated measures of motivation and adolescent-reported asthma medication adherence. Data were from adolescents (n=260) enrolled in the School-Based Asthma Care for Teens study and taking preventive medication at baseline. Eligible adolescents (aged 12-16 years) had physician-diagnosed persistent asthma or poor control. Adolescents taking daily preventive medicine reported higher AM and PC for adherence, whereas adolescents likely to miss ≥1 dose in the next 2 weeks had lower AM and PC. Adolescents taking medicines as prescribed, with plans to continue, and those feeling able to follow provider care plans, had higher AM and PC. Findings remained significant in regressions with control variables. Many factors interfere with adolescent medication-taking. Clinicians' efforts to build AM and PC with patients and caregivers may be key to promoting adherence in this group.

Food Allergy in At-Risk Adolescents With Asthma: A Key Area for Focus

To determine the prevalence of food allergies (FAs) in adolescents with persistent asthma and see whether concurrent FAs contributed to asthma morbidity.In the study, the researchers included 342 adolescents (12–16 years) with severe asthma who attended the Rochester City School District and participated in the School-Based Asthma Care for Teens (SB-ACT) trial from 2014 to 2018.The parent trial, SB-ACT, aimed to decrease asthma morbidity by directly observing asthma medication administration in the Rochester City School District to high-risk adolescents identified as having persistent symptoms or poor control. Additionally, an 18-item FA questionnaire was also administered to the participants and caregivers that assessed a history of physician-diagnosed FAs versus self-reported FAs, foods in question, status of allergy (current or previous), and whether diagnostic testing of FA (skin test, blood tests, or food challenges) was performed.A total of 101 (29%) respondents reported FAs, with shellfish being the most common (38%), followed by peanut (34%) and tree nut (30%). A total of 58% of the adolescents did not have an epinephrine autoinjector (EAI), and only 13% reported carrying their EAI daily. There was no statistically significant difference in the mean asthma symptom-free days in patients with and without FA, but those patients with FA had a higher fractional excretion of nitric oxide. In a linear regression analysis, adolescents with FAs had more days of activity limitation in a 2-week period because of asthma and a higher odds of missing school attributed to asthma than those without a FA did.FAs are commonly found in adolescents with severe asthma and can lead to negative impacts on their quality of life, including increased activity limitations as well as missed days of school. Less than one-half of this cohort with FA had access to an EAI, which may increase near fatal outcomes.In this study, the authors highlight the need to screen adolescents with severe asthma for other atopic diseases, including FAs, to minimize adverse outcomes. Adolescents are at higher risk for fatal food-induced anaphylaxis when they have asthma and if epinephrine administration is delayed. Therefore, it is of utmost importance to not only screen for FAs in this population but ensure both prescriptions for and counseling of proper use of an EAI to avoid adverse outcomes.

Effect of the School-Based Asthma Care for Teens (SB-ACT) program on asthma morbidity: a 3-arm randomized controlled trial

Urban adolescents with asthma often have inadequate preventive care. We tested the effectiveness of the School-Based Asthma Care for Teens (SB-ACT) program on asthma morbidity and preventive medication adherence. Methods: Subjects/Setting- 12-16yr olds with persistent asthma in Rochester, NY schools. Design- 3-group randomized trial (2014-2019). SB-ACT Intervention- Two core components: 1) Directly observed therapy (DOT) of preventive asthma medications, provided in school for at least 6-8 weeks for the teen to learn proper technique and experience the benefits of daily preventive therapy; 2) 4-6 weeks later, 3 sessions of motivational interviewing (MI) to discuss potential benefits from DOT and enhance motivation to take medication independently. We included 2 comparison groups: 1) DOT-only for 6-8wks, and 2) asthma education (AE) attention control. Masked follow-up assessments were conducted at 3, 5, and 7mos. Outcomes- Mean number of symptom-free days (SFDs)/2 weeks and medication adherence. Analyses- Modified intention-to-treat repeated measures analysis. Results: We enrolled 430 teens (56% Black, 32% Hispanic, 85% Medicaid). There were no group differences at baseline. We found no difference in SFDs at any follow-up timepoint. More teens in the SB-ACT and DOT-only groups reported having a preventive asthma medication at each follow-up (p<.001), and almost daily adherence at 3 and 5-months (p<.001, p=.003) compared to AE. By 7 months there were no significant differences between groups in adherence (p=.49). Conclusion: SB-ACT improved preventive medication availability and short-term adherence but did not impact asthma symptoms. Further work is needed to create developmentally appropriate and effective interventions for this group.

Health-related internet use among adolescents with uncontrolled persistent asthma

Objectives To describe internet use for health information among adolescents with uncontrolled persistent asthma, and to examine whether health-related internet use is associated with responsibility for home asthma management. Methods We analyzed baseline data from the School-Based Asthma Care for Teens (SB-ACT) Trial, which included adolescents (12–16 years) in an urban school district who had uncontrolled persistent asthma per caregiver report. We asked adolescents whether they had ever used the Internet to look for health or medical information (Y/N). Teens then described family responsibility for 9 asthma management tasks (e.g. full caregiver responsibility, shared responsibility, or full teen responsibility). We examined responsibility sum scores in addition to responsibility for individual management tasks. We used bivariate and multivariate analyses to compare health-related internet use with participant characteristics, teen-reported asthma symptoms, and management responsibility. Results We examined data for 425 adolescents (mean age 13.4 years). Almost half (45%) reported seeking health information on the Internet. In adjusted analyses, health-related internet use was strongly associated with teen responsibility (sum score and tasks relating to carrying and using medications); internet use was also more likely among teens who were older, female, or reported uncontrolled disease. Conclusions Adolescents with persistent asthma who share responsibility for home management or report uncontrolled disease are more likely to seek health information online. Future interventions to support teens who co-manage asthma should work to engage patients in both clinical and digital spaces, and ensure that all patients can access accurate, patient-centered asthma information when needed.

Food allergy in at-risk adolescents with asthma: A key area for focus

BackgroundAsthma affects more than 6.2 million children in the United States and is a major source of chronic disease burden. Concurrent food allergy (FA) may be a risk factor for worse asthma outcomes. ObjectiveTo estimate the prevalence of FA among a cohort of adolescents with persistent asthma and assess whether FA is an independent risk factor for asthma morbidity. MethodsWe included 342 adolescents aged 12 to 16 years with persistent asthma from the Rochester city school district who participated in the School-Based Asthma Care for Teens trial between 2014 and 2018. Multivariable models were used to estimate the association between FA and asthma morbidity. ResultsOverall, 29% of adolescents with asthma reported having a FA. Although there were no statistically significant differences in daytime asthma symptoms, teens with FA had higher fractional exhaled nitric oxide (47.5 vs 33.9 P = .002) and reported more days with activity limitation owing to asthma (3.1 vs 2.3 days/2 weeks, P = .03) compared with teens without FA. Less than half (42%) of adolescents with FA had an epinephrine autoinjector. ConclusionThis study found FA to be common among this cohort of adolescents with asthma. Although FA was not related to asthma symptom severity, adolescents with FA had higher fractional exhaled nitric oxide and more activity limitation, and most did not have epinephrine autoinjectors. A history of FA and lack of epinephrine autoinjector may increase near-fatal outcomes in adolescents with asthma. Preventive measures in addition to standard asthma treatments are warranted for these teens.

Building Bridges for Asthma Care: Reducing School Absence for Inner-City Children With Health Disparities

To assess the effect of a school-based asthma care program on improving school attendance and asthma control.Researchers in this study included children ages 5 to 14 years in 28 schools within the Denver and Hartford public school systems who were managed for 2 consecutive school years.Students were identified by using school health and medication authorization forms; risk was assessed by using the Asthma Intake Form, which used self-reported criteria such as emergency department or hospital visits, oral steroid requirement, school absenteeism, and markers of uncontrolled asthma. Students and their caregivers received targeted case management, including asthma education, inhaler training, regular school nurse visits, assessment of asthma control, and coordination with primary care. The control group consisted of matched children who did not participate in the program. The primary outcome was rate of absences; secondary outcomes included rescue inhaler use and Asthma Control Test (ACT) scores.Of the 2178 students who were identified as having asthma, 1390 returned an Asthma Intake Form, and 781 met high-risk asthma criteria. A total of 463 high-risk students were enrolled in the Building Bridges for Asthma Care Program, 292 declined to participate, and 26 were lost to follow-up. The majority of Building Bridges program participants were Hispanic (69.5%) or black (20.5%); 59% were boys. Participants experienced a 22% absolute decrease in school absenteeism, which equates to 5.5 additional days of school attendance per student per year. Likewise, the number of children with ACT scores of less than the control threshold of 20 decreased from 42.7% to 28.8%. Bronchodilator use >2 times per week decreased from 35.8% to 22.9%, and ACT scores improved in 37.4%. School nurses spent ∼120 minutes per week implementing the program.School-based interventions with an emphasis on school nurse involvement can both reduce school absenteeism and improve asthma control by coordinating care with children, their caregivers, and clinicians. Time spent by school nurses in program implementation was manageable and may be justified by time saved in acute asthma management. Limitations of the study include nonrandomized selection of controls and lack of data regarding the actual reason for school absences.This study highlights how school-based asthma management programs can improve asthma control and reduce school absenteeism with the potential for far-reaching impact. Broad application of such programs should be considered.

Considering the Control Group: The Influence of Follow-Up Assessments on Asthma Symptoms

ObjectiveIt is unclear whether research participation effects contribute to an improvement in asthma symptoms during clinical trials in the absence of any active intervention. We examined the impact of additional follow-up surveys on caregiver-reported symptoms among control subjects in a series of randomized controlled asthma trials. MethodsWe analyzed baseline and follow-up data for children (3–10 years) with poorly controlled persistent asthma that participated as control subjects in 1 of 3 randomized trials of urban school-based asthma care (study duration: 7–10 months). We compared mean symptom-free days (SFD) per 2 weeks between baseline and final follow-up; performed bivariate regressions to explore associations between demographics and changes in SFD; and performed multivariate random-effects generalized least square regression to examine the relationship between number of follow-ups beyond baseline (range: 1–10) and changes in SFD over time. ResultsFive hundred and sixteen children were enrolled as controls across the 3 trials (mean age 7.5 years, 61% Black, 28% Hispanic, 81% Medicaid). Mean SFDs increased significantly from baseline to final follow-up (7.8–11.4 days, P < .001). In adjusted analyses, significant improvements in SFD were observed with all follow-up contacts in comparison with baseline. Symptom improvement showed a dose-response relationship with the number of follow-up assessments completed (1, 2–3, 4–5, and 6–10 assessments). ConclusionsChildren with uncontrolled asthma who participate as controls in clinical trials experience a significant increase in SFD with additional follow-up assessments. This improvement should be considered when designing/analyzing asthma interventions, and may help guide clinical outreach efforts for underserved children with persistent asthma.

Comparing inhaled medications reported by adolescents with persistent asthma and their caregivers

Objectives: To compare concordance (agreement) between teens with persistent asthma and their caregivers on the reported number of inhaled asthma medications used (rescue and controller); examine concordance specific to controller medications; and determine whether concordance over controller medications within caregiver/teen dyads is associated with demographics or clinical outcomes.Methods: We used baseline data from the School-Based Asthma Care for Teens (SB-ACT) trial in urban Rochester, NY. Caregivers and teens (12–16 yrs.) with poorly controlled persistent asthma separately reported the teens’ inhaled therapy, and could name up to two rescue and two controller medications. We compared the total number of medications and number of controller medications reported by each dyad member with Cohen’s Kappa, and assessed whether concordance over the number of controller medications was associated with demographics, symptoms, or healthcare utilization using chi-square and t-tests.Results: Of 210 dyads (79% public health insurance, 61% Black teens), 132 (63%) were disconcordant in reporting the overall number of inhaled medications. Teens or caregivers from 173 dyads (82%) reported any controller medication; however, a majority (61%) were discordant in the reporting of controller medications. Compared with concordant dyads, fewer caregivers from dyads with controller medication discordance reported education past high school (35% vs. 51%, p = 0.04); no other differences in demographics, symptoms, or healthcare utilization were identified based on controller medication concordance.Conclusions: Most dyads identified different numbers of inhaled medications, with substantial disagreement over controller medications. Working to ensure a basic understanding of treatment plans may promote successful self-management in persistent childhood asthma.

Asthma management in school: parents’ and school personnel perspectives

Objective: Effective asthma management at school can help students with asthma stay healthy, learn better and participate fully during their school day. This study sought to understand school-based asthma care from the perspective of parents and school personnel to improve asthma care at school. Methods: A cross-sectional study was conducted in Hartford, CT. School personnel from 59 schools and 322 parents/guardians were invited to participate. Four cross-sectional surveys using Likert-type scales assessed parental and school personnel satisfaction, confidence in managing asthma, policy awareness, management of asthma during physical activity, and perceived gaps surrounding school-based asthma care. Results: 263/322 (82%) eligible parents of children with asthma (mean age 8.5 ± 4.3, 56% Hispanic, 30% African American) completed surveys. Thirty six school nurses (62%), 131 teachers (8%), 14 coaches (14%), and 17 school principals (29%) participated. 90% of parents were satisfied with asthma management in school. School nurses were more aware of asthma policies than teachers (74% vs. 24%, p < 0.001). 34% of school nurses, 30% of teachers and 36% of coaches were unaware of asthma-related absences. 14% of physical education teachers/coaches reported no asthma training. Conclusion: In this convenience sample of parents and school personnel, parents reported overall satisfaction regarding the asthma care their children receive at school, yet a number of gaps pertaining to school-based asthma care were identified. Increased asthma training and enhanced communication among school personnel is needed to address these gaps. National guidelines and resources are readily available to improve asthma care at school.

Depressive Symptoms Among Urban Adolescents with Asthma: A Focus for Providers

ObjectivesAsthma is the most common chronic disease of childhood in the United States, disproportionately affecting urban, poor, and minority children. Adolescents are at high risk for poor asthma outcomes and for depressive symptoms. The purpose of this study is to investigate associations between depressive symptoms and asthma-related clinical and functional outcomes among urban teens. MethodsWe used baseline data from a 3-arm randomized trial, School-Based Asthma Care for Teens, in Rochester, NY. We used the Center for Epidemiological Studies Depression Scale with a standard cutoff score of 16 to identify subjects at risk for clinical depression. We used structured in-home surveys and validated scales to assess clinical and functional outcomes and conducted bivariate and multivariate analyses to evaluate differences between groups. ResultsWe identified 277 eligible teens (ages 12 to 16, 80% participation, 54% black, 34% Hispanic, 45% female, 84% on Medicaid). Overall, 28% reported depressive symptoms. Teens with depressive symptoms experienced greater asthma symptom severity and more acute health care utilization for asthma (all P < .001); however, there was no difference in preventive care use between groups. Teens with depressive symptoms also reported lower asthma-related quality of life (P < .001), less sleep (P < .001), and more limitation in mild (adjusted odds ratio [aOR], 2.60; 95% confidence interval [CI], 1.34–5.02) and moderate (aOR, 2.56; 95% CI, 1.41–4.61) activity and in gym (aOR, 2.33; 95% CI, 1.30–4.17). ConclusionsDepressive symptoms are prevalent among urban teens with asthma and are associated with worse asthma-related clinical outcomes, functional limitation, and quality of life. Providers should consider depression as a significant comorbidity that may impact multiple aspects of daily life for this population.

Transition Readiness for Talking With Providers in Urban Youth With Asthma: Associations With Medication Management*

PurposeTeen readiness assessments may provide a developmental indicator of the transfer of responsibility for health self-management from caregivers to teens. Among urban adolescents with asthma, we aimed to describe teen readiness for talking with providers and identify how readiness relates to responsibility for asthma management, medication beliefs, and clinical outcomes. MethodsTeens and caregivers enrolled in the school-based asthma care for teen's trial in Rochester, NY completed in-home surveys. We classified ready teens as those reporting a score of five on both items of the transition readiness assessment questionnaire talking with providers subscale. We performed bivariate analyses to detect differences between ready teens and other teens in teen- and caregiver-reported responsibility, teen medication beliefs, and clinical outcomes (medication adherence over the past 2 weeks, and healthcare use over the past year). ResultsAmong this sample of 251 adolescents (mean age: 13.4 years), 35% were classified as "Ready." Ready teens were more likely than other teens to want to use a controller medication independently (7.6 vs. 6.5 out of 10, p < .01) and to have confidence in this ability (8.4 vs. 7.6 out of 10, p = .02). Teens reported poor adherence (missed 52.9% of prescribed controller doses), with no differences in responsibility or clinical outcomes based on level of teen readiness for talking with providers. ConclusionsIn urban adolescents with poorly controlled asthma, a higher level of teen readiness for talking with providers is associated with higher perceptions of independence in medication taking, but does not appear to relate to clinical outcomes.

A qualitative study of parent perspectives on barriers, facilitators and expectations for school asthma care among urban, African-American children

Objectives: Minority children experience the disproportionate burden of asthma and its consequences. Studies suggest ethnic groups may experience asthma differently with varied perceptions and expectations among parents of African-American and Latino children. Because parents coordinate asthma care with the school, where children spend a significant amount of their day, this study’s goal was to determine parents’ perspectives on school asthma management. Methods: Focus groups were conducted with parents of children with asthma at four urban schools whose student population is predominantly African-American. A semi-structured guide was utilized focusing on barriers, facilitators and expectations for asthma care at school. Grounded theory principles were applied in this study. Results: Twenty-two parents (91% females) representing 13 elementary and 10 middle school children with asthma (61% boys) participated in four focus groups. Most children (87%) had persistent asthma. The identified barriers to effective school-based asthma care included limited awareness of children with asthma by teachers/staff, communication issues (e.g. school/parent, within school), inadequate education and lack of management plans or systems in place. In contrast, the identified facilitators included steps that fostered education, communication and awareness, as supported by management plans and parent initiative. Parents described their expectations for increased communication and education about asthma, better systems for identifying children with asthma, and a trained asthma point person for school-based asthma care. Conclusions: Parents of children with asthma identified important barriers, facilitators and expectations that must be considered to advance school asthma management. Improved school-based asthma care could lead to better health and academic outcomes.

Knowledge of Inhaled Therapy and Responsibility for Asthma Management Among Young Teens With Uncontrolled Persistent Asthma

ObjectivesTo compare the abilities of teens with uncontrolled persistent asthma and their caregivers to identify inhaled medications and state correct indications for use; examine medication responsibility within dyads; and determine whether responsibility is associated with knowledge about inhaled therapies. MethodsIn the baseline survey for the School-Based Asthma Care for Teens (SB-ACT) trial, we separately asked caregivers and teens to: 1) identify the teen's inhaled asthma therapies by name and from a picture chart (complete matches considered “concordant”); 2) describe indications of use for each medication; and 3) describe the allocation of responsibility for medication use within dyads. We limited analyses to dyads in which either member reported at least one rescue and one inhaled controller medication; we used McNemar and Pearson chi-square tests. ResultsA total of 136 dyads were analyzed. More caregivers than teens concordantly identified medications (63% vs 31%, P < .001). There was no difference between caregivers and teens in the ability to state correct indications for use (56% vs 54%, P = .79). More teens than caregivers endorsed “full teen responsibility” for rescue medication (65% vs 27%, P < .001) and controller medication use (50% vs 15%, P < .001). Neither concordant identification nor knowing indications for use was associated with reported medication responsibility. ConclusionsMedication responsibility within dyads of caregivers and teens with persistent asthma is not associated with knowledge about inhaled therapies. Targeting both members of the dyad with education and self-management strategies before responsibility transitions start may allow providers to avoid a missed opportunity to support these emerging stakeholders to adherence.

Medication identification in pediatric asthma (MED ID): The reliability and validity of a novel screening tool

ABSTRACTObjectives: To evaluate the reliability and validity of medication identification (MED ID), a novel survey assessing caregiver-perceived ability to identify inhaled asthma medications. Methods: We analyzed baseline data from the School-Based Asthma Care for Teens trial in Rochester, NY. Caregivers of adolescents with persistent asthma named the inhaled medications used by their child and identified medications on a pictorial chart. Accurate identification was defined as completed matches between listed names and selected images. Caregivers answered the MED ID survey of four scaled questions on perceived ability to identify inhaled medications. We determined internal consistency reliability using Cronbach's alpha; examined concurrent validity by comparing MED ID sum scores with accurate identification using bivariate and multivariate analyses; and assessed the diagnostic utility of MED ID through receiver operating characteristic analysis. Results: 126 caregivers (76% of enrolled) reported >1 inhaled medication; 52% of caregivers accurately identified medications. Two MED ID questions were removed during analysis. The two remaining questions had a score range of 2–10 points; higher scores indicate greater caregiver-perceived ability to identify medications. The Cronbach's alpha was 0.603. Accurate identification of medications was associated with a higher mean MED ID score (8.6 vs 7.6, p = 0.01). Accuracy was most strongly associated with MED ID scores ≥8 points (88% vs 60%, p < 0.001, Phi 0.32); findings were consistent in regression analysis. The greatest area under the curve was seen with MED ID scores ≥8 points (0.638). Conclusions: The two-item MED ID survey is a reliable and valid way to assess caregiver's ability to identify inhaled asthma medications.

Building school health partnerships to improve pediatric asthma care: the School-based Asthma Management Program.

Children with asthma require care that is seamlessly coordinated so that asthma symptoms are recognized and managed at home and at school. The purpose of this review is to discuss recent consensus recommendations in school-based asthma care. The School-based Asthma Management Program (SAMPRO) provides a widely endorsed framework to coordinate care with schools and consists of four components: establishing a circle of support around the child with asthma; facilitating bidirectional communication between clinicians and schools; comprehensive asthma education for schools; and assessment and remediation of environmental asthma triggers at school. SAMPRO standardizes recommendations for school-based asthma care coordination and provides a toolkit with websites and resources useful for the care of children with asthma in the school setting. The review will discuss the need for coordinated school asthma partnerships, the inception and development of SAMPRO, and its vision to improve pediatric asthma care coordination within the circle of support, comprising clinicians, school nurses, families, and communities.

Creation and implementation of SAMPRO™: A school-based asthma management program

Clinicians who care for children with asthma have an obligation to coordinate asthma care with the schools. Aside from routine clinical care of asthmatic children, providers must educate the family and child about the need for an asthma treatment plan in school and support the school nurse meeting the needs of the student requiring school-based asthma care. The following article was developed by multiple stakeholders to address this need. It describes the 4 components of the School-based Asthma Management Program (SAMPRO™). SAMPRO™ details elements necessary for the education of children, families, clinicians, and school-based personnel based on a “circle of support” that would enhance multidirectional communication and promote better care for children with asthma within the school setting.

The School-Based Preventative Asthma Care Trial: Results of a Pilot Study

JS Halterman, M Fagnano, G Montes. J Pediatr. 2012;161(6):1109–1115 To test the feasibility and preliminary effectiveness of the School-Based Preventive Asthma Care Technology (SB-PACT) program, which included directly observing therapy of preventive asthma medications in school facilitated by Web-based technology for systemic symptom screening, electronic report generation, and medication authorization from providers. The study included 100 children (aged 3–10 years) with physician-diagnosed asthma with persistent symptoms based on National Heart, Lung, and Blood Institute guidelines from 19 inner-city schools in Rochester, New York. The investigators conducted a pilot, randomized trial of SB-PACT versus usual care. Outcomes were …