A new community based approach to helping children manage their asthma symptoms will launch in up to 40 public, charter and parochial schools across the Bronx, and enroll 416 students aged 4-12.
The five-year study, titled “Evaluation of the Asthma Management Program to Promote Activity for Students in Schools,” (Asthma-PASS), is supported by a $4.2 million grant from the National Institutes of Health to Albert Einstein College of Medicine and the Children’s Hospital at Montefiore (CHAM). The research will be led by Dr. Marina Reznik, vice chair for clinical and community based research, CHAM and Einstein and professor of pediatrics at Einstein.
Montefiore-Einstein research shows the rate of asthma prevalence in the Bronx is as high as 25% in some neighborhoods, the highest rate of all New York City boroughs. The Bronx also has the highest overall rates of asthma hospitalizations and deaths in New York.
“We developed Asthma-PASS in collaboration with Bronx elementary schools, parents of children with asthma, and community members, and then conducted a pilot study in four schools, which showed an increase in symptom-free days and children’s physical activity — an important component of asthma management,” Reznik said. “Our goal with the expanded study is to see if we can reduce asthma symptoms among high-risk urban school children.”
The new cluster-randomized controlled trial will assign participating schools to either the Asthma-PASS intervention or the Asthma Management comparison group.
Schools randomized to Asthma-PASS will receive an asthma workshop for school personnel and hold an asthma awareness week where students will participate in hands-on activities, such as writing poems, making posters and learning facts about asthma to reduce stigma about the disease and bring asthma awareness to everyone at the school. Asthma-PASS families will also work with a Community Health Worker (CHW) to address care coordination needs or concerns about physical activity.
All schools, regardless of their assigned group, will continue to offer ongoing classroom and school-based opportunities for physical activity. After students in Asthma-PASS schools complete the intervention and final assessment, children in the Asthma Management comparison schools will be offered asthma workshops and asthma awareness week activities. Additionally, children and caregivers enrolled in both groups will receive asthma education and COVID-19 support from a CHW. At the end of the study, researchers will assess outcomes for children in the Asthma-PASS group compared to the children in the Asthma Management comparison group.
“During the pilot Asthma-PASS study, we were blown away by the creative ways children learned and shared information about asthma during the awareness week,” Reznik said. “We hope that all the students participating in the study will find it an engaging and enjoyable way to learn how to better manage their condition and improve their long-term health.”
In prior research, Reznik and colleagues found that urban minority children with asthma face barriers to physical activity, including asthma-related stigma reported by children, parent/child fear of an asthma attack caused by physical activity, and lack of teacher confidence in assisting students with acute asthma. Asthma clinicians and researchers support physical activity for children with asthma as it is associated with decreased severity of asthma symptoms, as well as improved disease control and quality of life.
Another prior study led by Reznik showed that CHWs delivering home-based asthma education can decrease symptom days and reduce disparities in children’s health outcomes. The new Asthma-PASS program combines both elements of the successful prior studies, aiming to enhance the support and outcomes for children with asthma and their families.
Reznik has dedicated her career to caring for patients with asthma in her clinic, but also to finding ways to improve the socioeconomic and environmental factors that influence children’s asthma management. To date, she has conducted 10 community based asthma interventions, enrolling approximately 3,000 children and/or caregivers and collaborating with several community based organizations to create and assess practical, actionable ways to improve children’s asthma, and reduce exacerbations and hospitalizations.