Asthma Link: A Partnership between Pediatric Practices, Schools, and Families to Improve Medication Adherence and Health Outcomes in Children with Poorly Controlled Asthma

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PROJECT SUMMARY/ABSTRACT Asthma is the most common chronic disease of childhood with significant morbidity including school absences, poor school performance, parental lost workdays, emergency room visits and hospital admissions. The majority of childhood asthma morbidity is due to medication non-adherence, and both morbidity and medication non-adherence disproportionately impact low-income, Black, and Latino children. School-supervised asthma therapy ensures that children receive their preventive asthma medication daily at school and has shown efficacy in improving medication adherence and asthma health outcomes, particularly in low-income and racial/ethnic minority children. However, this strategy has not been widely adopted in practice to produce meaningful public health impact. This is likely due to costly and resource intense protocols that have not yet leveraged the established infrastructure of pediatric practices, schools, and families; groups that play vital roles in the asthma health of children, yet largely work in silos. To address this gap, our team developed a new model, Asthma Link, which partners pediatric practices, schools, and families to deliver school-supervised asthma therapy. First, pediatric providers identify eligible children as part of their routine clinical practice and send preventive medication orders to schools to initiate supervised asthma therapy. Next, families pick up and deliver the asthma medication to school, and existing school staff supervise daily preventive asthma medication use. This intervention leverages established infrastructure and requires minimal resources to operate, enhancing sustainability in a real-world setting. Our pilot trial of Asthma Link showed improved asthma symptoms when compared to an enhanced usual care condition, particularly among low-income, Black and Latino children, and demonstrated trial feasibility. Moreover, we have adapted this intervention for real- world use using input from diverse, multi-level community stakeholders. Asthma Link is now primed for an effectiveness trial and rigorous process assessment. We propose a cluster RCT in 14 pediatric practices (n=350 parent-child dyads) in two of the highest asthma burden cities in the nation, Worcester and Springfield, Massachusetts. In Aim 1 we will determine the effectiveness of Asthma Link versus an enhanced usual care condition in improving asthma health outcomes in school-aged children with poorly controlled asthma. Our primary outcome is asthma symptoms (measured by Asthma Control Test scores) and secondary health outcomes are adherence to inhaled corticosteroids, child and parent quality of life, emergency department visits, hospital admissions, school absences, and parental lost workdays. Aim 2 of this study will explore the implementation potential of Asthma Link by examining clinic, school and family-level measures of fidelity and acceptability using mixed methods and the Proctor framework. Data collected will inform a future nation-wide implementation trial. If proven to be effective, Asthma Link could become the standard of care for children with high-risk asthma, with the power to transform practice, even within limited resources.