Researchers in New York City are organizing a community-based approach based on prior successful research to help children and their families learn about and manage asthma symptoms.
The Asthma-PASS program will be implemented in up to 40 public, parochial and charter schools across the Bronx with the aim of providing children and their families with asthma education as well as COVID-19 support from a community health worker (CHW). The Asthma-PASS program will be supported by a $4.2 million grant from the NIH to Albert Einstein College of Medicine and Children’s Hospital at Montefiore (CHAM). The program will focus on educational and physical activities for children in order to improve asthma and limit hospitalizations and exacerbations.
In an interview with Healio, Marina Reznik, MD, MS, vice chair for clinical and community-based research at CHAM and Einstein, professor of pediatrics at Einstein, and lead researcher for the Asthma-PASS program, discussed the methods of the study, its significance to the Bronx and future plans regarding asthma research.
Healio: Why is the Bronx such an important starting point for studying how to help children and adults cope with and learn about asthma?
Marina Reznik
Reznik: Of all the New York City boroughs, the Bronx has the highest overall rates of asthma hospitalization, deaths and prevalence among children and adults. In some areas of the Bronx, one in four school-age children have asthma. Poor asthma control can increase asthma exacerbations, absence from school, health care utilization and costs, and it can decrease quality of life. The Bronx population is at increased burden from the disease, warranting an urgent need for intervention and support. Multicomponent programs that include patient education about asthma, its triggers and disease self-management could improve asthma control and other outcomes.
Healio: Can you describe the creative ways in which children learned about asthma during previous asthma awareness weeks?
Reznik: During asthma awareness week, children participated in activities to bring awareness about asthma to everyone in the school. Teachers decided what activities related to asthma the class will participate in during the week. I was impressed by the creative ways in which students with and without asthma displayed what they learned about asthma during the week. Teachers played a major role in making the asthma awareness week a success. Some teachers incorporated the topic of asthma and living a healthy life despite having a disease within what they were teaching
that week. For example, one class was learning about poetry and all students in that class wrote poems about asthma. Other classrooms created posters and all students worked on the poster contributing their drawings about asthma. Students in another classroom wrote about what they learned during the week from their teacher about asthma facts. It was great to see all the amazing work that was completed during just 1 week! I look forward to seeing new ways and ideas that teachers and students will develop and work on during the future asthma awareness weeks in the upcoming study.
Healio: How are you conducting this study?
Reznik: The schools will be randomly assigned to either the Asthma-PASS intervention or the asthma management comparison group. All enrolled families, regardless of their assigned group, will receive asthma education and COVID-19 support from a CHW. All schools will continue to offer ongoing classroom and school-based opportunities for physical activity.
Schools randomly assigned to Asthma-PASS will receive an asthma workshop for school personnel and hold an asthma awareness week. Families of students attending schools with Asthma-PASS will also work with a CHW to address care coordination needs or concerns about physical activity. Once the final assessment is completed for the students attending Asthma-PASS schools, we will offer the asthma workshop and asthma awareness week activities to the asthma comparison group schools.
We will compare several outcomes between the participants in two groups such as asthma control, symptom-free days and physical activity. The purpose of randomly assigning the schools to two groups is to see if there will be a difference found on these outcomes between them.
Healio: A prior pilot study showed an increase in symptom-free days among children; how do you think the activities explored were able to make such a substantial difference in these symptoms?
Reznik: The Asthma-PASS program has multiple components, and it is the combination of all the components that made a significant difference in increasing symptom-free days in the prior pilot study, especially among children who had persistent and uncontrolled asthma. It is not possible to know which specific component of Asthma-PASS made such a difference. But, one way that I anticipate some of the intervention components contributed to increase in symptom-free days is through CHW support and education about asthma that increased child and parental knowledge and confidence in managing asthma along with improved physical activity. In addition, through asthma awareness week and a school staff asthma workshop, stigma that children with asthma may experience was decreased and teachers felt more comfortable with handling asthma symptoms in the classroom. All of these activities together improved the symptom-free days that we observed in the pilot study.
Healio: What impact do you hope your findings will have among children with asthma in the Bronx?
Reznik: The components of the Asthma-PASS program were developed in collaboration with the Bronx schools, teachers, parents and community members to best fit to the needs of New York City students with asthma, which were then pilot tested in four Bronx elementary schools. We are fortunate to be able to expand and evaluate Asthma-PASS in up to 40 Bronx schools with the funding we received from the NIH. The lessons we learned from the pilot study, as well as other community-based asthma studies conducted by our team and others, will help us with implementation of the new Asthma-PASS program. Building a relationship with the schools and families and earning the trust of the community is important in studies such as this. The new challenge that we have not experienced in the pilot and our other prior studies is the COVID-19 pandemic and its detrimental effect on the Bronx community and school system. Although all the intervention components were done in person in the pilot study and we were able to visit schools frequently to meet with teachers, students, families and other school personnel to build that relationship, now due to the COVID-19 pandemic and limited access to the schools, these components would need to be completed remotely. We hope that the Bronx schools continue to see the importance of addressing asthma in the students given that uncontrolled asthma is also a risk factor for COVID-19 morbidity. This project will deliver asthma education, support and COVID-19 resources to the population that has been disproportionately affected by both asthma and COVID-19. The new study would provide critical new knowledge on the effectiveness of the Asthma-PASS intervention that could help improve asthma outcomes among Bronx children with asthma during the COVID-19 pandemic or any future epidemics.
Healio: Do you have any advice to offer other health care professionals trying to make a difference among children with asthma with a similar large-scale initiative?
Reznik: I would advise to start small and work with the community where the program is going to be implemented to get their input on the program development and its implementation. This is the most important first step for the successful future launching of a large-scale project.
Healio: Do you have future plans to expand research and studies on this topic outside of the Bronx?
Reznik: Yes, definitely. The Asthma-PASS program, if found to be effective in this large-scale study, would be of interest to other inner-city communities across the country with a high prevalence of pediatric asthma. It would be exciting to collaborate with colleagues who conduct community-based asthma research outside of the Bronx on implementing the program in their schools and communities in the future.