Clinic-school partnerships to advance pediatric asthma care
Published online August 22, 2025
Childhood asthma affects 8% of children, causes over 14 million missed school days annually, and costs billions of dollars in healthcare expenditures. Much of the suffering from childhood asthma is due to challenges with taking a daily preventive inhaler, called an inhaled corticosteroid (ICS). One promising strategy to address this is school-supervised administration of ICS. This approach has improved children’s ability to receive their daily preventive medication and has reduced suffering from asthma in prior clinical trials. However, these supervised asthma interventions have not been widely adopted in pediatric practice to improve the public’s health and effectively reach children.
In prior foundational studies, substantial research resources were used to identify children with asthma, request medication orders from a study physician, deliver medications to schools and supervise ICS administration within schools. Thus, a sustainable model, one that could be continued beyond a research study, has been lacking and it has been challenging to continue school-supervised asthma therapy after research studies have ended. Until now, there have not been examinations of sustainable partnerships that link pediatric primary care, schools, and families. Such sustainable partnerships would leverage each of these partners’ natural roles, rather than relying on research staff in these locations, to provide at-risk children access to school-supervised asthma therapy and enable practices, schools and families to use school-supervised asthma therapy outside of a research context.
The primary objective of the study conducted by Dr. Trivedi et al, published in The Journal of Allergy and Clinical Immunology: In Practice was to conduct a real-world, pilot randomized controlled 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 (EUC), the same workbook alone. The study recruited children 6-17 years with poorly controlled asthma that were prescribed a daily inhaled corticosteroid. Parent-child dyads completed surveys at baseline, 3-, 6- and 12-months. Primary outcomes were recruitment and retention of pediatric practices and parent-child dyads, as well as intervention fidelity. Secondary outcomes were asthma symptoms, medication adherence, emergency room visits, hospital admissions, oral steroid use, missed schooldays.
Four primary care practices and 66 parent-child dyads were included in this trial (average child age 9 years, 44% female, 65% Hispanic, 23% Black, 62% low-income). All (4/4) practices were retained throughout the study. Retention of parent-child dyads was 95%, 91%, and 89% at 3-, 6-, and 12-months respectively. All (31/31) Asthma Link families brought their child’s preventive inhaler into school; children received school health staff-supervised therapy on >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 (oral steroid use, emergency room visit or hospitalization for asthma), less oral steroid use and better medication adherence compared to the EUC group.
This study demonstrated the feasibility of extending the reach of pediatric practices to facilitate the delivery of daily asthma prevention medication at school. This innovative and sustainable approach to school-supervised therapy improved suffering from childhood asthma.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
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