October 18, 2021
5 minute read
October 18, 2021
5 minute read
New York City researchers are organizing a community-based approach based on previous 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 in the Bronx with the goal 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 NIH grant to the Albert Einstein College of Medicine and Children’s Hospital at Montefiore (CHAM). The program will emphasize educational and physical activities for children to improve asthma and limit hospitalizations and exacerbations.
In an interview with Healio, Marina Reznik, MD, MS, vice president for clinical and community research at CHAM and Einstein, professor of pediatrics at Einstein and principal investigator of the Asthma-PASS program, discussed study methods, its importance to the Bronx and future plans for the research on asthma.
Helio: Why is it the Bronx such an important starting point to study how to help children and adults cope with and learn more about asthma?
Reznik: Of all the boroughs in New York City, the Bronx has the highest overall rates of asthma-related hospitalizations, deaths, and prevalence among children and adults. In parts of the Bronx, one in four school-aged children has asthma. Poor asthma control can increase asthma exacerbations, school absenteeism, health care utilization and costs, and can decrease quality of life. The people of the Bronx are experiencing an increased burden of disease, justifying an urgent need for intervention and support. Multicomponent programs that include patient education about asthma, its triggers, and disease self-management may improve asthma control and other outcomes.
Helio: Can you describe the creative ways children learned about asthma during previous Asthma Awareness Weeks?
Reznik: During Asthma Awareness Week, children participated in activities to raise asthma awareness at school. The teachers have decided which asthma-related activities the class will participate in during the week. I was impressed with the creative way the students with asthma and without asthma presented what they learned about asthma during the week. Teachers played a major role in the success of Asthma Awareness Week. Some teachers integrated the theme of asthma and living a healthy life despite illness into what they taught that week. For example, one class was learning poetry and all the students in that class wrote poems about asthma. Other classes created posters and all the students worked on the poster by bringing their drawings on asthma. Students from another class wrote down what they had learned during the week from their teacher about the facts of asthma. It was great to see all the amazing work that was done in just 1 week! I look forward to seeing new ways and new ideas that teachers and students will develop and work on over the next weeks of Asthma Awareness in the upcoming study.
Helio: How are you conducting this study?
Reznik: Schools will be randomly assigned to either the Asthma-PASS intervention or the asthma management comparison group. All registered families, regardless of their assigned group, will receive asthma education and COVID-19 support from a CHW. All schools will continue to provide ongoing opportunities for physical activity in the classroom and at school.
Schools randomly assigned to Asthma-PASS will receive an Asthma Workshop for School Staff and host 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. After the final assessment is completed for students attending Asthma-PASS schools, we will offer the Asthma Workshop and Asthma Awareness Week activities to schools in the Asthma Control Group.
We will compare several outcomes between participants in two groups such as asthma control, symptom-free days, and physical activity. The purpose of randomly assigning schools to two groups is to see if there will be any difference found on these results between them.
Helio: A an earlier pilot study showed an increase in symptoms–free days between children; how do you think the activities explored could have made 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 the number of symptom-free days in the previous pilot study, particularly in children with asthma. persistent and uncontrolled asthma. It is not possible to know which specific component of Asthma-PASS made such a difference. But, I anticipate that some of the components of the intervention contributed to the increase in symptom-free days through the support and education of CHWs on asthma which increased the knowledge and confidence of children and caregivers. parents in managing asthma while improving physical activity. Additionally, through Asthma Awareness Week and an Asthma Workshop for school staff, the stigma that children with asthma may experience has been reduced and teachers have felt more comfortable managing asthma. asthma symptoms in the classroom. Together, all of these activities improved the symptom-free days we observed in the pilot study.
Helio: What impact do you hope your findings will have on children with asthma in the Bronx?
Reznik: Components of the Asthma-PASS program were developed in collaboration with Bronx schools, teachers, parents, and community members to best meet the needs of students with asthma in New York City, which were then tested in four elementary schools in the Bronx. 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, along with other community-based asthma studies conducted by our team and others, will help us implement the new Asthma-PASS program. Building a relationship with schools and families and gaining the trust of the community is important in studies like this. The new challenge that we have not encountered 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 components of the intervention were delivered face-to-face in the pilot study, and we were able to visit schools frequently to meet with teachers, students, families, and other school staff to establish this relationship, now due to the COVID-19 pandemic and limited access to schools, these components should be completed remotely. We hope Bronx schools will continue to see the importance of treating asthma in students given that uncontrolled asthma is also a risk factor for COVID-19 morbidity. This project will provide asthma education, support and resources on COVID-19 to the population that has been disproportionately impacted by asthma and COVID-19. The new study would provide critical new insights into the effectiveness of the Asthma-PASS intervention that may help improve asthma outcomes in children with asthma in the Bronx during the COVID-19 pandemic or any future outbreak.
Helio: Do you have advice to offer other health care healthcare professionals trying to make a difference in asthmatic children with large-scale initiative?
Reznik: I would advise starting small and working with the community where the program is going to be implemented to get their input on program development and implementation. This is the most important first step for the successful future launch of a large-scale project.
Healio: Do you Future plans expand research and studies on this topic outside of the Bronx?
Reznik: Yes definitely. The Asthma-PASS program, if proven effective in this large-scale study, would be of interest to other inner-city communities across the country where the prevalence of pediatric asthma is high. 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.
Marina ReznikMD, MS, can be contacted at [email protected]