Asthma is a common chronic condition that causes substantial morbidity among children and
much of it is attributable to medication non-adherence. The National Asthma Education and
Prevention Program (NAEPP) and the American Academy of Asthma, Allergy, and Immunology have
urged others to develop more effective adherence programs.Schools are a logical setting to
deploy such interventions because they are where children congregate, spend much of their
day, and are frequently monitored. Because many schools serve a high proportion of minority
and low-income students, engaging them presents a unique opportunity to reach populations who
experience the greatest burden of preventable morbidity.
Supervising inhaled corticosteroid (ICS) use in the school setting can increase medication
adherence and reduce episodes of poor asthma control. Under certain conditions, it can also
be cost-effective. However, recruiting children from school settings tends to enroll children
with mild asthma and infrequent health care use. Therefore, initiating supervised treatment
in these children tends to burden school personnel with unnecessary work and diminishes the
program's cost-effectiveness. To address this inefficiency, the investigators propose to
recruit children who are discharged from the Hospital Emergency Departments (EDs) following
successful treatment of an asthma attack. Such children have much higher risk of a future
asthma attack than their peers.
The Pediatric Emergency Care Applied Research Network (PECARN) com- prises10
hospital-affiliated EDs that serve 1 million acutely ill and injured children annually. Their
primary research mission is to reduce childhood morbidity and mortality by establishing
creative partnerships between emergency medical service providers and their surrounding
communities. The networks size and geographic diversity make it uniquely situated to develop,
implement, and evaluate the feasibility and effectiveness of ED-Initiated School-Based Asthma
Medication Supervision (ED-SAMS).
Approximately one-third of children treated for an asthma attack within PECARN experience a
second ED-managed attack within 6 months. While the NAEPP guidelines recommend that long-term
ICS treatment should be initiated at ED discharge, <20% of children actually receive a
prescription for controller therapy. Observational data indicate that patients who use ICS
following discharge are almost half as likely as non-users to experience a repeat ED visit.
Many have also argued that ED-initiated treatment could be cost-effective. However, simply
providing patients with a prescription does not ensure that they will actually use it once
discharged. To ensure better medication adherence, the investigators propose to dispense ICS
at discharge and supervise its use in the school setting.