Asthma prevalence in Bronx, NY schools is 20-25%. Physical activity (PA) is an important component of asthma management in children. Studies show that PA is associated with decreased severity of asthma symptoms, as well as improved disease control and quality of life. However, urban minority children with asthma face barriers to PA on multiple levels. In our prior work (K23HD065742), we identified several barriers to PA in urban minority schoolchildren with asthma. These barriers include: inadequate access to asthma rescue medications in school, suboptimal prescribing of preventive asthma therapy by primary care physicians (PCPs), lack of school PA opportunities, stigma associated with asthma, parent/child fear of an asthma attack with PA, and lack of teacher confidence in assisting students with asthma. We developed a novel Asthma management program to Promote Activity for Students in Schools (Asthma-PASS) in collaboration with stakeholders to address these key barriers. We pilot tested Asthma-PASS with 109 students with asthma from 4 Bronx elementary schools and their parents to demonstrate proof of concept and preliminary evidence of intervention effectiveness. Results from the pilot study demonstrated significantly greater increase in symptom-free days (SFDs) (primary outcome measure) and PA levels. In addition, preliminary mediation analyses suggested vigorous PA and step counts are mediators of SFDs. We now plan to build upon this work and evaluate in a full-scale randomized trial whether the Asthma- PASS intervention reduces asthma morbidity among high-risk urban schoolchildren. We propose a cluster- randomized controlled trial with 416 children ages 5-11 years with persistent or uncontrolled asthma from 26 Bronx schools. Schools will be stratified by size and then randomly assigned to either (1) the Asthma-PASS intervention (PCP collaboration to ensure optimal guideline-based preventive asthma care and community health workers to facilitate rescue medication availability in school and provide asthma awareness programming and education for children, parents and school personnel to reduce stigma around asthma and PA) or (2) an asthma management (AM) comparison group (PCP and parent notification of child?s asthma status and general asthma education). Both groups will participate in an existing district-wide classroom-based daily activity program (?Move to Improve?). We will assess the effectiveness of Asthma-PASS in reducing asthma morbidity (primary outcome - SFDs), and improving PA (secondary outcome) as well as additional clinical and functional outcomes. We will measure PA with accelerometers using previously established procedures. We will also identify potential mediators and moderators of the intervention effect. We will evaluate the process of intervention implementation by applying the RE-AIM framework. This proposal directly builds on our prior work in schools to improve asthma outcomes and reduce health disparities. If Asthma-PASS successfully reduces symptoms and improves health, it will provide a powerful argument for policy change in schools and urban communities nationwide.
Although physical activity is an important component of pediatric asthma management, urban minority children with asthma face many barriers to participation in sports and other forms of physical activity. The current study may have a profound impact on public health because it aims to rigorously evaluate the effectiveness of a novel school-based intervention that addresses key barriers to physical activity in urban minority children with asthma. Should the intervention prove successful in reducing symptoms and improving health of urban children with asthma, it has the potential to serve as a model for improved asthma care in urban communities.
