Addressing Childhood Asthma

Youth should be a time for adventures and play, when kids can be kids, free from the stresses and dilemmas adults must face. For many children with asthma, however, everyday activities such as riding a bike or running around on the playground can be major challenges.

Over a decade ago, the Centers for Disease Control and Prevention (CDC) released an alarming report that showed the burden of childhood asthma was significantly higher in African-American and Puerto Rican communities and for families living below the poverty line. This confirmed what many already knew – progress to close the disparities in asthma morbidity in the United States was stalled and ground was being lost.

The Merck Foundation recognized the need to extend research from the laboratory into the real world by disseminating community-centered evidence-based interventions (EBIs). From this resolve, the Merck Childhood Asthma Network (MCAN) was established in 2005 as the only independent 501(c)(3) organization exclusively focused on the burden and associated morbidity of chronic childhood asthma. From inception, MCAN set out to effect real meaningful change by cultivating public-private partnerships and creating a strong network of collaborators.

Disaster Response

In Phase I, MCAN funded the implementation and evaluation of the effectiveness of five EBIs in diverse community settings where children live, learn and play. Concurrently, Hurricane Katrina hit the Gulf Coast in 2005, leaving a path of destruction in its wake. In New Orleans, the levees couldn’t withstand the rising waters, causing widespread flooding throughout many parts of the city.

Increased mold, mildew and other triggers of asthma symptoms left in the wreckage put thousands of children at increased risk for worsening asthma, and MCAN responded accordingly. In partnership with the National Institutes of Health (NIH) and a private family foundation, MCAN assisted children and their families in New Orleans through the Head-off Environmental Asthma in Louisiana (HEAL) Project. HEAL combined evidence-based care management and mitigation of asthma triggers in the homes where allergens and irritants were the highest.

SEE ALSO: Providing Care for Inner-City Asthmatic Children

In Phase II, beginning in 2010, MCAN supported interventions at four different program sites across the country and in Puerto Rico that coordinated care and were grounded in a single EBI. The presence of local care coordinators and managers who had ties to the communities they served was a critical part of the equation to foster trust and collaboration with patients, parents and other stakeholders, especially healthcare providers.

MCAN also supported federally qualified health centers to implement the evidence-based “hybrid” intervention shown to be effective in New Orleans. These centers provided the asthma care, including preventive services that families needed.

MCAN appreciated soon after its establishment that advocacy at the national, state and local levels on behalf of asthma patients is necessary to ensure even more children can be reached by evidence-based, efficacious intervention approaches to asthma management. MCAN facilitated advocacy efforts that focused on federal policy initiatives to improve asthma management and the formation of the Childhood Asthma Leadership Coalition, which will continue long after MCAN’s closure at the end of this year.

MCAN also was invited to collaborate with the President’s Task Force on Asthma Disparities and the U.S. Environmental Protection Agency to co-sponsor, where all MCAN tools and resources will continue to be available.

Where Are We Now?

Ten years later – what progress and impact has been made? Thus far, MCAN has succeeded in making a measurable positive impact in reducing school absenteeism and ED visits resulting from chronic asthma symptoms, as evidenced by a 30% decline in ED visits among children at MCAN-funded sites and an 80% reduction in asthma-related school absences in Phase I.

In Phase II, of the 805 children enrolled in care coordination programs, missed school days due to asthma declined from an average of 11 to four days a year at the one-year follow up. In addition, during this same period, the number of days of limited activity due to asthma (monitored over a month) for children enrolled in care coordination programs declined from six days to two.

Despite positive impacts, the morbidity of childhood asthma is unacceptably high, especially in impoverished communities. On a broader scale, many of the principles applied and lessons learned at the community level have valuable implications for potential management of other disease states, especially chronic conditions.

In 2005, there was an urgent need to address a growing health crisis of childhood asthma. In 2015, significant improvements in asthma management have been observed. In another 10 years, with even better management programs through the advancement of science, as well as stronger commitment and more public and private sector collaboration, the goal is to no longer see kids sitting out their childhoods due to asthma.

Floyd J. Malveaux, MD, PhD is Executive Vice President and Executive Director of the Merck Childhood Asthma Network, Inc. (MCAN), as well as Emeritus Dean of the College of Medicine and Professor of Microbiology and Medicine at Howard University.

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