Approximately 9 percent of children in Texas have asthma, while rates in Northeast Texas are disproportionately higher at 14 percent. The region consists of mostly rural communities with a few small metropolitan areas. Environmental triggers such as higher than average smoking rates, pollution and air impacts from high pollen, and mold exposures both outdoors and indoors, as well as substandard housing in Northeast Texas, contribute to these high rates. Access to primary or specialty care is limited due to a lack of providers, which leads to increases in emergency department visits and subsequently missed school days due to asthma-related symptoms. In response to this health care challenge, in 2008 the University of Texas Health Science Center at Tyler initiated a mobile asthma program coined “The Breath of Life Mobile Pediatric Asthma Clinic” (BOLMPAC). The mobile asthma program travels not only to schools, but to other locations such as apartment complexes, churches and community health centers, serving 2,500 unique patients a year. Comprehensive asthma care is provided, and because asthma and environmental triggers go hand in hand, all patients receive allergy testing and treatment, if indicated. Patients that have severe or uncontrolled asthma receive a home assessment provided by a BOLMPAC community health worker. This successful program has seen a significant decrease in missed school days and a 50 percent decrease in emergency department visits.
Children's Hospital Colorado (CHCO) is a private, not-for-profit pediatric healthcare network dedicated 100 percent to caring for kids. CHCO’s Pulmonary Department, known as The Breathing Institute, is nationally recognized for their work with patients who have asthma and other complex respiratory and related illnesses. The Asthma Program, started in 2006, has expanded and supports comprehensive community asthma care through several initiatives. Their team focuses on a four-county area home to approximately 525,000 children. These counties are all diverse, with minority populations ranging from 20 percent to 70 percent and up to 25 percent of children living in poverty. Environmental remediation is accomplished through a thorough home assessment, planned with the family and implemented by community health workers with nurse support to assess asthma control. Because children typically spend a third of their day at school potentially exposed to multiple asthma triggers, CHCO incorporates EPA’s Tools for Schools Indoor Air Quality Framework into their comprehensive school program. The environmental components of CHCO’s asthma program are funded through two mechanisms: a grant using state tobacco tax revenue and an innovative funding stream from Colorado Medicaid, which is focused on improving care and outcomes for Medicaid patients across Colorado. CHCO has seen impressive results with a 24 percent decrease in school absenteeism, significant improvements in asthma control, and decreased emergency department visits and hospitalizations.