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It's time to overcome the heavy burden of childhood asthma. Although we don't have all the pieces of the childhood asthma puzzle, we know enough to better manage this chronic condition and help millions of families across America.

Most people don't realize that 1 in every 11 children has asthma and that asthma is the most common chronic condition among children. Asthma also accounts for children missing 13 million school days a year.

Abstract Background: A substantial proportion of low-income children with asthma living in rural western North Carolina have suboptimal asthma management. To address the needs of these underserved children, we developed and implemented the Regional Asthma Disease Management Program (RADMP); RADMP was selected as one of 13 demonstration projects for the National Asthma Control Initiative (NACI). Methods: This observational intervention was conducted from 2009 to 2011 in 20 rural counties and the Eastern Band Cherokee Indian Reservation in western North Carolina. Community and individual intervention components included asthma education in-services and environmental assessments/remediation. The individual intervention also included clinical assessment and management. Results: Environmental remediation was conducted in 13 childcare facilities and 50 homes; over 259 administrative staff received asthma education. Fifty children with mild to severe persistent asthma were followed for up to 2 years; 76% were enrolled in Medicaid. From 12-month preintervention to 12-month post-intervention, the total number of asthma-related emergency department (ED) visits decreased from 158 to 4 and hospital admissions from 62 to 1 (p50.0001). From baseline to intervention completion, lung function FVC, FEV1, FEF 25–75 increased by 7.2%, 13.2% and 21.1%, respectively (all p50.001), and average school absences dropped from 17 to 8.8 days. Healthcare cost avoided 12 months post-intervention were approximately $882 021. Conclusion: The RADMP program resulted in decreased ED visits, hospitalizations, school absences and improved lung function and eNO. This was the first NACI demonstration project to show substantial improvements in healthcare utilization and clinical outcomes among rural asthmatic children.

Background: Asthma continues to be a significant public health issue for children. The extent to which tailored evidence-based interventions address the needs of children at varied levels of risk in the community is unclear.

Objective: Using data from five impoverished communities with high levels of pediatric asthma morbidity, this study assessed morbidity outcomes associated with tailored evidence-based interventions after stratifying children for risk based on two variables that reflect control, severity, and behavior: hospitalizations and daily use of a controller medication.

Methods: A pre/post evaluation (n=721) was used to categorize and analyze change in outcomes for four groups of patients: patients with one or more hospitalizations in the past 12 months with or without a baseline controller medication use, and no hospitalizations in the past 12 months with or without baseline controller medication use.

Results: Patients with one or more hospitalizations in the past 12 months and no baseline controller use made the biggest gains in several areas, including the largest percent increase in daily controller medication usage and asthma action plans, and the largest decrease in days and nights of symptoms. However, other groups made larger gains in reducing school days missed and emergency department visits and increasing parent confidence, consistent with the notion that community-based interventions can help a diverse set of patients make progress.

Conclusion: Practitioners in low-income communities where there are varying levels of resources and disease severity can tailor interventions to each child's needs and make substantial gains in outcomes across a range of risk profiles.