Michelle Trivedi, MD, MPH: How COVID-19 Affected School-Based Asthma Programs

New approaches to pediatric asthma are always welcome among patients and allergists alike, with many of them building upon the foundation of school-based asthma programs.

Michelle Trivedi, MD, MPH, Associate Professor at the University of Massachusetts Medical School, has contributed to the development of a new school-based asthma program which provides care to children with asthma from communities of color, who are often disproportionately affected by the condition.

Her work will be presented at the 2022 American Academy of Allergy, Asthma & Immunology Annual Meeting (AAAAI) in Phoenix during the session, "Impact of COVID on School -Based Asthma Programs in Communities of Color".

In an interview with HCPLive, Trivedi spoke to the strength of school-based programs as well as how were affected in recent years due to the COVID-19 pandemic.

“I have been involved in school-based asthma programs for nearly a decade now, and I think most powerful component to them is that they are really able to reach our most vulnerable children with asthma,” Trivedi said. “So, even pre-pandemic we were fortunate to see that school based asthma programs are very unique in their ability to provide access to care to mostly historically marginalized children.”

Trivedi added that when analyzing the national landscape of clinical trial studies for asthma, many of them neglect to include historically marginalized populations and instead recruit a majority of White participants.

Additionally, children who experience the most significant symptoms and morbidity from asthma have typically been underrepresented minority children, which is why school-based asthma programs can provide innovative strategies for managing asthma in these populations.

Of course, the beginning of COVID-19 led nationwide school closures, resulting in an abrupt cessation from these asthma programs. Though school closures did vary across the nation, Trivedi noted that there were disproportionate impacts on communities of color.

This created a significant challenge, but Trivedi and fellow investigators responded with the Asthma Link Clinical and Research programs.

“We developed this essentially as a program that partners our clinical system to the schools in our community, and the idea is that we're using infrastructure that's real world, it’s not infrastructure, and we're delivering supervision to children who are having a hard time remembering their preventive asthma inhaler every day,” Trivedi said.

At school, children with asthma may be supervised by a school nurse to ensure their allergies are properly acknowledge and managed. However, to overcome school closures in disadvantaged communities, the Asthma Link programs contacted families affected by asthma directly to hear what asthma prevention methods would work best for them.

This led to the development of a text message intervention to help remind parents and children of their asthma inhalers and other preventative measures. Responses to the messages would also be linked to school nurses who could check in with families on a weekly basis through remote mechanisms.

The program was piloted for 6 months beginning in December 2020, with a total of 81% of parents responding consistently throughout. Trivedi attributes the robust response rate to the accessibility of the program which, like other forms of telemedicine, will inform the future of pediatric asthma care.

“We've kind of created a digital ecosystem in our healthcare entities and I think also in our schools,” Trivedi said. “Families and children have gotten very comfortable with Zoom and with different technological mediums that people were not familiar with before and same goes for healthcare systems and staff. So, I think that these are here to stay just in the same way that telehealth is and I think the more that we sort of harness these interventions the better off we'll be.”

To hear more from Dr. Trivedi on the impact of COVID-19 on school-based asthma programs, watch the full video interview above.