336 - Implementing a Pediatric Asthma Clinic for Native American Children in the Great Plains: Early Outcomes of an Evidence-Based, Community-Driven Model

Publication Number: 2325.336

Kenneth Macneal, Harvard Medical School, Boston, MA, United States; Kimberly Ann. Miller, Boston Children's Hospital, Bottineau, ND, United States; Ayongwi Tazuh, Quentin N. Burdick Memorial Healthcare Facility, Belcourt, ND, United States; Patricia A. McQuilkin, Boston Children's Hospital, Harvard, MA, United States

Background: Asthma is a leading cause of emergency department (ED) visits, hospitalizations, and missed school days. Native American children experience higher asthma prevalence, worse outcomes, and greater barriers to care, especially in rural areas with limited subspecialty access. Underdiagnosis, low use of controller medications, and inconsistent education contribute to poor control. Evidence-based approaches such as Single Maintenance and Reliever Therapy (SMART), using an inhaled corticosteroid/long-acting beta-agonist (ICS-LABA), improve outcomes but remain underused. To address these gaps, a pediatric asthma clinic was established with the Indian Health Service to provide structured, culturally sensitive care for Native American children with difficult-to-control asthma.

Objective: This project aimed to implement a sustainable, evidence-based asthma clinic in a rural Native American community to improve outcomes. Goals were to enhance diagnostic accuracy, initiate or escalate controller therapy when indicated, improve adherence and caregiver understanding, and reduce acute care use.

Design/Methods: The clinic was staffed by a pediatrician or nurse practitioner, a respiratory therapist, and a pharmacist. Patients were referred from EDs, hospital discharges, and outpatient clinics. Each completed the Asthma Control Test (ACT), had peak flow measured, and received individualized asthma action plans, trigger counseling, and when indicated, cetirizine or montelukast for allergic triggers. Pulmonary function testing was performed when diagnosis was uncertain. Follow-up was scheduled at one month for new therapy starts and six months for established patients.

Results: From June 2024–June 2025, there were 64 visits (45 new, 19 follow-up). Of new referrals, 17 (38%) had intermittent asthma, 23 (51%) required SMART therapy, three (7%) needed step-up therapy, and two (4%) had normal PFTs and were not asthmatic. Nineteen returned for follow-up; 17 (89%) remained adherent. Six patients had ED visits within six months—two had not started therapy—and no hospitalizations occurred.

Conclusion(s): A dedicated asthma clinic for Native American children improved diagnostic accuracy, adherence, and symptom control while eliminating hospitalizations in its first year. Over half required initiation or escalation of controller therapy, reflecting baseline undertreatment. Family education, home monitoring, and consistent follow-up were key to success. This community-driven model demonstrates the impact of structured asthma management in underserved populations and provides a framework for replication in similar rural settings.