Answers provided by Mary Beth Bollinger, Director and staff

1) What is the name of the asthma mobile program in your city?

Our unit is called "The University of Maryland Hospital for Children Breathmobile". It is a 34-foot long mobile asthma and allergy clinic that provides evaluation, management and education services to children at their schools free of charge. It is the first of its kind on the East coast. The Breathmobile is staffed by a pediatric nurse practitioner, a nurse, a pulmonologist or allergist, and a driver/assistant. It is equipped with 2 exam rooms, a spirometry room (a test to evaluate lung function), and a space for allergy skin testing and asthma education. We service Baltimore City and Prince Georges County, Maryland.

2) When was it established?

The University of Maryland Breathmobile has been in operation since March 2002.

3) How and why was it established?

Asthma, a chronic incurable lung disease, is the leading cause for children to be absent from school and the number one reason children are brought to hospital emergency rooms. Statewide, children miss over 640,000 days of school per year; 10 million school days are lost nationwide (1993 statistics). Baltimore City children have a higher prevalence of asthma than children statewide. Eighty percent of the children currently enrolled in the Baltimore City CHIP (Children's Health Initiative Program) program have asthma. During a one-year period, 8,516 children were treated in Baltimore- area hospital emergency rooms for asthma attacks (1997 statistics). When children are chronically ill and are unable to attend school on a regular basis, they tend to fall behind in their studies and learning development skills. Children with asthma are three times more likely to miss school than children without asthma. Without the proper intervention and follow-up care, the worst-case outcome for children with asthma is death. Over 5,000 people die each year in the US from asthma (CDC data), and a disproportionate number are African American. One of the highest risk groups is school-aged children.

The University of Maryland Breathmobile program was established to address the asthma problem in Baltimore by providing improved access to specialized preventive care right at the neighborhood schools. This program is based on the model created and established by a collaborative program developed by the Southern California Chapter of the Asthma & Allergy Foundation of America and Dr Craig Jones, an allergist. Elements of their successful program have been incorporated into the Baltimore model, with modifications added to best suit our climate and population. The University of Maryland Hospital for Children decided that a Breathmobile was essential to keep children healthy and in the classroom.

4) Who is served by the clinic?

The Breathmobile serves 19 schools (elementary and middle) in Baltimore City, 4 Baltimore City Headstart Centers, a Latino Community Center and 1 school in Prince George's County (with students referred from 10 area schools).

5) How does the mobile clinic work in your city -- where does it go and when, and how does your team publicize the routes?

The Breathmobile is operational Tuesday-Friday. Each site is revisited every 4-6 weeks to provide continuity of care. Appointments are scheduled in advance with the assistance of the school health nurses and aides. Parents are called the day prior to the visit to remind them of their appointments. Each visit includes: a complete history and physical, lung function assessment by spirometry, prick skin testing for common environmental allergens and extensive asthma teaching. Knowledge of asthma medications, triggers, equipment such as spacers and peak flow meters is assessed. Patients and caregivers are given patient-specific instructions about environmental controls, action plans for exacerbations and proper use of medications. At the conclusion of the visit the kids are given a follow up appointment depending on their severity. All sites and the schedule of visits are posted on our website www.umm.edu/breathmobile.

6) How do parents and kids find out about the services offered?

The schools are provided with an asthma screening questionnaire to distribute to students to determine who may benefit from Breathmobile services. Students are referred to the Breathmobile by school nurses, parents, primary care providers and local hospitals. The Breathmobile also participates in numerous community health fairs and has been featured in local newspapers, asthma related websites, local news broadcasts, and local health department programs. Potential patients can also access our website, www.umm.edu/breathmobile.

7) How are the services funded?

The Asthma and Allergy Foundation of America MD-DC provided funding for the Breathmobile unit and most of the first year operating costs of the service from their national office. Sustaining funds have been obtained from a number of donors including pharmaceutical companies, local foundations, insurance providers and individual donors. Some of our donors over the last 3 years include Baltimore City Public Schools, Apple Ford, the Maryland Statewide Health Network Other Tobacco-Related Diseases Grant, the Thomas Wilson Sanitarium, Associated Black Charities, GlaxoSmithKline, Rite-Aid, Abell Foundation, Aetna, and many others.

8) What gaps does this program fill in your city?

Numerous studies have shown that asthmatic children receiving care by asthma specialists have an improved quality of life and less need for emergency treatment and hospitalizations. Despite this improved management by specialists, less than 10% of patients with asthma have access to specialty asthma care services. This number is much less in underserved populations where access to specialty care is even more limited. Missed days of school and work traveling to clinics are reduced by the University of Maryland Hospital for Children Breathmobile, because services come to the children and their families right in their own neighborhoods.

9) How many kids are served by your program, per day and each year?

During the 2003-2004 school years the Breathmobile had 1200 visits. The average daily number of children seen is 8-10. The Breathmobile has serviced approximately 1000 children and about 600 children are actively receiving continued care in the program.

10) Over the last 10 years, how has the asthma rate changed for children in your area?

There are limited data to answer that question but I would refer you to this website:
http://www.marylandasthmacontrol.org/mch/pdf/Asthma2002Report.pdf. We do know that the prevalence rates that we are seeing in our schools are as high as 20 percent, which is much higher than the national average.

11) How is your program affecting the kids you serve?

During the first 3 years of the program, the Baltimore Breathmobile has seen an improvement in the health of the children involved in the program, a decreased number of lost school days, an increased use of preventive asthma medications and decreased number of emergency visits for asthma. Children seen for at least 3 visits (a number determined by the Los Angeles Breathmobile to have the greatest impact) had a decrease in lost school days from an average of 4.8 days/year at baseline to 1.9 days/year after 3 visits. Emergency department visits decreased from an average of 1.65 to 0.37 per year and hospitalizations from 0.29 to 0.09 per year. Patients also reported less exercise- induced symptoms.