Outcomes of the Navajo Community Asthma Program during the COVID-19 pandemic

Background: Despite elevated rates of asthma among Native American children, few interventions have been tested on tribal lands. Objective: Our aim was to test whether the Community Asthma Program reduced the number of asthma exacerbations on the Navajo Nation. Methods: Following 1 year of community engagement meetings on the 27,000–square mile Navajo Nation, a 7-year, stepped wedge study was commenced sequentially in 3 communities, each with its own Indian Health Service medical center and school system. Health care staff were trained in evidence-based guidelines for the management of childhood asthma. School staff were trained in the American Lung Association Asthma 101 and Open Airways for Schools programs. Stock inhaler programs were implemented in schools. The primary outcome, asthma exacerbations, was defined as emergency room visits, hospitalizations, or oral corticosteroid requirement. With the arrival of the coronavirus disease 2019 (COVID-19) pandemic in the second year of the program, schools and medical clinics were closed. All medical visits were conducted through emergency departments. Training in the third community was delayed by 1 year. Results: A total of 439 health care and school staff were trained either in person or virtually. Reflecting national trends, the numbers of asthma exacerbations fell dramatically during the pandemic. After control for the effect of the pandemic, asthma exacerbation visits increased by 53% and routine visits increased by 56%. Conclusions: Although the impacts of the pandemic and the program on asthma exacerbations are difficult to disentangle, the collective evidence indicates that that the program led to increased community awareness of asthma and increased asthma care–seeking behavior by families of children with asthma.