Parents of elementary students with asthma at three Bayview Hunters Point schools in San Francisco can expect their children to bring home more than just books and homework assignments this spring. The students likely will be waving personalized asthma treatment plans and gushing about the fancy gadgets that let them interact with an asthma expert at Lucile Packard Children’s Hospital.

Paul Sharek (left) and David Bergman test the two-way video monitors that will be used to link physicians to elementary students with asthma. They hope to improve children's health with personalized disease management plans and real-time video consultations with asthma specialists. PHOTO: KRISTA CONGER

Students will be some of the first in the nation with asthma to benefit from telemedicine — an emerging field that relies upon two-way interactive video and specialized medical instruments to allow physicians not only to talk to their young patients from a distance but also to listen to their chests and inspect their ears. Behind the knee-jerk "cool" factor, though, lies an alarming statistic: Up to 30 percent of the total student population in the area may be fighting asthma — often with inadequate or out-dated treatment plans.

"My guess is that at least some of these students are going to school feeling sick," said the study’s principal investigator David Bergman, MD. "These kids frequently don’t get the medication they need to mitigate or eliminate their symptoms."

Bergman, an associate professor of pediatrics in the School of Medicine, and co-investigator Paul Sharek, MD, staff physician in pediatrics, were recently awarded over $600,000 by the California Endowment to design and implement a two-year pilot program to bring specialized asthma care to the students in the Bayview Hunters Point neighborhood. Asthma rates in the predominantly low-income, African-American community area are about twice the national average, most likely due to a combination of ethnic, economic and environmental factors.

The researchers hope to improve the students’ health and reduce the behavioral problems, poor academic performance and difficulty exercising sometimes associated with the disease. The program will also be among the first to systematically analyze the potential clinical benefits of telemedicine.

Bergman, Sharek and Dale Umetsu, MD, PhD, chief of the division of allergy and immunology at Packard Children’s Hospital, first put their heads together six years ago to design a coordinated plan of asthma treatment, education and management for low-income children. However, they found that conflicting work and school schedules caused the patients to miss about half their appointments. So the researchers banded together with the San Francisco School District and Public Health Department, the Asthma Resource Center, community health workers and local pediatricians to take their fight into the trenches.

"We thought ‘why not go to the schools, where the kids are for 160 days a year," said Bergman. Students at the test schools will have a total of six visits with their school nurse and two remote "visits" with an asthma specialist at Packard Children’s Hospital. The specialist will assess the student’s health through pulmonary function and medical histories during a real-time video consultation. They will design a personalized disease-management plan for each student, including written instructions on how to use medications based on daily measurements of peak air flow. Subsequent visits will allow the specialists to review proper inhaler and peak flow meter technique with the students.

"We know that asthma specialists tend to be more aggressive than general pediatricians with therapies, such as inhaled steroids and long-acting beta agonists," said Sharek, who also noted that only about 50 percent of all kids with asthma have a disease-management plan.

Community health workers will also be enlisted to visit students’ homes to assess environmental factors such as dust or insects and to teach parents about asthma management. Examination results, prescriptions and the specialist’s comments will be integrated into a Web-based asthma management plan that will be shared with the students’ primary care providers.

The researchers will also gather data to assess the clinical effectiveness of telemedicine. Previous telemedicine programs have been evaluated only on the number of patients seen and their satisfaction with the program.

"We’re actually going to look at disease-specific outcomes: pulmonary function tests, utilization of health care and quality of life," said Sharek. "Until now, telemedicine has been seen primarily as a health care access tool, which it is, but there hasn’t been evidence that it improved clinical outcomes." But that’s not why the researchers are eager for positive results.

"The hope is that the child will get more involved in the management of their disease," said Sharek. "A well-educated child and family will be in better control. It’s an empowerment issue."