UA Collaborative Research Project: Managing Asthma in Youth on the Navajo Nation

Hanna Phan and UA colleagues are helping to improve asthma care to the Navajo Nation.
"We will learn from each other, from the community -- with the common goal of improving asthma care for the community’s children."

Hanna Phan, PharmD, FCCP is the only pharmacist on an interprofessional team of researchers working with the UA Asthma and Airway Disease Research Center, helping to lead an effort to teach children, families, teachers and school nurses how to manage asthma in youth.

The project, funded by an $8.5 million grant from the National Heart, Lung, and Blood Institute, brings two widely successful programs that aims to improve asthma care over a six-year period to the Navajo Nation. This is the first large effort to address health disparities in the Navajo Nation where asthma rates are two to three times higher than in the general population.

Dr. Phan’s background in pediatrics, pharmacy, medication adherence, and pulmonary care made her a natural fit for the research team.

“The research team was looking for someone with medication and school health expertise,” said Dr. Phan. “I was fortunate to have previously worked with Dr. Lynn Gerald, a PI for the grant, and one of my mentors here at UA. My research interest is in medication adherence, so, when asked if I was interested in collaborating with her and Dr. Bruce Bender—who are both internationally known for their work in adherence—I was in awe and deeply honored.”

Together, the team will observe what is happening, understand the challenges of managing asthma in youth and develop potential programs with the community, from school to health care system.

The project will be managed through a collaboration between National Jewish Health, the nation’s leading respiratory hospital, and the UA Asthma and Airway Disease Research Center. The project will utilize the National Jewish Health Asthma Toolkit Program that has been used to teach caregivers across Colorado how to diagnose and manage asthma, and the University of Arizona School Asthma Program, which has provided asthma education and care coordination through public and private schools. The grant is one of only four awarded to reduce health disparities for children with asthma.

Community advisory committees have been created to provide guidance and help form working partnerships with school systems, the Navajo Health Department, chapter houses and any other interested community groups. Meetings with community members have been met with success, and already new ideas have been generated and gaps in asthma education have emerged.

“We had a focus group with teachers, staff and school administrators—anyone who interacts with the kids. A suggestion was made to provide asthma education and arm school bus drivers with inhalers since these kids can spend hours on the bus due to the vast area where they reside in,” said Dr. Phan. “What if a child has an asthma attack on the bus and forgot their inhaler? These are the types of situations we hope to avoid by providing them with information and tools.”

The community asthma programs will be implemented in Tuba City, Chinle and Fort Defiance on the Navajo Nation. The programs will occur consecutively, one year each in each of the locations. This approach will allow investigators to compare outcomes before and after the program within each community. After the final program, there are two follow-up years where sustainability will be evaluated.

Researchers will measure several outcomes in each community, including urgent care/emergency department visits, hospitalizations, systemic steroid use, and adherence to prescribed asthma medication.

“It will be an excellent opportunity to work with fellow UA colleagues and establish new collaborative relationships with experts from National Jewish Health and The University of Utah. We will learn from each other, from the community -- with the common goal of improving asthma care for the community’s children.”

This research was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under grant number 1U01HL138689-01.