Telemedicine and School-Based Asthma Care: Evidence from TEAM-UP

Even though asthma is one of the most common chronic diseases in childhood, many children with persistent symptoms do not receive the level of preventive care recommended by clinical guidelines. Barriers to adherence, environmental exposures, and limited access to asthma specialists contribute to ongoing morbidity. These challenges are especially pronounced in underserved communities, where children with asthma are less likely to receive specialist care and more likely to experience emergency visits, hospitalizations, and school absenteeism.

To address this gap, a randomized clinical trial published in The Journal of Pediatrics examined whether a coordinated, school-based asthma program enhanced with telemedicine consultations from specialists could improve outcomes for children with poorly controlled disease. The intervention, called Telemedicine Enhanced Asthma Management–Uniting Providers (TEAM-UP), integrated daily school-based medication supervision with virtual specialty care. The study evaluated whether this model could strengthen guideline-based management for children whose asthma remained difficult to control within routine care systems.

Trial Design and Intervention

Researchers conducted the trial in Rochester, New York, enrolling 326 children aged 4 to 12 years between 2018 and 2024. All participants had physician-diagnosed asthma with moderate-to-severe persistent symptoms or evidence of poor control. Children were randomly assigned either to the TEAM-UP intervention or to enhanced usual care.

The TEAM-UP program combined two elements. First, children received directly observed therapy of their preventive asthma medication at school, supporting consistent adherence. Second, asthma specialists conducted telemedicine consultations after several weeks of observed medication use. These visits allowed specialists to review symptom history, evaluate treatment response, and adjust therapy according to guideline-based recommendations. Communication occurred among school nurses, caregivers, primary care clinicians, and specialists to coordinate follow-up care.

In contrast, children assigned to enhanced usual care were encouraged to pursue similar strategies, including specialist referral and school-based medication administration, but the research team did not facilitate these services or arrange telemedicine consultations.

Characteristics of the Study Population

The trial population reflected children at elevated risk for asthma morbidity. The mean participant age was 8.4 years, and 60% were male. Most participants came from historically underserved communities: 58% identified as Black, 35% as Hispanic ethnicity, and 80% had public insurance coverage. 40% lived in households where at least one smoker was present.

At baseline, asthma control was limited across the cohort. Children averaged 6.6 symptom-free days over a two-week period, indicating frequent symptoms. Nearly half had experienced at least one acute health care visit for asthma during the previous year. Although 72% reported using a preventive medication, only about one third had attended a preventive asthma visit and just 15% had seen a specialist during the prior year.

Improvements in Symptom Control

Looking at the results, children assigned to the TEAM-UP intervention experienced measurable improvements in asthma symptoms compared with those receiving enhanced usual care. Over the follow-up period, the average number of symptom-free days per two-week interval was significantly higher in the intervention group, reaching 9.8 days compared with 8.7 days in the enhanced usual care group.

Secondary outcomes demonstrated similar patterns. Children in the intervention group reported fewer daytime and nighttime symptoms related to asthma, and fewer days requiring rescue medication. The improvement in symptom-free days increased over time, with the intervention group showing a larger gain by the 12-month follow-up compared with children receiving enhanced usual care.

Effects on Health Care Use and School Attendance

Clinical benefits extended beyond symptom control. Children participating in the TEAM-UP program were less likely to require emergency department visits or hospitalizations for asthma. The odds of these acute care encounters were reduced by roughly half compared with enhanced usual care.

School attendance also improved. The likelihood of missing school because of asthma was significantly lower among children in the intervention group. By the end of the school year, caregivers of children in TEAM-UP more frequently reported that their child’s symptoms were mild or well controlled and that preventive medications had been used in the previous two weeks.

Implementation and Study Considerations

Several factors influenced interpretation of the findings. The trial was conducted within a single urban school district, which may limit generalizability to other geographic or health system contexts. The COVID-19 pandemic disrupted some elements of the program, temporarily shifting care from school-based supervision to home-based telemedicine visits when schools were closed. Symptom outcomes were primarily based on caregiver reports, which may introduce recall bias despite the use of symptom diaries.

The authors also noted that specialist care can vary between clinicians, and the study design did not standardize specific treatment adjustments during telemedicine visits.

Implications for Pediatric Asthma Care

The TEAM-UP trial provides evidence that integrating school-based medication supervision with specialist telemedicine consultations can improve asthma control among children with persistent symptoms. The program addresses two longstanding barriers in pediatric asthma management: inconsistent medication adherence and limited access to specialty expertise. Within this coordinated framework, children experienced more symptom-free days, fewer acute health care encounters, and fewer school absences.

Reference:

Halterman JS, Fagnano M, Tremblay PJ, Perry TT, Wang H, Mustafa SS, Ramsey A, Stern J. Effect of the Telemedicine Enhanced Asthma Management–Uniting Providers (TEAM-UP) program on asthma outcomes: a randomized clinical trial. J Pediatr. 2026;289:114872. doi:10.1016/j.jpeds.2025.114872.