Asthma symptoms are among the top reasons why school-aged children miss class. Those absences can hinder academic performance and the ability to graduate and move on to higher education and the workforce.
It’s why University of Colorado Anschutz School of Medicine faculty members are working with school districts across the state to identify effective ways to connect students who have asthma to the health care and resources that are best for them.
“If asthma is uncontrolled, it can completely change a child’s lifestyle,” says Stanley Szefler, MD, professor emeritus of pediatrics at the School of Medicine and former director of the Breathing Institute Pediatric Asthma Research Program at Children’s Hospital Colorado. “For the most part, asthma can be easily managed with good medical care, but often it’s a matter of getting these children there.”
More than 20 years ago, Szefler and colleagues started an effort to support local students with asthma. In 2005, the state health department helped fund several asthma navigators for Denver Public Schools, allowing school districts to better identify and assist students with uncontrolled asthma.
Today, the programming has grown to include various school districts across the state and may be a model for assisting schools help students manage other chronic health challenges.
AsthmaCOMP and the classroom
Asthma is one of seven educationally relevant health disparities that school leaders seek to address to eliminate the widening achievement gap between low-income and higher income students.
Asthma exacerbations can lead to a variety of outcomes that impact education and quality of life, including loss of sleep, fewer days in class, and activity limitation – which is why school can be a key point of intervention.
AsthmaCOMP (Colorado Comprehensive School-Centered Asthma Program), a statewide partnership with school nurses funded by the Colorado Department of Public Health and Environment (CDPHE) Cancer, Cardiovascular and Pulmonary Disease Program, supports asthma care in schools, and helps bridge the gap between access and health care that often exists for students with asthma, especially low income families.
“This program is incredible because it leverages a place where kids spend so much of their time during the day, and we’ve made that place a leading partner in health care,” says Heather De Keyser, MD, MSCS, associate professor of pediatrics and investigator at the Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS).
De Keyser has worked alongside Szefler and Melanie Gleason, PA, associate program director and senior instructor in pediatrics, to help connect children with asthma to the resources they need to thrive. That includes scaling AsthmaCOMP, the evidence-based program for addressing pediatric asthma disparities that Szefler started directing in 2006 for the Denver metropolitan area.
The AsthmaCOMP leadership team has helped maximize use of academic student information systems for children with asthma in Denver Public Schools to identify students with asthma that are not well-controlled. From there, they implemented programs to help ensure asthma care and rescue medications were available to students.
In the past few years, the team behind AsthmaCOMP has scaled their efforts beyond Denver through the Better Asthma Control for Kids (BACK) program, funded by the National Institutes of Health (NIH) National Heart, Lung and Blood funding into four additional regions in the state, each with a community advisory board to help tailor the implementation and approach to each community.
During the 2025-2026 school year, AsthmaCOMP recognized 221 schools across the state as being “asthma-friendly,” meaning they demonstrate the use of a comprehensive approach to asthma management that prioritizes well-being and improves academic achievement.
Funding from the state and NIH has allowed AsthmaCOMP to expand across Colorado, helping regional school nurse specialists provide asthma education and support to school nurses in selected areas throughout Colorado.
School nurses lead the way
Over the years, the program has seen impressive growth and De Keyser and Szefler say the program’s impact has been significant. Asthma navigators, community health workers trained to focus on asthma management in children, have been a large part of that success, helping improve education for students and their families, thinking proactively about care plans, and communicating with health care clinicians when necessary to help students best manage asthma symptoms.
Asthma navigators have helped more than 2,500 students and their families across the state by providing one-on-one coaching, care coordination, and assistance for overcoming barriers to health care. As a result, students are enhancing self-management skills and efficacy, better controlling asthma symptoms, and missing fewer days of school and participating more in physical activities.
“Good communication has been our ‘secret sauce’ in a lot of ways,” Szefler says. “You must have a trusting relationship with the school district to be effective. We’ve been fortunate to work with these partners for many years and show success, so these programs really do end up having impact.”
An effective school nurse-clinician interaction has enabled a strong foundation for identifying children who are not receiving optimal chronic disease care, the researchers say. Such efforts can leverage existing partnerships between schools and the health care system to improve the network for children with poorly controlled asthma.
A major component of helping school-aged children manage asthma has been the hard work from school nurses, a feat that is particularly impressive because there are so few across Colorado. The most recent data available from the states shows there are 804 full-time school nurses in a state of more than 881,000 K-12 students. In rural parts of the state, nurses may cover a region spanning up to 100 miles.
“We hope the asthma navigator position can continue as an aide to this work because it's where a school district asthma resource nurse can act as an educational leader and evaluate data. There is a big opportunity to learn from data especially as we continue into this era of artificial intelligence,” Szefler says. “That’s my hope for the future. That's where I've handed the program off and said, ‘Go for it.’”
Thinking beyond asthma
Through AsthmaCOMP’s efforts, there has been a sixfold increase in the number of students who have an asthma care plan and quick relief medication at school, data shows.
Success means there’s an opportunity to scale even larger than across Colorado. That would require additional partnerships, De Keyser and Szefler say.
“The vision is massive, if I'm being honest, because there's just such opportunity here. There's a vision to spread the asthma program even further.” De Keyser says.
Ultimately, implementation science shows that scaling is possible and the methods used to help students better control asthma could be made to work in other instances, too. Mental health, food allergy, and diabetes are areas where the researchers say they could see a method like AsthmaCOMP working.
“We're hoping that by making these connections with the school nurses, talking to gym teachers, and the facilities manager that we’re able to create these connections and hubs in schools where there can be conversations that are going to improve student health in general,” De Keyser says. “We want to recognize school nurses for the experts that they are and utilize the opportunities we have to help kids live their healthiest lives.”
