Supporting asthma guideline-based management by integrating patient navigators.

Adding navigator-supported home visits modestly improved asthma control in high-risk adults.
*Randomized controlled factorial trial; Level 2 (OCEBM).

Citation

Apter AJ, Morales KH, Klusaritz H, et al. Supporting asthma guideline-based management by integrating patient navigators. Journal of Allergy and Clinical Immunology: In Practice. 2026. doi:10.1016/j.jaip.2026.09.009.

Background

Adults in low-income communities have higher asthma-related emergency visits, hospitalizations, and deaths. Patient navigators may help by improving access, visit preparation, communication, and attention to home and social needs.

Patients

350 adults with doctor-diagnosed moderate to severe asthma from low-income urban zip codes; most were Black women. Patients used inhaled steroid medicine and had a recent steroid course, emergency visit, or hospitalization for asthma. Key exclusions were not clearly reported.

Intervention

All received navigator-supported clinic preparation. Randomized additions were home visits, clinician feedback forms, or both.

Control

Navigator-supported clinic intervention alone, not usual care without navigation.

Outcome

Primary: asthma control score (0 to 6; lower is better) and asthma quality of life score (1 to 7; higher is better). Service use and prednisone use were secondary.

Follow-up Period

18 months: 3-month baseline, 12-month intervention, 3-month post-intervention observation.

Results

Analyses were intention-to-treat. The accepted minimally important difference is about 0.5 points for both primary scores; observed asthma control improvement narrowly missed this threshold, and quality-of-life differences versus control were not significant. Composite service outcomes were used; individual drivers were not reported.

Limitations

No group received usual care without a navigator, so the full navigator effect is uncertain. The pandemic shifted many home visits to virtual visits and may have changed asthma exacerbation rates. Service use was self-reported. Participants were a selected high-risk, low-income, mostly Black female group, limiting generalizability. Some statistically significant changes may not be clearly meaningful to patients.

Funding

National Institutes of Health; no company funding reported.

Clinical Application

Consider navigators for high-risk, low-resource asthma patients; evidence refines care but is not strong enough to mandate broad routine use.