Improving outcomes among children with asthma through real-world evidence and targeted intervention


A five-year study found that children with asthma are 2.5 times more likely to experience an exacerbation in September compared to the prior summer months. As a result, a multi-pronged approach is being developed to prevent this predictable outcome among those at highest risk.

Context and Aims

The “September spike” in asthma is a well-documented phenomenon worldwide; however, efforts to prevent this occurrence through controller therapy have yet to be implemented on a large scale.

The Clalit Research Institute aims to measure and monitor trends in asthma among children. As a result of a preliminary study showing a repeated spike in asthma-related healthcare utilization during September, this research is being translated into a preventive initiative. In partnership with Clalit Health Services, the Institute is designing a multi-pronged targeted outreach intervention as a pilot to reduce asthma exacerbations during September.

Research Approach


To monitor trends in asthma and related health care utilization, medication purchases, outpatient or inpatient visits for asthma and chest radiographs are tracked.


Children with asthma are being identified using multiple sources from our electronic medical records system. Outpatient record diagnoses (during a clinic visit) are collated. Children with persistent active asthma (‘high-risk’) are then identified by recent controller medication prescriptions or recent hospital admissions for asthma exacerbations, and are being targeted if they did not purchase a controller medication within the two months prior to September.

Trends in asthma before and after the implementation of the intervention will be measured.


Key Findings and/or Potential Impact

We found a similar trend as other studies identifying an increase in asthma-related symptoms and health care utilization at the beginning of each school year from 2005-2009. The majority of children with asthma who experienced the September spike did not receive treatment in the preceding summer.

As part of the pilot intervention, Clalit Health Services is identifying and informing parents of children with persistent active asthma of the importance of starting controller medication prior to symptoms. This proactive outreach intervention is being implemented to prevent the September spike.




Cohen HA, Blau H, Hoshen M, Batat E, Balicer RD. Seasonality of asthma: a retrospective population study. Pediatrics, 2014. 133(4): e923-32.