BREATHE
Bringing Resources, Education and Asthma Treatment to Home Environments
Helping children with asthma breathe easier—starting at home.
Asthma is the most common chronic disease of childhood, affecting approximately 1 in 15 U.S. children. A child's environment—including the air they breathe and the conditions in their home—can play an important role in asthma symptoms and control.
BREATHE is a virtual asthma home visit program at Denver Health that brings clinical asthma education, environmental assessment, and care coordination directly into the home environment. The program helps families identify and address environmental and medication-related barriers that may otherwise be difficult to see during a clinic visit.
Why BREATHE?
Asthma doesn't stop at the clinic door.
Children spend most of their time indoors, and the home can contain environmental factors that trigger or worsen asthma. These can include:
- Mold and moisture
- Tobacco and vaping smoke
- Dust and dust mites
- Pets and other allergens
- Pests
- Indoor air pollution
- Poor ventilation
- Other housing-related concerns
Environmental exposures can contribute to airway inflammation and increased asthma symptoms. At the same time, families may face barriers to medications, inhaler technique, follow-up care, or making changes to their home environment.
These challenges are not distributed equally. Social and economic factors—including housing conditions—can contribute to differences in children's exposure to environmental risks and differences in asthma outcomes.
The good news: some environmental triggers can be changed.
Evidence supports home-based, multi-trigger interventions for children with asthma. These programs can reduce asthma symptom days and missed school days and may reduce healthcare costs.
BREATHE builds on this evidence while using a virtual model that connects families with a clinical provider and practical resources.
Why visit the home?
A clinic visit gives us an important view of a child's health. A home visit gives us a different view.
During a virtual home visit, families can show the BREATHE team their child's living environment, including where they sleep, play, and spend time. This can help identify environmental triggers and practical barriers that may not come up during a traditional clinic visit.
The program combines:
Clinical care
Asthma education, medication review, inhaler and spacer technique, and asthma action plan review.
Environmental assessment
Identification of potential triggers such as mold, smoke, pests, allergens, and other indoor air quality concerns.
Practical solutions
Education and, when appropriate, free home supplies such as HEPA air purifiers, HEPA filter vacuums, humidity detectors, and protective covers.
Care coordination
Connections to primary and specialty care, social work, community organizations, and other resources when needed.
From home visits to BREATHE
A program that evolved to meet families where they are
2015-2020
Original home-visit program
Confirm original launch date
The original Denver Health program used in-home visits to address both asthma management and environmental conditions contributing to poor asthma control. A multidisciplinary approach helped families identify home-based triggers, reinforce medication skills, and connect families with resources to address housing-related concerns.
2020–2021
A virtual pivot
The COVID-19 pandemic prompted a shift away from traditional in-home visits. The program evolved into a virtual model focused on maintaining clinical connection, providing asthma education, identifying environmental concerns remotely, and prioritizing low-cost, high-impact interventions.
2021
BREATHE launches in its current model
The Intensive Asthma Education Program began its current virtual model in 2021. Since then, it has reached 261 patients.
The program identified environmental triggers and asthma-management barriers across participating homes and provided tailored education, supplies, and connections to additional services.
Today
BREATHE
BREATHE continues to bring clinical asthma education and environmental health expertise together, with a focus on reaching children and families who may benefit most from additional support.
What happens during a BREATHE visit?
Eligible Denver Health patients are referred to the program and scheduled for one to two virtual visits, generally lasting about 60 minutes each. Families can participate with their camera on or off, depending on their comfort level.
The visit is tailored to the child and family's needs and may include:
1. Understand the home environment
Families and the BREATHE team work together to identify potential environmental asthma triggers, including mold, smoke, pests, allergens, and other indoor air quality concerns.
2. Strengthen asthma management
The nurse practitioner reviews asthma symptoms, medications, inhaler and spacer technique, and use of daily controller medications.
3. Review the asthma action plan
The team reviews the child's asthma action plan and helps families understand what to do when asthma symptoms change.
4. Connect families with resources
When needed, the team helps connect families with primary and specialty care, social work, community organizations, and resources related to housing or other barriers.
5. Provide practical tools
Eligible families may receive home supplies at no cost, such as:
- HEPA air purifiers
- HEPA filter vacuums
- Humidity detectors
- Pillow and mattress protectors
- Non-toxic cleaning supplies
Additional referrals may be available for home supplies through community partners.
Who is eligible?
BREATHE currently serves Denver Health pediatric patients with asthma whose parents or caregivers agree to participate.
There is no additional requirement based on the number of emergency visits or severity of asthma; the program is available when a Denver Health clinician believes the family may benefit from additional asthma education and support.
Who can refer?
Referrals can be made by Denver Health:
- Primary care providers
- Allergy and asthma specialists
- Emergency department providers
- Hospital teams
Families who receive their child's care at Denver Health can also ask their pediatrician about the BREATHE program.
Who runs BREATHE?
BREATHE is led by a nurse practitioner with experience in asthma care who also works in Denver Health's pulmonary and primary care clinics.
The program is supported by Rocky Mountain PEHSU, with funding through a PEHSU partnership with the U.S. Environmental Protection Agency (EPA).
The BREATHE team works alongside the child's existing healthcare team rather than replacing primary or specialty care.
What have we learned?
Our experience with virtual home visits has shown that looking at the home environment can uncover barriers that may otherwise remain invisible during a clinic visit.
During 2024–2025, the program identified:
Poorly controlled asthma
More than 20 children needed additional asthma-management support, including inhaler/spacer and SMART therapy education.
Environmental triggers
Potential triggers were common across participating homes, including pets, cockroaches, mold/moisture, and tobacco or vaping exposure.
Medication barriers
Incorrect inhaler technique and challenges with medication use were frequently identified.
Housing concerns
Some families needed help addressing mold, pests, ventilation, or other housing-related issues.
The program responded with individualized asthma education, environmental interventions, home supplies, smoke-exposure counseling, and connections to community and social resources.
Evaluating BREATHE
We are continuing to evaluate the program to better understand whether and how virtual home visits improve asthma outcomes and how the program can best meet families' needs.
Our evaluation work includes:
Looking back
A retrospective evaluation will examine whether participation in the program was associated with measurable changes in asthma outcomes and healthcare utilization.
Learning from families
A prospective evaluation will ask families about their experience with the program and use their feedback to improve how asthma and environmental health education is delivered.
Looking ahead
Future program development will explore:
- Integrating more education about climate change and outdoor air quality
- Reaching additional high-risk patients at Denver Health
- Strengthening connections with inpatient care
- Expanding the model to additional communities across Colorado and the Region 8 PEHSU network
BREATHE is one part of a bigger solution
Changing the home environment can be an important part of asthma care—but families should not have to solve environmental health problems on their own.
BREATHE brings together clinical asthma care, environmental health education, practical interventions, and connections to community resources to help families address the factors that affect their child's health.
Our goal is to continue learning from families and partners and develop approaches that can reach more children across our region.
For you
For Families
Does your child receive care at Denver Health?
If your child has asthma and receives care at Denver Health, ask your pediatrician whether BREATHE may be appropriate for your family.
BREATHE does not replace your child's regular asthma care. Your pediatrician or asthma specialist remains your first point of contact for medical concerns.
Not a Denver Health patient?
You can still find practical information about asthma and environmental health through our:
These resources can help families learn about environmental asthma triggers and ways to create healthier indoor environments.
For Clinicians
Interested in bringing a program like BREATHE to your organization?
We are interested in sharing what we have learned from developing and implementing a virtual asthma home visit model.
If you are a healthcare professional in Colorado, Montana, North Dakota, South Dakota, Utah, or Wyoming and would like to discuss developing a similar program at your institution, contact Rocky Mountain PEHSU.
We can share information about program structure, virtual home assessment, environmental health education, potential interventions, and lessons learned from implementation.
For Community Members & Organizations
Want to help families create healthier homes?
Rocky Mountain PEHSU provides education and resources for community organizations, schools, early childhood programs, and others interested in children's environmental health.
We can provide educational sessions and materials on healthy homes and environmental asthma triggers for community groups and organizations across our region.
Interested in a presentation or educational materials?
Explore more
Asthma & the Environment
Learn about environmental factors that can contribute to asthma and ways to reduce exposure.
Healthy Homes
Explore practical information about mold, pests, indoor air quality, smoke, and other home environmental concerns.
Education & Outreach
Find trainings, presentations, and educational resources from Rocky Mountain PEHSU.
Ask PEHSU
Healthcare professionals can contact PEHSU for consultation about pediatric environmental health concerns.