Physician has dedicated career to improving access to asthma care ‘that people deserve’

Key takeaways:

• Andrea A. Pappalardo, MD, improves access to asthma and allergy care.
• She helped start a program to get inhalers into 3,000 Illinois schools.
• She believes the physician voice is essential to health care advocacy.

When Andrea A. Pappalardo, MD, FAAAAI, FACAAI, became an allergist, she discovered how difficult it was for many people in her community to access asthma and allergy care, which motivated her to find ways to reach those who needed it.

Throughout her career, Pappalardo has personally gone to historically marginalized communities to provide vital care to children and adults, and she collaborated with key partners to implement a statewide initiative to help children with asthma in Illinois.

These accomplishments were far from easy, exacerbated by personal obstacles along the way, such as finding work-life balance as a single mother, obtaining tenure at her academic institution after a career shift from private practice and establishing herself as a clinician scientist with a unique research niche in her field.

“It is not always supported when you’re a strong woman who might have some ideas, directions and ambition that may not be the status quo,” Pappalardo said. “How do you overcome those challenges? You see them as opportunities to grow and figure out how to navigate or barrel through those roadblocks that are placed in front of you.”

Today, Pappalardo serves as a tenured associate professor of medicine and pediatrics as well as the allergy service director in the division of pulmonary, critical care, sleep and allergy at University of Illinois College of Medicine/UI Health (UIC). She recently served as the medical director of the Coordination of Healthcare for Complex Kids program, which began as a Medicaid Innovation Project to improve care coordination for children with chronic medical conditions that require integrative services to improve health outcomes.

She also worked for 7 years as a provider, then as medical director of Mobile Care Chicago, a mobile asthma and allergy service van that provides free care to children in Cook and Lake County schools in historically marginalized communities. She served Chicago neighborhoods such as Pilsen and Little Village, among others, to provide bilingual subspecialty care and expanded programmatic services while mentoring young attendings to do the same.

Path to public service

As soon as Pappalardo decided to go study medicine, she knew she wanted to see patients of all ages. She completed a combined residency in internal medicine and pediatrics at University of Chicago Medical Center. She had an interest in pulmonary disease and gained experience working with allergic reactions during residency, which sparked her desire to study allergy/immunology.

“I realized that allergy/immunology was the perfect setup,” Pappalardo said. “We could take care of allergic diseases that are very common and take care of whole families throughout the lifespan. I thought that was beautiful, and it was exactly what I wanted to do.”

After finishing her allergy/immunology fellowship at Cook County Hospital and Rush University, Pappalardo searched for an academic position with a dual appointment in internal medicine and pediatrics — a setup she said is not very common for a subspecialist.

While searching for her dream job at a university, Pappalardo spent several years working at a private practice in a Chicago suburb. She enjoyed working with patients and taking on complex cases, but it was disheartening when she was unable to follow up with patients on Medicaid.

“I understood what private practices need to survive, and Medicaid reimbursement is much lower than the time we spent with patients at our normal hourly rate,” Pappalardo said. “But, at the same time, I could not reconcile that within myself.”

Luckily, Pappalardo found the dual appointment position she now holds back at UIC where she received her medical degree, which has afforded her the opportunity to work with all Illinois residents as UIC is a safety-net hospital. Since she began her tenure, she has focused her energy and research on improving asthma and allergy care for those who need it most and learning how to address systems-level challenges in the health care system to improve the patient and provider experience for all, she said.

Connecting with the community

Pappalardo said that during her residency she realized how important it was to improve access to asthma care and maintain continuity of care with patients.

“I saw some of the most severe asthma I have ever seen in my life, including patients requiring intubation for asthma, and it made me respect the disease,” Pappalardo said. “I got to see what goes wrong when there is no access or continuity of care.”

Instead, she realized providing continuity of care and the “access that people deserve” could help better control their asthma and improve their outcomes.

In her role at UIC, she has taken multiple steps to make those changes. She was heavily involved in screening children for asthma and skin allergies with Mobile Care Chicago’s “Asthma Vans” — converted RVs that offer spirometry and skin testing at local schools — and she eventually became the program’s medical director.

She is also working with Food Allergy Research and Education (FARE) to increase food allergy awareness and education, mostly in Chicago, but also within urban and rural areas across the nation. The educational campaign involves teaching community members about food allergy misconceptions and connecting people with allergists to facilitate guideline-based food allergy management.

Along the way Pappalardo has said she has learned the importance of physicians becoming involved in advocacy.

“We need the physician voice, especially the voice of subspecialists, within those conversations about fixing the health care system,” she said. “That is what has prompted me to do a lot of work within implementation science and addressing asthma and allergy care at the basic level and within the community in the school setting, to provide a service to those who are otherwise disenfranchised.”

RESCUE Illinois Schools program

As Healio previously reported, in 2018, Pappalardo successfully pushed for legislation to allow Illinois schools to stock asthma medication for emergencies through the RESCUE Illinois Schools program. In 2023, the Asthma and Allergy Foundation of America – MidStates Chapter secured $2.4 million in state funding to provide inhalers to 3,000 schools. As of today, 80% of schools in the state have been supplied with albuterol inhalers.

“We wanted to get inhalers into schools to avoid emergency room visits and keep kids in school,” Pappalardo said. “Because when students are not in school, they do not learn, they do not reach their potential, they [go on to] make less money and have more chronic diseases as adults with uncontrolled asthma.”

Further, Pappalardo’s project provided training for school staff to manage asthma.

“We cannot just give them inhalers and say, ‘Good luck,’” Pappalardo said. “We had to establish a protocol and train more people than just the school nurse, because sometimes there is no school nurse.”

According to a press release from the Illinois Department of Public Health, in the first 5 months of the 2023-2024 school year, 126 schools in 96 districts reported using the provided inhalers. Seventy-nine percent of students returned to class and 20% went home with a parent or guardian. Only two students needed to be transported to hospitals.

With the success of this initiative, Pappalardo has begun working with groups in Wisconsin to implement similar legislation. This summer, she is planning to expand on this research to establish a follow-up network for children who experience asthma symptoms at school and to improve Medicaid access to subspecialty care.

Despite doing what she calls “unconventional research,” Pappalardo was promoted to a tenured associate professor at UIC, which she considers her proudest achievement in her career.

“Academic medicine traditionally promotes drug development and clinical trials, and my research is very practical,” Pappalardo said. “When something works and it is not getting to everyone who needs it, it does not do its purpose. That is where I come in and try to get the rest of the world on board.”

Reference:

• Illinois schools authorized to keep medication on hand to treat students’ respiratory distress. https://www.illinois.gov/news/press-release.29772.html. Published March 20, 2024. Accessed July 29, 2024.

For more information:

Andrea A. Pappalardo, MD, FAAAAI, FACAAI, can be reached at apappa2@uic.edu.