How might school-based asthma management and are programs overcome resource constraints and be sustained over time? Sustainability in the context of health programs has been focused on the program’s ability to continue to achieve positive health outcomes among participants, sustain activities, and continue to build the capacity of the community to continue activities after the end of funding.18 Without a regular influx of money to provide resources for program implementation, staff, equipment, etc, to sustain the work and the outcomes, the services and practices being provided through the programs need to be taken up by the agency implementing the program and absorbed into its day-to-day processes. There is much literature regarding the benefits and strategies involved in this absorption of the work, which is most often referred to as the institutionalization of health promotion programs.16-18 Institutionalization of health promotion programs was first discussed by Goodman et al,16 who defined it as occurring when a program is sustained as an integral part of an organization. Institutionalization does not require the formalized writing of policies or regulations, but the continuation of procedures or routines in the day-to-day process of the organization.19 School-based interventions may be sustained through policy and practice changes both interinstitutional—change occurring in the ways institutions, caregivers, and other entities interact with each other—and intrainstitutional—change occurring within one institution.20 Friedman et al21 outlined the 4 sustainability strategies that emerged from the Allies Against Asthma work as resource development, institutionalization, system change, and capacity building. These approaches, which can occur both within and between organizations, were reported to help sustain the work of the Allies Against Asthma coalitions over time.