College Students With Asthma: The Perfect Storm

As health care costs continue to rise, management of chronic diseases such as asthma becomes paramount. A great deal of attention has been focused on asthma management for children and adolescents, ranging from school-based programming^1,2 and community health workers³ to shared decision making.⁴ However, the transition to adulthood goes largely unaddressed. It has been noted that college students with asthma face reduced psychological and academic functioning,⁵ reduced social functioning and quality of life,⁶ and increased risk taking and depression⁷ compared with their healthy counterparts. For these reasons, they represent a vulnerable population.

The American Academy of Pediatrics reports that the decade-old consensus statement recommending a smooth pediatric-to-adult transition in care for those with chronic health needs has not been fully implemented in clinical practice.⁸ Moreover, transition guidelines have not even been addressed on college campuses. A representative survey of United States colleges⁹ indicated that fewer than 10% of student health centers actively reach out to an entering student with a medical history of asthma for an initial appointment, and over 40% of schools have no formal system for identifying students with chronic illnesses. The schools that do are more likely to be smaller, private schools. Nevertheless, 83% of student health centers reported that they had the capability to manage asthma on campus.

But can they? In this issue of Respiratory Care, the ability of college student health centers to manage asthma is questioned. Collins et al¹⁰ noted that less than one fourth (23.5%) of their sample offer individual action plans, and only about one third (35%) have emergency action plans, yet most remain satisfied with the asthma services they offer students, with the caveat that affected students largely underutilize their services.

What does this mean for students with asthma entering college for the first time? What about those who will attend a large university, where the chance of being noticed is small? What if the large university is located in a city named as one of the most challenging places to live with asthma, having worse-than-average crude death rates and emergency department visits for asthma?¹¹ Furthermore, what if the student health center does not embrace best practices, such as asthma action plans? A perfect storm ensues.

Let us consider the options for primary prevention of this perfect storm. First, as Mellinger¹² suggests for college students with diabetes, the student's clinician could arrange for an introductory meeting at the student health center upon the freshman's arrival on campus. Second, the student health center could develop a registry and conduct a deliberate outreach to incoming students with asthma. Third, the student health center could, as a policy, implement state-of-the-art protocols, such as asthma action plans. Finally, the university could implement a vigorous marketing campaign directed to students with chronic diseases to make them feel welcome and engaged. This might have great appeal to parents seeking a college for their child with asthma.

From a public health standpoint, poor asthma control among college students can have dire consequences on physical, academic, and economic well-being. By implementing national guidelines for transition, mandating established standards of care, and taking a proactive stance, the student health center can be a port in the storm.

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