Reviews and feature article
School-based asthma programs

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Asthma is prevalent in school-age children and contributes to school absenteeism and limitation of activity. There is a sizable literature on school-based interventions for asthma that attempt to identify children with asthma and improve outcomes. The purpose of this review is to describe and discuss limitations of screening tools and school-based asthma interventions. Identification of children with asthma may be appropriate in schools located in districts with a high prevalence of children experiencing significant morbidity and a high prevalence of undiagnosed asthma, provided there is access to high-quality asthma care. We review strategies for improving access to care, for teaching self-management skills in schools, and for improving school personnel management skills. Although studies indicate that school-based programs have the potential to improve outcomes, competing priorities in the educational system present challenges to their implementation and emphasize the need for practical, targeted, and cost-effective strategies.

Section snippets

Case identification of asthma in schools

A recent report from the American Thoracic Society has provided a comprehensive review of issues in screening for asthma in children both in the general population and in schools.9 Screening has the theoretical advantage of identifying undiagnosed and undertreated children. Questionnaires to identify students with undiagnosed asthma have been developed and validated across racial, ethnic, and socioeconomic groups. For example, Redline et al10 validated a 7-item screening tool to identify

Strategies to improve access to care

One strategy for improving control of asthma in school children is to ensure that the students have access to medical care, either in the school or in the community. A variety of approaches have been tried, all of which involve some degree of partnership among school personnel, health care providers in the community, and parents. Access to rescue care at school is perhaps the most widespread approach. In the majority of the public schools in the United States, students or their parents can work

Strategies to teach students self-treatment skills

School-based interventions have effectively improved asthma knowledge, self-treatment skills, and self-efficacy; reduced asthma morbidity, including reductions in symptoms, ED visits, and hospitalizations; and improved quality of life, including reductions in school absences and improved grades.39, 40, 41, 42, 43, 44, 45, 46, 47 The recently revised National Heart, Lung, and Blood Institute Expert Panel guidelines for diagnosis and management of asthma48 and a recent review by Clark et al49

Strategies to teach school faculty and personnel management skills

Given the significant amount of time children spend in school during the academic year, it is important for school faculty and staff to be educated about asthma and to have skills to prevent and to manage asthma. Although school nurses are the most common provider of school health services, only about one third of schools nationwide have full-time nurses, and one third have full-time health aides.22 In the absence of having a full-time medical staff, medication administration and asthma

Future directions

Several studies suggest that school-based asthma interventions can improve health outcomes and quality of life in children who have persistent asthma. However, the partnership of the educational and public health systems requires clearer delineation. Screening instruments need to be refined to identify those children who would benefit most from further assessment and treatment. A notable goal of school-based asthma programs is to have nurses present in the school. School nurses have important

References (64)

  • M. Kattan et al.

    Characteristics of inner-city children with asthma: the National Cooperative Inner-City Asthma Study

    Pediatr Pulmonol

    (1997)
  • T.C. Lewis et al.

    Identification of gaps in the diagnosis and treatment of childhood asthma using a community-based participatory research approach

    J Urban Health

    (2004)
  • K. Yeatts et al.

    Who gets diagnosed with asthma? frequent wheeze among adolescents with and without a diagnosis of asthma

    Pediatrics

    (2003)
  • K. Quinn et al.

    Racial and ethnic disparities in diagnosed and possible undiagnosed asthma among public-school children in Chicago

    Am J Public Health

    (2006)
  • M.G. Fowler et al.

    School functioning of US children with asthma

    Pediatrics

    (1992)
  • L.B. Gerald et al.

    An official ATS workshop report: issues in screening for asthma in children

    Proc Am Thorac Soc

    (2007)
  • L.B. Gerald et al.

    Validation of a multistage asthma case-detection procedure for elementary school children

    Pediatrics

    (2004)
  • S.P. Galant et al.

    Predictive value of a cross-cultural asthma case-detection tool in an elementary school population

    Pediatrics

    (2004)
  • S. Bonner et al.

    Validating an asthma case detection instrument in a Head Start sample

    J Sch Health

    (2006)
  • L.P. Boss et al.

    Population-based screening or case detection for asthma: are we ready?

    J Asthma

    (2003)
  • B.P. Yawn

    Asthma screening, case identification and treatment in school-based programs

    Curr Opin Pulm Med

    (2006)
  • The role of the school nurse in providing school health services

    Pediatrics

    (2001)
  • L. Kann et al.

    Overview and summary: School Health Policies and Programs Study 2006

    J Sch Health

    (2007)
  • M.P. Webber et al.

    Impact of asthma intervention in two elementary school-based health centers in the Bronx, New York City

    Pediatr Pulmonol

    (2005)
  • T. Oruwariye et al.

    Do school-based health centers provide adequate asthma care?

    J Sch Health

    (2003)
  • A.B. Balaji et al.

    School health profiles: characteristics of health programs among secondary schools

    Atlanta: Centers for Disease Control and Prevention

    (2006)
  • N.D. Brener et al.

    Health services: results from the School Health Policies and Programs Study 2006

    J Sch Health

    (2007)
  • O. Barbot et al.

    Using preprinted rescue medication order forms and health information technology to monitor and improve the quality of care for students with asthma in New York City public schools

    J Sch Health

    (2006)
  • T. McLaughlin et al.

    Evaluating the availability and use of asthma action plans for school-based asthma care: a case study in Hartford, Connecticut

    J Sch Health

    (2006)
  • B.L. Frankowski et al.

    Community collaboration: concurrent physician and school nurse education and cooperation increases the use of asthma action plans

    J Sch Health

    (2006)
  • C.M. Richmond et al.

    Asthma 411—addition of a consulting physician to enhance school health

    J Sch Health

    (2006)
  • J.-M. Bruzzese et al.

    Using school staff to establish a preventive network of care to improve elementary school students' control of asthma

    J Sch Health

    (2006)
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    Disclosure of potential conflict of interest: M. Kattan has received research support from the National Institutes of Health. D. Evans has received research support from the National Institute of Environmental Health Sciences, the National Heart, Lung, and Blood Institute, and the Merck Childhood Asthma Network. J.-M. Bruzzese has declared that she has no conflict of interest.

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