Academic journal article Journal of School Health

Introduction: Learning from Each Other about Managing Asthma in Schools

Academic journal article Journal of School Health

Introduction: Learning from Each Other about Managing Asthma in Schools

Article excerpt


Asthma is a major public health problem of increasing concern in the United States; (1,2) between 1980 and 1996, the lifetime prevalence of asthma in the United States increased 45% among children 5 to 14 years of age. (2) In 2003, 7.6 million (14.3%) school-aged children had a diagnosis of asthma in their lifetime, and 5 million (9.5%) school-aged children currently had asthma. (3) On average, in a classroom of 30 students, about 3 are likely to have current asthma.

Asthma presents a considerable burden to families and society. In 2002, children aged 0-17 years had 5 million clinic and physician visits, more than 727,000 emergency department visits, and 196,000 hospitalizations due to asthma. (4) Indeed, asthma is the third-ranking cause of hospitalization among US children younger than 15 years. (5) Asthma can be fatal: 187 children aged 0-17 years died from asthma in 2002. (4) The impact of emergency department visits, hospitalizations, and deaths due to asthma is disproportionately greater among low-income populations, minorities, and children living in inner cities than in the general public. (6,7) The estimated cost of treating asthma in those younger than 18 years is $3.2 billion per year. (7,8)

The burden of asthma extends beyond these traditional measures of morbidity. Asthma symptoms not severe enough to require urgent care can still be severe enough to interfere with a child's ability to get a good night's sleep, play vigorously, and participate fully in academic or school-related physical activities. It is estimated that children miss almost 15 million days of school each year because of asthma. (4) School absence figures vary widely depending upon the population studied, the source of the data, and the questions asked. An analysis of the 2002 National Health Interview Survey found that parents report children with asthma miss about 3 more days of school annually than children without asthma. (8) Some students with asthma may be at a higher risk for poor school performance. (9)


Most of this burden can be prevented. Effective control treatments for asthma are now available so that most children with asthma should experience minimal symptoms, engage in ordinary activities, and have no school absences related to asthma episodes. (10) Why do children with asthma continue to suffer? There are several possible explanations: children with asthma and their families may not appreciate that the child's asthma is out of control and can be effectively treated; children and families may not consistently follow a prescribed asthma management plan; children may not have appropriate or consistent medical care; children may not receive effective self-management education; the school environment, where children spend most of their waking hours, may not allow them to follow their management plan.

Schools can play a major role in addressing these problems. Asthma-friendly schools have policies and procedures that help students and their families learn about asthma management, allow students to successfully manage their asthma during school hours and school events, and facilitate communication with the family and the family's medical care provider about the child's asthma. (11,12) School-based asthma education programs teaching self-management skills and behaviors may improve overall control of asthma and school performance. (13,14) School nurse activities, like case management and medication administration, can facilitate the use of quick-relief medications at school and reduce asthma symptoms. (15,16)


One of the most important functions of schools has always been to maintain and improve health. (17,18) However, schools cannot do it alone. They need meaningful commitments and collaboration from the community and especially from the health sector. …

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