Academic journal article Journal of School Health

School-Based Asthma Case Finding: The Arkansas Experience

Academic journal article Journal of School Health

School-Based Asthma Case Finding: The Arkansas Experience

Article excerpt

INTRODUCTION

Schools are responsible for the safety of all students, including those with poorly controlled asthma. Current recommendations support individual case identification rather than population-based case finding? However, individual case identification might not adequately detect all students at risk. Accurate identification is important for planning appropriate preventive measures for day-to-day management and response to potentially life-threatening exacerbations. (2) The widespread problem of poorly controlled asthma (3,4) highlights the need for validated, easy-to-use tools to identify children at risk. A population-based case-finding study using an asthma survey (5) was conducted in collaboration with the Little Rock School District (LRSD). The aims of the study were to (1) identify students with asthma and students with undiagnosed disease and (2) characterize asthma severity for the purpose of school health services planning.

METHODS

Subjects. Parents of children enrolled in the 2002-2003 school cycle were surveyed in 36 schools in the LRSD. The study was approved by the University of Arkansas Medical Sciences Human Research Advisory Committee. Participation in the study was voluntary for both school nurses and parents. No incentives were provided.

Survey and Asthma Algorithm. The study used a guideline-based survey consisting of 11 multiple-choice questions and scoring algorithms developed and clinically validated by Jones and colleagues (5) (Table 1). Jones' (5) scoring algorithms, which combine asthma symptoms, symptoms with activity, emergency department (ED) visits, and medication use, correctly identified children with asthma with a sensitivity of 87% and specificity of 84%. To identify diagnosed students parents were asked, "Has a medical provider ever told you that your child has asthma?" (ie, lifetime prevalence) as recommended by the Centers for Disease Control and Prevention for the 2-pronged definition of asthma cases. (6) A packet including a survey and cover letter was prepared for every child in the schools. The letter included an explanation of the purpose of the survey and instructions for parents on how to complete and return the survey to the school. School nurses distributed and collected the packets. Nurses were instructed to follow the distribution process used to collect other health information at schools. The LRSD health coordinator managed data collection. Completed surveys were entered into an Access database with data checks built in.

Case Definition. Asthma cases were defined using (1) parent-reported asthma diagnosis and (2) validated symptom and utilization asthma algorithms. These variables were used to define the following 4 groups: (1) current asthma--children with a reported diagnosis and identified by an algorithm as having asthma, (2) possible asthma--children without a reported diagnosis but classified by an algorithm as having asthma, (3) controlled asthma--children with a reported diagnosis but not classified by algorithms as having asthma, and (4) non-asthma cases--children with no asthma diagnosis and not identified by algorithms as having asthma. School-reported cases were identified by the following question on a school health card: Does your child have any of the following conditions? (Asthma is one option.)

Asthma Severity. Scoring algorithms developed by Jones (5) included parent-reported respiratory symptoms and use of medication (physician or self-prescribed) to treat symptoms. These items were used to classify asthma severity using the National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines. (7) Objective lung function tests, considered impractical for population-based studies, (8) were not performed. In keeping with the NHLBI guidelines, individuals were assigned to the most severe classification for which any asthma feature occurred. (7) Symptoms with activity were assessed using the question: Does your child have episodes of cough, chest tightness, trouble breathing, or wheezing when they play or exercise? …

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