Vol. 18 •Issue 19 • Page 28
School-Based Asthma Management Program Pays Big Dividends
Asthma prevalence has increased to epidemic proportions over the past several decades and now affects approximately 22 million Americans, including 4.8 million children under the age of 18. As a result, asthma has become the leading chronic cause of school absenteeism, accounting for more than 10 million lost school days.
In order to combat this disease, a coalition of asthma organizations formed a multi-disciplinary asthma management team in New Orleans to educate asthmatics during school hours. The rationale for implementing an asthma program in schools was based on the amount of time children spend in school, noting that school is where most children spend the majority of their awake and active hours.
Many asthma triggers are commonly found in schools, and numerous asthma attacks occur during physical activity in physical education classes and recess. The program stressed the importance of being in school, rather than home sick, and the correlation between proper asthma management and success in school. Other reasons for implementing a school-based program included having a captive audience, school was a natural learning environment and school provided ample discussion of common social issues related to asthma.
Our multi-disciplinary health care team includes a pediatric allergist and immunologist as the medical director and principal investigator, another pediatric allergist who served as the program coordinator, an epidemiologist, a nurse case manager and a respiratory therapist. The respiratory therapist was responsible for most of the clinical education, including diagnostic testing, monitoring, treatment modalities, development of the asthma action plan and outcome measures.
RT Inclusion in Efforts
Based on the results of the initial screening for asthma, the RT performed diagnostic testing such as pre- and post-bronchodilator spirometry. Proper use of a peak flow meter was emphasized for regular monitoring using the green, yellow and red zones described in the asthma action plan.
The RT provided hands-on instruction with the following treatment modalities: metered dose inhalers, dry-powder inhalers, spacers and nebulizers. Finally, the RT played a significant role in developing the patient’s asthma action plan and measuring program outcomes with the other members of the multi-disciplinary team.
In order to provide the program effectively throughout as many schools as possible, we contacted the appropriate decision makers for each school or school district. Depending on the design of the school district, we would meet with the school board, school principal, administrative secretary, school nurse or physical education teachers.
It was critical to obtain the cooperation and support from the school administrators.
Without question, schools with administrative support had the best educational outcomes. It is also important to note that very few schools in our area have access to a school nurse on a regular basis.
Consent Forms Used
The design of the program includes a screening consent form, the International Study of Asthma and Allergies in Childhood (ISAAC) screening tool and the National Institute of Health (NIH) Classification of Asthma Severity screening tool.
Individuals who meet the criteria for a positive asthma screen from the above tools are given an initial assessment which includes spirometry, a quality of life questionnaire and an evaluation of their educational understanding of asthma management. Follow-up assessments are performed monthly, at mid-year of the school year and annually to assess progress.
Our program has also been able to provide valuable resources for students enrolled in the program.
The real benefit of our program is the ability to complement our asthma education with practical devices and medications so that patients can monitor and treat their asthma. In other words, they can put into practice what they learned in the educational sessions.
In the first year of implementation, we were very impressed with the outcome measures. During the 2002-2003 school year, we screened approximately 1,600 children. Of these, 404 children (25 percent ) had abnormal results; 244 children (60 percent) had mild asthma; and 160 children (40 percent) had moderate to severe disease.
After the first two years of the program, we recorded a 100 percent decrease in emergency room use and hospitalizations by the asthmatic, a 58 percent decrease in missed school days and a 62 percent decrease in missed work days by family members and caregivers of asthmatics.
Additionally, we witnessed an 83 percent decrease in days with limited activities, 53 percent usage of inhaled steroids and 65 percent usage of any control medication.
However, one of the biggest challenges is to generate recurring funding to keep the program viable. In order to maintain the credibility of our program, we continually search for public, private or government grants, faith-based community financial support and monetary assistance from the Centers for Disease Control.
Thomas Lotz is the executive director of the American Lung Association of Louisiana.