Vol. 11 •Issue 3 • Page 14
Allergy & Asthma
The ABC’s of a School-Based Asthma Program
Asthma prevalence has increased over the past two decades, especially among children 15 years and younger, an age group that faces many obstacles when dealing with this serious yet controllable disease. Unstable home environments make it impossible for some children to fully comply with their medical regimens, resulting in poor school performance because their asthma is inadequately managed.
School, however, can provide a secure place for learning about self-care and disease prevention. If .poorly controlled asthma negatively affects children’s school performance and prevents them from participating fully in all school activities, why not address this health issue in the school itself? School-based asthma programs can empower educators to set a policy that enables children and their parents or guardians to more effectively manage this chronic condition.
The Center for Asthma and Environmental Exposure (CAEE), based at the University at Buffalo School of Medicine and Biomedical Sciences, Kaleida Health Buffalo General Campus, developed a school-based asthma policy that emphasized education of school staff, children and parents to prevent asthma attacks. Started as a pilot program at two Buffalo elementary schools in 1997, it has since expanded to include eight elementary schools and a Head Start program. The schools have a total enrollment of 3,250 children.
The program was sorely needed in Buffalo. Because of two decades of budget cuts, school nurses started to be eliminated from the city’s public schools. By the mid-1990s, only 10 of Buffalo’s 77 schools had a nurse or clinic. In the remaining schools, office staff with no asthma training administered medications.
The CAEE conducted in the spring and fall of 1997 a parent-answered questionnaire survey of three elementary schools located on Buffalo’s east side. The three schools had a total enrollment of approximately 1,300 children ages 4 to13 years.
With a return rate of 65 percent, the survey revealed the prevalence of diagnosed asthma was 20 percent. Another 19 percent of the children had suspected undiagnosed asthma, based on parent-reported symptoms. Thus, in a classroom with 30 children, 11 on average had asthma, and five to six required daily medications for the disease.
Each school’s principal implemented the asthma policy. Health care providers were asked to supply a written action plan for each child with asthma, indicating the medications the child took to prevent or control symptoms and what to do in case of an emergency.
Asthma counselors trained school staff, children and parents how to: recognize early warning signs of an asthma attack, control and manage an asthma attack, monitor responses to treatment, avoid or control asthma triggers in the home or school, administer metered dose or dry powder medication and use a peak flow meter.
Lastly, parents provided information in a 14-item questionnaire survey about their children and assisted in identifying triggers in the home. Parents also were responsible for ensuring that children were equipped with the prescribed asthma medication and that the children had up-to-date asthma care plans in school.
In the pilot implementation of the program, the CAEE compared the number of rescue treatments per child with asthma during the 1996-97 and 1997-98 school years for school A, which continued its usual asthma care, and school B, which used the asthma policy. Compared to the previous school year, school B had an 80 percent reduction in rescue treatments while school A went down 28 percent. However, it’s important to point out that the two schools are unique among Buffalo city schools in that they have a full-time nurse’s aide on site.
Due to these encouraging results, the CAEE expanded the program to an additional five schools in 1998-99. Overall, 65 percent of physicians provided written .asthma action plans upon request, and school personnel noted a decrease of 17 percent in rescue treatments from 1998 to 2000.
This project demonstrated that a school-based asthma policy was feasible, effective and well accepted by school personnel, community practitioners and parents. This type of education not only set a foundation for lifelong self-care of asthma but also established the importance of prevention in other health care issues.
Dr. Lwebuga-Mukasa is an associate professor of medicine and director of the Center for Asthma and Environmental Exposure at the SUNY Buffalo School of Medicine and Biomedical Sciences, Kaleida Health Buffalo Campus.