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

Current Opinion in Pulmonary Medicine

Volumn 12, Issue 1, 2006, Pages 23-27

  Yawn, Barbara P ^a  

^a UNIVERSITY OF MINNESOTA   (United States)

Author keywords

Asthma; Children (school aged); School based; Screening

Indexed keywords

BETA ADRENERGIC RECEPTOR STIMULATING AGENT; CORTICOSTEROID;

ASTHMA; BREATH ANALYSIS; CASE FINDING; CLINICAL TRIAL; EXERCISE; HEALTH PROGRAM; HUMAN; KNOWLEDGE; MASS SCREENING; PATIENT IDENTIFICATION; POLICY; PREDICTION; PROVOCATION TEST; QUESTIONNAIRE; REVIEW; SCHOOL HEALTH SERVICE; SCOLEX; SCREENING TEST; SENSITIVITY AND SPECIFICITY; SKILL; SPIROMETRY; SYMPTOM; CHILD; EDUCATION; HEALTH CARE QUALITY; METHODOLOGY; ORGANIZATION AND MANAGEMENT; OUTCOME ASSESSMENT; PATIENT REFERRAL; SCHOOL HEALTH NURSING;

ASTHMA; CHILD; HUMANS; MASS SCREENING; ORGANIZATIONAL POLICY; OUTCOME ASSESSMENT (HEALTH CARE); PROGRAM EVALUATION; REFERRAL AND CONSULTATION; SCHOOL HEALTH SERVICES; SCHOOL NURSING;

EID: 33646832029     PISSN: 10705287     EISSN: 15316971     Source Type: Journal    
DOI: 10.1097/01.mcp.0000198063.19963.24     Document Type: Review

References (26)

1. Mannino DM, Homa DM, Akiinbami LJ, et al. Surveillance for asthma: United States, 1980-1999. MMWR Surveill Summ 2002; 51:1-13.
2. Olson AL, Seidler AB, Goodman D, et al. School professionals' perceptions about the impact of chronic illness in the classroom. Arch Pediatr Adolesc Med 2004; 158:53-58. This study used surveys to query teachers about their concerns for children with chronic diseases. The teachers had greater concern about children with congenital heart disease and seizure disorders than about children with asthma. The results suggest a need to support teachers in understanding the prevalence and severity of asthma-related issues within the overall context of children with chronic illnesses. They appear to have misplaced comfort with asthma.
3. Knorr RS, Condon SK, Dwyer FM, Hoffman DF. Tracking pediatric asthma: the Massachusetts experience using school health records. Environ Health Perspect 2004; 112:1424-1427. This report describes the use of schools as the foundation of a state-wide asthma surveillance program. It is a report of a pilot study. It will be interesting to see how many of the smaller school districts can provide the needed information without financial support.
4. Redline S, Gruchalla RS, Wolf RL, et al. Development and validation of schoolbased asthma and allergy screening questionnaires in a 4-city study. Ann Allergy Asthma Immunol 2004; 93:36-48. This study validated both parent and student completed surveys to identify children with unrecognized asthma and allergies. The allergy screening was of very little value because the best question related to use of allergy medications. The asthma screening questions had moderate predictive values but continued to identify many children who would be false positives. The study did address children of varying racial, ethnic, and socioeconomic backgrounds.
5. Galant SP, Crawford LJ, Morphew T, et al. Predictive values of a cross-cultural asthma case-detection tool in an elementary school population. Pediatrics 2004; 114:e307-e316. This is a nicely described validation conducted in children in California who are Vietnamese, Hispanic, or white. It again tries to address the issue of screening without adequate follow up by asking for better access. It is a nice validation but it fails to realistically address the issues of screening.
6. Yawn BP, Wollan P, Kurland MJ, Scanlon P. A longitudinal study of the prevalence of asthma in a community population of school age children. J Pediatr 2002; 140:576-581.
7. Clark NM, Brown R, Joseph CLM, et al. Issues in identifying asthma and estimating prevalence in an urban school population. J Clin Epidemiol 2002; 55:870-881.
8. Yawn BP, Wollan P, Scanlon P, Kurland M. Outcomes results of a school-based screening program for undertreated asthma. Ann Allergy Asthma Immun 2003; 90:508-515.
9. Jones CA, Morphew T, Clement LT, et al. A school-based case identifications process for identifying inner city children with asthma: the Breathmobile program. Chest 2004; 125:924-934. Although the title of the report suggests that it describes a program using a breathmobile, this is really a report of a validation study that brought children to the breathmobile to accomplish the validation examination. The validated questionnaire is similar to those developed by others, with good sensitivity for persistent asthma but poor sensitivity for those with intermittent asthma.
10. Gerald LB, Grad R, Turner-Henson A, et al. Validation of a multistage asthma case-detection procedure for elementary school children. Pediatrics 2004; 114:e459-e468. This important study discusses the testing and validation of one-stage, two-stage, and three-stage asthma screening. Additional stages can improve the predictive value of the screening, but the authors go beyond what many research groups do. They include important context and use common sense in assessing the outcomes. One of the major outcomes may be the suggestion that if asthma screening is to occur, then it should be with a simple instrument that has high specificity and moderate sensitivity to limit the need to evaluate large numbers of children that will be false positives. Although this is contrary to usual public health recommendations, it seems very reasonable in the schools with limited human and financial resources to deal with children who have mild asthma.
11. Wheeler LS, Boss LP, Williams PV. School-based approaches to identifying students with asthma. J Sch Health 2004; 74:378-380. This article has caused significant controversy regarding the asymptomatic stage of asthma and the impact of early treatment versus later onset of inhaled corticosteroid use. This is important but fails to grasp the importance of the article. Where should limited energy and resources be directed - at children with asthma that is disrupting their school performance or at trying to find children with currently unrecognized asthma, children who appear to have milder disease than those who are under-treated?
12. Carter ER, Debley JS, Redding GJ. Changes in asthma prevalence and impact on health and function in Seattle middle-school children: 1995 vs. 2003. Ann Allergy Asthma Immunol 2005; 94:634-639. Using surveys in 1995 and 2003 to identify rates of diagnosed asthma and asthma symptoms in school-aged children, the authors report a doubling of the rate of diagnosis but no change in the frequency of symptoms. The asthma is being diagnosed but not controlled. These findings support the need to move from screening or case identification of unrecognized asthma to identification of undertreated asthma.
13. Halterman JS, McConnochie KM, Conn KM, et al. A randomized trial of primary care provider prompting to enhance preventive asthma therapy. Arch Pediatr Adolesc Med 2005; 159:422-427. School personnel used questionnaires to determine the level of symptoms experienced by children with asthma and sent letters to the children's personal physician to attempt to bring care in closer alignment with national asthma guidelines. Outcomes were not changed.
14. Sapien RE, Fullerton-Gleason L, Allen N. Teaching school teachers to recognize respiratory distress in asthmatic children. J Asthma 2004; 41: 739-743. Comparing video-based and didactic teaching methods, the authors showed that videos can be used to help teachers to recognize better respiratory distress in other videos. This must be assessed in actual children, in whom the findings may be more subtle.
15. Halterman JS, Szilacyi PG, Yoos HL, et al. Benefits of a school-based asthma treatment program in the absence of secondhand smoke exposure: results of a randomized clinical trial. Arch Pediatr Adolesc Med 2004; 158:460-467. The use of a multi-method intervention is presented and stratified by the important variable of household smoking. The school-based intervention was not effective in children exposed to second-hand smoke at home.
16. Sturm JJ, Yeatts K, Loomis D. Effects of tobacco smoke exposure on asthma prevalence and medical care use in North Carolina middle school children. Am J Public Health 2004; 94:308-313.
17. Tinkelman D, Schwartz A. School-based asthma disease management. J Asthma 2004; 41:455-462. This report presents another multi-method approach. This one does not include student education that has been validated, such as Open Airways. The results provide limited help to future studies because some details, such as the number of students invited who refused to participate, are not provided. The limited sample size also means that further work is needed.
18. Clark NM, Brown R, Joseph CL, et al. Effects of a comprehensive schoolbased asthma program on symptoms, parent management, grades and absenteeism. Chest 2004; 125:1674-1679. This comprehensive study included seven methods to engage students with and without asthma, parents, school officials, and custodians. They were unable to engage private physicians. The outcomes are also very broad, including school grades. The many steps require further study to assess the amount of 'additive' effect and cost to help school districts decide what they can afford and what outcomes they would like to achieve.
19. Tranter DC. Indoor allergens in settled school dust: a review of findings and significant factors. Clin Exp Allergy 2005; 35:126-136. This is a review of studies looking at assessments and simple solutions to allergens in schools.
20. Chamberlain LJ, Bauer L. The crucial role of the vanishing school nurse. Arch Pediatr Adolesc Med 2004; 158:1091; author reply 1901-1902. This editorial urges the inclusion of school nurses in school health programs. This is a good idea, but it must be linked to proper education of school nurses related to care of chronic illnesses, including asthma.
21. RCSD Student Services. School nurse staffing in California public schools. Sacramento, CA: California School Nurses Organization; 2004.
22. Guttu M, Engelke MK, Swanson M. Does the school nurse-to-student ratio make a difference? J Sch Health 2004; 74:6-9.
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25. Telljohann SK, Dake JA, Price JH. Effect of full-time versus part-time school nurses on attendance of elementary students with asthma. J Sch Nurs 2004; 20:331-334. It is better to have more nurses, but we continue to struggle with getting any.
26. Jones SE, Wheeler L. Asthma inhalers in schools; rights of students with asthma to a free appropriate education. Am J Public Health 2004; 94:1102-1180. This is an important paper for those working to improve students' rights to carry necessary asthma medications. The presentation based on a review of rules for rights of children with special needs may be new and useful to many state activists.