Vol. 16 •Issue 18 • Page 8
School-Based Asthma Interventions
Learning New Approaches to an Old Disease
Julius was six and just starting first grade when he seemed unusually tired and irritable. A nagging cough and restlessness at night were the only warning signs. These symptoms soon developed into wheezing, and three specialists later, a diagnosis of asthma was made.
His mother, Cindy, recalled those early frustrations of just having the school nurse give Julius the inhaler without “a little bit of wheezing becoming much worse.” She also recalled agonizing over the fate of Thomas, their cat, who was later determined to be the cause of the wheezing.
Julius is one of approximately 5 million school chidren with asthma who collectively miss an estimated 11.8 million school days per year. Asthma is the most common childhood illness, and it is no surprise that alternatives to traditional hospital-based treatment are being explored.
COMPREHENSIVE ASTHMA PROGRAMS
One of these approaches is to manage the child with asthma in a “normative environment” or an environment of normal, day-to-day experiences for the child, such as a school, said Jacalyn P. Dougherty, MS, MA, RN, PNP manger of the Asthma Project for the National Association of School Nurses (NASN).
The Asthma Project provides funding for schools to develop comprehensive asthma programs that involve the “coordination of the school’s health team members, including school nurses, teachers, administrators, coaches and parents,” Dougherty said.
A core curriculum that stresses policies friendly to asthma students has been provided in four states to pilot programs to identify children with asthma and those with high risk symptoms and to help with development of asthma action plans.
These action plans are designed in concert with physicians, parents and parallel hospital treatment plans. Dougherty added that outcome measures are now being designed, and the goal of the program is to “promote collaboration and the continuity of care among health care providers, school and home.”
School-based health centers are now a focus of asthma interventions, where care far exceeds the usual band-aid and Tylenol, and with good reason. Recent studies exploring the effectiveness of treating asthma in the school have shown a the use of rescue treatments, missed days from school, emergency department visits and hospitalization days.
A “Blueprint for Policy Action” to improve childhood asthma outcomes recently was published as a cooperative effort between RAND Health and the University of California-Los Angeles. This paper outlined steps to “promote asthma friendly schools and school-based asthma programs” as part of its comprehensive recommendations.
Included in these recommendations are the development of performance measures for asthma school services, a nurse trained to deliver asthma care in every school, policies for managing acute asthma symptoms and an asthma education program.
The National Institutes of Health also address the need for school-based asthma care with the National Asthma Education and Prevention Program (NAEPP). Its emphasis is to implement policies that “encourage the active participation of students in the self-management of their condition and allow for the most consistent, active participation in all school activities.”
ASTHMA AND THE INTERNET
Some schools have incorporated Internet technology into their approach for asthma. Witness the National Jewish Asthma Program in Denver. Here, students come to school a few minutes early to meet with a nurse, to record information into a daily asthma diary and for advice using inhalers if neccessary. This is an interactive, Internet-based diary, which provides educational sessions for children and family along with a “care management” program for children with more advanced asthma.
This is great news for both children diagnosed with asthma and for those who are wheezing but go undiagnosed. Grants, sponsored by the American College of Allergy, Asthma and Immunology and a host of pharmaceutical companies, have been awarded to explore school-based methods of screening children for the presence of allergies and asthma.
Four programs were selected from a field of 67 proposals. Grant recipients include: the Dallas Asthma Consortium, Dallas; La Rabida Children’s Hospital and Research Center, Chicago; Olmsted County Asthma Action Coalition, Rochester, Minn.; and Rainbow Babies Children’s Hospital, Cleveland.
TEACHING PARENTS AND KIDS
The RCP is no stranger to the care of children with asthma, but walking the hallways of an elementary school might be unfamiliar turf for therapy. Not so, says Harold Finn, CRT, president and CEO of Respiratory Consulting Services, who organizes care to children with asthma in nine school districts in North Carolina. He describes three components of the delivery system: the school board, the physician and the school nurse, who have now added licensed respiratory therapists as a care partner.
“Parents really like the idea of a specialized individual do.ing nothing else but asthma care,” Finn said. His service strategically deploys therapists to local schools to work specifically with children who are in the yellow or red zones of their action plan or are in cases of acute exacerbation of the disease.
Finn emphasized that “the school nurse is the gatekeeper of the child’s care, and we work very closely with them” as they provide care to kids in distress. “Our mission statement is to empower every child to manage asthma on his own. The most important thing is to improve the child’s compliance with a care plan through education; the children then teach the parents,” he added.
Finn and his colleagues are now collecting data on absenteeism, admission rates and asthma exacerbations before and after this specialized service.
Perhaps there is a school clinic in your future. The data are compelling and several national programs are under way to fully document the efficacy of school-based asthma care.
The time is ripe for RCPs to aggressively explore this venue of care. Just ask Julius. His school-based treatment program evolved to the point that he rarely has episodes of wheezing, and he’s now playing baseball. But best of all, he got to keep his cat.
1. Lara M. Improving childhood asthma outcomes in the United States. A blueprint for policy action. Pediatrics, (2002; 109:5)
2. Lwebuga, Mukasa J. A school based asthma intervention program in the Buffalo, New York, schools. J School Health, (2002; 72;1: 27-32).
3. Webber M. Burden of asthma in inner-city elementary schoolchildren. Arch Pedicatr Adolesc Med, (2003; 157: 125-129).
4. School-Based Asthma/Allergy Screening Grants. www.allergy.mcg.edu/news/school.html.
5. The National Asthma Education and Prevention Program (NAEPP). Retrieved from www.nhlbi.nih.gov/about/naepp (2003).
Eric Bakow is a Pennsylvania practitioner.