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Can morbidity associated with untreated asthma in primary school children be reduced?: a controlled intervention
R Hill1, J Williams, J Britton
1Respiratory Medicine Unit, City Hospital, Nottingham.
Insights
A school-based asthma intervention improved GP visits and teacher understanding but did not significantly reduce school absence or missed games for children with asthma.
Area of Science:
- Pediatric respiratory health
- School-based health interventions
- Asthma management in children
Background:
- Unrecognized or undertreated asthma significantly impacts school attendance and participation in physical activities.
- Existing school and community resources can be leveraged for asthma management programs.
Purpose of the Study:
- To evaluate an intervention program aimed at reducing school absence and improving participation in physical education for children with undiagnosed or undertreated asthma.
- To assess the impact of school nurse-led asthma education on teachers' management strategies.
Main Methods:
- A parallel group controlled intervention study involving 102 primary schools in Nottingham.
- Children aged 5-10 with wheezing-related absences and minimal asthma treatment were identified.
- Intervention schools received asthma education for teachers by school nurses; control schools did not.
Main Results:
- The intervention led to a higher rate of general practitioner assessment for children with asthma.
- Parent-reported school absence due to wheezing decreased similarly in both intervention and control groups.
- While teacher understanding of asthma management improved in intervention schools, there was no significant reduction in school-recorded absence or participation in physical activities.
Conclusions:
- The intervention successfully increased medical assessment and improved teacher awareness and management of childhood asthma.
- The program did not demonstrate a significant reduction in school absence or impact participation in games and sports.
- Further strategies may be needed to effectively reduce asthma-related morbidity in the school setting.
Objective:
To determine whether an intervention programme based on existing school and community resources can reduce school absence and improve participation in games lessons and sport in children with unrecognised or undertreated asthma.
Design:
Parallel group controlled intervention study.
Setting:
102 primary schools in Nottingham: 49 were randomised to receive the intervention and 53 to be control schools.
Subjects:
All children aged 5 to 10 years with parent reported absence from school because of wheezing in the previous year and taking no treatment or beta agonists only.
Interventions:
Children with asthma were referred to their general practitioner for assessment of symptoms and treatment. Teachers were given education on asthma by the school nurse in 44 of the 49 intervention schools.
Main Outcome Measures:
Changes in school absence and missed games and swimming lessons because of wheezing, and schools' policy towards management of asthma in school.
Results:
Of 17,432 children screened, 451 met the entry criteria--228 in intervention schools and 223 in control schools. 152 (67%) children in intervention schools visited their general practitioner, of whom 39 (26%) were given a new diagnosis of asthma and 58 (38%) had treatment for asthma increased or changed. Over the next academic year mean (SE) parent reported school absence due to wheezing fell significantly, but to a similar extent, in both intervention and control schools (0.82 (0.11) and 1.09 (0.21) weeks respectively). There was little change in school recorded absence or participation in games lessons and swimming lessons in either group. At the end of the study intervention schools were more likely to have improved aspects of management of asthma in school.
Conclusion:
The intervention resulted in a majority of children being assessed by their general practitioner and improved teachers' understanding and management of asthma, but it did not result in any appreciable reduction in morbidity.