2004 OPEN FORUM Abstracts
School Based Asthma Intervention and Screening: Does it Work?
Thomas J. Kallstrom, RRT, AE-C, FAARC.
Fairview Hospital, Cleveland, Ohio
Introduction: Children with uncontrolled asthma miss school three times more often that the non-asthmatic. Childhood asthma is the most commonly seen chronic illness of school children yet many are undiagnosed despite obvious and not so obvious symptoms. In most public school systems hearing and eye screenings are mandatory but this is not the case for asthma. We sought to trial a school based asthma screening and intervention program in assorted Cleveland and Euclid, Ohio public schools.
Methods: The Cleveland Clinic Health System configured a team of respiratory therapists from 10 hospitals who were instrumental in this two-stage asthma intervention pilot. We approached a senior high school, a middle school and an elementary school. The high school felt that asthma was not an issue and decided not to join the study. The program entailed an asthma-screening day at which time a team of 12 respiratory therapists did pulmonary screening. The screening involved measuring the FEV1 of the students. An FEV1 of 80% or less was considered a positive test if a 20 question ACAAI validated questionnaire indicated at least one positive answer. All positive tests were then referred to the child’s parent (via mail and follow-up phone-calls) and teacher. When we followed up with phone calls we sought to determine if the child had seen their physician for definitive diagnosis. In addition to this we presented educational programs for teachers, parents and students as a follow-up to the program.
Results: At the elementary school there were 47 positive responses out of 278 (17%) and at the middle school there were 19 positive responses out of 93 (20%). Out of the 46 positive elementary students we were able to make contact with 7 parents of the elementary school children and none of the middle school parents (despite numerous attempts). Four of the elementary age children did seek medical attention and of them 3 were diagnosed with asthma and subsequently treated. The teaching sessions were done at each school in three segments. 50 teachers voluntarily sat in on the classes, 650 students heard our asthma message and 25 parents attended an evening presentation.
Conclusions: Screening of school aged children for asthma is an important approach that can help identify asthmatic children and perhaps allow ongoing consultation with a physician. While our approach in identification of potential asthmatics was successful, getting the parents and guardians to follow through was more problematic. The education sessions with the parents, teachers, and students allowed us to answer many questions that until then were unresolved. As a result some school policies regarding peak flow meter use was revised as a result. This pilot has allowed us to analyze parts of the program that need to be refined. We will be working with an entire school system in 2005-06 and will report our findings at that time.