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.