Whether school health services are currently meeting the needs of children with asthma is questioned in an article in the September 2006 issue of the journal Pediatrics, published by the American Academy of Pediatrics.

Based on a survey of school nurses responsible for health care in urban and rural school districts in one state—Pennsylvania—the article concludes that much of what is recommended as best practice in child asthma management is lacking in many school systems. While the researchers did not study whether the shortcomings they found in Pennsylvania are present in other states, they noted that poor adherence to 2002 National Heart, Lung and Blood Institute (NHLBI) policies for asthma management at school is widespread.

Here are some findings from the Pennsylvania survey:

• The prevalence of asthma among schoolchildren in Pennsylvania is 9.3 percent, according to the state Department of Health, slightly higher in urban than rural areas;
• Registered or licensed practical nurses are physically present as few as 8 hours a week in some schools, with nursing coverage more comprehensive in high schools than in elementary schools;
• Asthma-related equipment (peak flow meters, nebulizers, spacers) were available for student use in only half of urban schools, slightly more in rural schools, most often in the health office. Rural schools were more likely than urban schools to allow students to carry their own inhalers while at school (72 percent rural and 47 percent urban) and several districts reported that inhalers were not available at all in their schools;
• In all schools in the study sample, fewer than one-third of children with asthma had asthma management plans on file, and those plans that were available often lacked important information such as protocols for handling emergencies and how to contact parents or physicians. Other recommended components of asthma management programs--peak flow monitoring procedures, plans for physical education participation, a list of specific asthma triggers, and procedures for storing and administering medication--were even less likely to be included;
• Both urban and rural nurses noted lack of time as a major obstacle to asthma management in their school settings, followed by lack of clear policies about asthma management. Few cited lack of administrative support as an obstacle;
• Staff who know what to do for a severe asthma attack were reported to be available in more than 80 percent of urban and rural schools;
• More than 90 percent of both urban and rural schools had emergency response plans for medical emergencies, and two-thirds had rapid response systems linking the school campus to emergency medical services;
• The primary ways school nurses learn which students have asthma are parental notification, medical history, an examination form from a physician, and a medication order. Often, however, the school nurse’s first indication that a child suffers from asthma is when the child presents with asthma symptoms in the school health office;
• Support services for children with asthma and their families, such as counseling and support groups, were available in relatively few schools, and case management was provided in only one-third of schools.

Clearly needed to improve school-based asthma management in Pennsylvania, and probably elsewhere, the researchers noted, are "more consistent availability of staff who are knowledgeable about asthma and symptom management," including more nurse staffing and more widespread asthma education for teachers, administrators, and other staff members; more universal use of asthma management plans; and maximum access to inhalers, including increasing the numbers of children who are allowed to self-carry and self-administer asthma medications.

The Pennsylvania study was conducted by the Department of Health Policy and Administration and the College of Medicine at Pennsylvania State University and was funded by a grant from the Center for Rural Pennsylvania. It appears in the September 2006 issue of the journal Pediatrics.

See also:
School Children with Asthma: An Introduction
http://www.healthinschools.org/sh/asthma.asp

Improving Childhood Asthma Outcomes in the United States: A Blueprint for Policy Action
http://www.healthinschools.org/ejournal/2002/june02_1.htm.