School-based Asthma Management Program Research Articles

Factors Affecting Adaptation of the AAAAI Picture-based Asthma Action Plan: a Survey-Based Study

Asthma Action Plans (AAPs) are used to guide asthma self-management. In 2018, School-based Asthma Management Program (SAMPRO™) and the American Academy of Allergy, Asthma and Immunology (AAAAI) added pAAP to their online toolkit. Picture-based AAPs (pAAPs) allow for quick recognition of asthma medications but has been under-utilized. This study seeks to understand how to increase uptake of the pAAP.

Building school health partnerships to improve pediatric asthma care: the School-based Asthma Management Program.

Children with asthma require care that is seamlessly coordinated so that asthma symptoms are recognized and managed at home and at school. The purpose of this review is to discuss recent consensus recommendations in school-based asthma care. The School-based Asthma Management Program (SAMPRO) provides a widely endorsed framework to coordinate care with schools and consists of four components: establishing a circle of support around the child with asthma; facilitating bidirectional communication between clinicians and schools; comprehensive asthma education for schools; and assessment and remediation of environmental asthma triggers at school. SAMPRO standardizes recommendations for school-based asthma care coordination and provides a toolkit with websites and resources useful for the care of children with asthma in the school setting. The review will discuss the need for coordinated school asthma partnerships, the inception and development of SAMPRO, and its vision to improve pediatric asthma care coordination within the circle of support, comprising clinicians, school nurses, families, and communities.

Creation and implementation of SAMPRO™: A school-based asthma management program

Clinicians who care for children with asthma have an obligation to coordinate asthma care with the schools. Aside from routine clinical care of asthmatic children, providers must educate the family and child about the need for an asthma treatment plan in school and support the school nurse meeting the needs of the student requiring school-based asthma care. The following article was developed by multiple stakeholders to address this need. It describes the 4 components of the School-based Asthma Management Program (SAMPRO™). SAMPRO™ details elements necessary for the education of children, families, clinicians, and school-based personnel based on a “circle of support” that would enhance multidirectional communication and promote better care for children with asthma within the school setting.

Indicators of asthma control among students in a rural, school-based asthma management program

Objective: The evaluation sought to determine if a comprehensive, school-based asthma management program in a small, rural school district helped students improve asthma control. Methods: To determine if students in the asthma program demonstrated better asthma control than students in a comparison school district, the evaluation team used a quasi-experimental, cross-sectional design and administered questionnaires assessing asthma control (which included FEV1 measurement) to 456 students with asthma in the intervention and comparison districts. Data were analyzed for differences in asthma control between students in the two districts. To determine if students in the intervention experienced increased asthma control between baseline and follow-up, the evaluation team used a one-group retrospective design. Program records for 323 students were analyzed for differences in percent of predicted forced expiratory volume in one second (FEV1) between baseline and follow-up. Results: Students with asthma in the intervention district exhibited significantly better asthma control than students with asthma in the comparison district. Percent of predicted FEV1 did not change significantly between baseline and follow-up for the intervention participants; however, post hoc analyses revealed students with poorly controlled asthma at baseline had significantly higher FEV1 scores at follow-up, and students with well-controlled asthma at baseline had significantly lower FEV1 scores at follow-up. Conclusions: Findings suggest that the comprehensive school-based program led to improvements in asthma control for students with poorly controlled asthma at baseline, and school-based programs need mechanisms for tracking students with initially well-controlled asthma to ensure they maintain control.

Comparison of early-, late-, and non-participants in a school-based asthma management program for urban high school students

BackgroundTo assess bias and generalizability of results in randomized controlled trials (RCT), investigators compare participants to non-participants or early- to late-participants. Comparisons can also inform the recruitment approach, especially when working with challenging populations, such as urban adolescents. In this paper, we describe characteristics by participant status of urban teens eligible to participate in a RCT of a school-based, web-based asthma management program.MethodsThe denominator for this analysis was all students found to be eligible to participate in the RCT. Data were analyzed for participants and non-participants of the RCT, as well as for students that enrolled during the initially scheduled recruitment period (early-participants) and persons that delayed enrollment until the following fall when recruitment was re-opened to increase sample size (late-participants). Full Time Equivalents (FTEs) of staff associated with recruitment were estimated.ResultsOf 1668 teens eligible for the RCT, 386 enrolled early, and 36 enrolled late, leaving 1246 non-participants. Participants were younger (p < 0.01), more likely to be diagnosed, use asthma medication, and have moderate-to-severe disease than non-participants, odds ratios (95% Confidence Intervals) = 2.1(1.7-2.8), 1.7(1.3-2.1), 1.4(1.0-1.8), respectively. ORs were elevated for the association of late-participation with Medicaid enrollment, 1.9(0.7-5.1) and extrinsic motivation to enroll, 1.7(0.6-5.0). Late-participation was inversely related to study compliance for teens and caregivers, ORs ranging from 0.1 to 0.3 (all p-values < 0.01). Early- and late-participants required 0.45 FTEs/100 and 3.3 FTEs/100, respectively.ConclusionsRecruitment messages attracted youth with moderate-to-severe asthma, but extending enrollment was costly, resulting in potentially less motivated, and certainly less compliant, participants. Investigators must balance internal versus external validity in the decision to extend recruitment. Gains in sample size and external validity may be offset by the cost of additional staff time and the threat to internal validity caused by lower participant follow-up.Trial RegistrationClinicalTrials.gov: NCT00201058

Outcomes for a comprehensive school-based asthma management program.

This article describes the evaluation of a comprehensive school-based asthma management program in an inner-city, largely African-American school system. All 54 elementary schools (combined enrollment 13,247 students) from a single urban school system participated in this study. Schools were randomly divided between immediate and delayed intervention programs. The intervention consisted of 3 separate educational programs (for school faculty/staff, students with asthma, and peers without asthma) and medical management for the children with asthma (including an Individual Asthma Action Plan, medications, and peakflow meters). Children with asthma were identified using a case detection program and 736 were enrolled into the intervention study. No significant differences were observed in school absences, grade point average, emergency room visits, or hospitalizations between the immediate and delayed intervention groups. Significant increases in knowledge were observed in the immediate intervention group. This study of a school-based asthma management education and medical intervention program did not show any differences between the intervention and control groups on morbidity outcomes. Our experience leads us to believe that such measures are difficult to impact and are not always reliable. Future researchers should be aware of the problems associated with using such measures. In addition, connecting children with a regular source of health care in this population was difficult. More intensive methods of medical management, such as school-based health centers or supervised asthma therapy, might prove more effective in inner-city schools.

Improved asthma quality of life in parents/caregivers of inner-city school children enrolled in a school-based asthma management program (SBAMP)

Rationale To assess the improvement in quality of life in parents/caregivers of children in an SBAMP. Methods Parents of 106 SBAMP enrollees with mild to moderate persistent asthmatic students were assessed, pre- and post-intervention, using a validated parent/caregiver Quality of Life (QOL) questionnaire in the spring of 2002. Domains of the QOL questionnaire included the Activities (AD) and Emotional (ED) Domains and Total Quality of Life (TQL). The QOL instrument required a two-month time period to determine the impact of intervention using a repeated t-test measure. Results Forty-four parents who completed at least 60 days post-baseline QOL assessment were included in the present analysis. The mean age of the children was 9.8 ± 2.7; 56.2% female, 93.2% African American. All domains of QOL improved significantly (AD from 5.2 ± 1.5 to 6 ± 1.4, p<004; ED from 1.6 ± 0.4 to 6 ± 1.3, p<0.0001; TQL from 5.2 ± 1.5 to < 6 ± 1.3, p<0.001, respectively). Logistic regression analysis revealed students with low pre-QOL scores were more likely to show significant improvement (p<0.01) using this intervention program. Conclusions The School-Based Asthma Management Program significantly improved parental QOL parameters: frustration, worry, missed days from work, night time wakefulness, and changes in family outing plans due to asthma. Significant improvements in QOL for parents are fundamental to a successful asthma intervention program.

School-based asthma management program in inner-city New Orleans: Outcomes

Rationale To decrease morbidity among inner-city schoolchildren who have persistent asthma. Methods One hundred six mild to moderate-persistent inner-city asthmatic schoolchildren received asthma education and nurse-case management November 2001-February 2002. Base-line assessment included demographic information, health history, quality-of-life, and asthma knowledge. ER visits, hospitalizations, school absences and parental work absences, unscheduled office visits, and nights awakened due to asthma symptoms were tracked monthly for 5 months. Data analysis performed using SAS compared follow-up outcomes to base-line data. Chi square for categorical data and t-tests for continuous data were performed. Results The mean age in this group was 10 years; 42.4% female, 48.5% male; 30% of mothers had some college education; and 58% of the sample size had insurance. The ratio of steroid to short acting beta agonist improved from 1:4 to 1:2 (50% steroid use, p<.005). Significant increases in asthma knowledge, use of asthma tools, and knowledge of asthma medication occurred during the intervention. Three months after the intervention significant reductions in ER visits (p<0.0009), hospitalizations (p<0.02), urgent care visits (p<0.0038), missed school days (p<0.001), missed work days (p<0.03), and nights awakened due to asthma symptoms (p<0.00003) were recorded. Conclusions A School-Based Asthma Management Program that utilizes asthma education and nurse case management significantly reduces asthma morbidity in inner-city minority schoolchildren. School environments provide an appropriate setting for evidence-based medical interventions for chronic pediatric disorders.