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Am Fam Physician. 1998;57(7):1660-1662

Asthma has a high prevalence among economically disadvantaged urban children, since they often do not have regular access to medical care and, when they do, the care is often fragmented or substandard. This lack of care is believed to account for the higher degree of asthma-related morbidity and mortality in this population. Christiansen and colleagues developed and implemented a school-based asthma education program to assess the effectiveness of such a program for inner-city children with asthma.

Fourth-grade students from four schools in San Diego, Calif., were eligible for the study. Children with asthma symptoms were identified through a parent survey, a student questionnaire or a physical examination. Each participant was categorized with mild, moderate or severe asthma on the basis of frequency of specific symptoms, including nocturnal awakening, effect on physical activity, type and frequency of medication use and need for emergency medical care. Participants were assigned to either the educational program or a control nonintervention group. The educational program was based on the asthma guidelines of the National Heart, Lung, and Blood Institute and consisted of 20-minute teaching segments conducted over a five-week period during school hours. All lessons had bilingual (English and Spanish) interaction that was intended to be at the students' level of comprehension.

Outcomes measured at the beginning and the end of the study included the children's knowledge about asthma, their skills in using a peak flow meter and a metered-dose inhaler, and the effect of the educational intervention on asthma severity. In addition, participants were interviewed at school on a monthly basis to assess their level of functional asthma severity. Questions focused on the frequency and duration of symptoms, the use of medication, the need for medical care (including emergency department visits and hospitalizations), absences from school and restriction of physical activities. Monthly symptom scores were generated on the basis of the children's responses to several of these questions.

Following the study, children in the education group knew more about asthma (scores improved from 9.9 to 13.7) and had improved their skills in using both the peak flow meter (3.9 to 6.4) and the metered-dose inhaler (2.3 to 4.3). Those in the control group showed no improvement in asthma knowledge (11.3 to 10.9) or in use of the inhaler (2.5 to 2.2). Peak flow meter scores increased slightly from 2.6 to 3.1. Neither group experienced any improvement in asthma severity or frequency of wheezing, nor were there any differences in school absences, emergency department visits or hospitalizations. However, symptom scores for asthma severity after 180 days were significantly lower in the education group (2.87) than in the control group (4.36). Children in the education group also tended to use less medication over time. The authors concluded that a school-based asthma education program can be successful, as it can increase asthma knowledge, improve peak flow meter and metered-dose inhaler skills, and may reduce the severity of asthma symptoms.

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