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Asthma classes in school may help reduce attacks

(Reuters Health) – School-age children with asthma who receive education on managing the condition may have fewer attacks, emergency room visits and hospitalizations than those who don’t get such classes, a recent study suggests.

Asthma is one of the most common chronic diseases in childhood. Severe asthma attacks and breathing problems are associated with an increased risk of health problems like obesity as well as academic challenges like chronic absences from school and cognitive impairments that can lead to lower grades and test scores.

For the current study, researchers analyzed data from 33 prior studies that tested how well school-based asthma management programs help kids to avoid severe symptoms that can take a toll on their health and school performance.

All of these smaller studies included children with asthma from 5 to 18 years old, and randomly assigned some kids to get asthma education while others went without this instruction.

With the school-based asthma interventions, students were 30 percent less likely to visit the emergency room, suggesting they had fewer severe asthma attacks, researchers report in the journal Thorax.

“For children who cannot easily access healthcare providers, schools may be a particularly effective route for the delivery of self-management education,” said lead study author Dylan Kneale of University College London in the UK.

“Among children who may otherwise have low levels of contact with healthcare providers, interventions provided in schools may provide something of a safety-net for recognizing the symptoms of asthma, the delivery of medication, and the teaching of self-management skills,” Kneale said by email.

Compared to children who didn’t get asthma-management training in school, those who did also appeared to have fewer hospitalizations and fewer days when their symptoms were so severe that they had to cut back on activities.

The study didn’t find a connection between the school-based asthma programs and absenteeism, however.

While the review does not provide guidance on which type of school-based self-management intervention is most effective, the asthma interventions did share some common elements, the researchers note. These include: reinforcement of regular monitoring of lung function; instruction on inhaler techniques; creation and review of written asthma management plan for each kid; and education on when to use rescue inhalers and maintenance drugs to control symptoms.

Most of the studies in the analysis were done in the U.S. and Canada. That is a limitation, the authors point out, because the effect of school-based programs might be more pronounced in U.S. schools, where children are more likely to be uninsured or lack access to care, than in other countries where access and affordability are less of a problem.

The smaller studies in the analysis also used a wide variety of methods for assessing the effectiveness of school-based asthma programs, and that made it hard to measure exactly how much impact these interventions had on reducing hospitalizations, the researchers note.

Even so, the results reinforce the essential role schools can play in asthma management, said Dr. Deepa Rastogi, director of the pediatric asthma program at Montefiore Health System and a professor at Albert Einstein College of Medicine in New York City.

“Children tend to learn better about asthma management in school settings,” Rastogi, who wasn’t involved in the study, said by email. “Having access to asthma care and learning about self-management is likely to have multiple beneficial effects including better social support, increased gym participation, better wellbeing etc.”

School-based programs may also help children feel less stigma about using an inhaler in school, said Dr. Avni Joshi, a pediatric allergy and immunology specialist at Mayo Clinic Children’s Center in Rochester, Minnesota, who wasn’t involved in the study.

“Knowledge is power; these school-based programs empower children to detect and direct their own care,” Joshi said by email. “Their comfort with self-help increases and the use of medications is ‘normalized’ for these children, who in other circumstances may feel embarrassed to use them in the school environment.”

SOURCE: Thorax, online January 27, 2019.

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