WASHINGTON — How well schools are doing to help children manage their asthma depends on the question you ask, said one expert speaking at the annual meeting of the Pediatric Academic Societies.
“We found that appropriate services, equipment, and policies and procedures for asthma management are not uniformly available in public schools,” said Marianne M. Hillemeier, Ph.D., of Pennsylvania State University in University Park.
For this study, a stratified random sample of schools representing each school district in Pennsylvania was selected. Surveys were mailed to 996 school nurses; 757 were completed. Roughly half of the schools were in rural settings.
Nurses were asked to list all of the places where students had access to their asthma medication: 93% were kept in the health office, 67% allowed children to carry their inhalers with them, 9% had medications available in other locations. Alarmingly, in three schools, children with asthma had no access to their inhalers, Dr. Hillemeier said.
Just over half of schools (56%) had peak flow meters available, 52% had nebulizers available, and 31% had spacers available. Only 22% of schools had written asthma management plans on file for children with asthma. Of these, only 32% included peak flow monitoring procedures, and 40% included a plan for physical education participation.
For those with written plans, only 56% included emergency contact information for the child's pediatrician, 68% included emergency contact information for the child's parent, and 62% included an emergency protocol for handling severe asthma attacks.
Most schools (89%) had medical emergency plans in place, but only 63% had rapid communication systems that link to emergency medical services.
Most schools (79%) had a staff member knowledgeable about what to do for an asthma attack available at all times, and 91% of schools notified teachers when a child with asthma was in their class. Almost half of the schools routinely taught students (49%) and teachers (52%) about asthma.
Case management for children with frequent asthma-related problems—extra attention to asthma care, medical monitoring, and proper preventive care—was available in 29% of schools, said Dr. Hillemeier, speaking at the meeting also sponsored by the American Pediatric Society, the Society for Pediatric Research, the Ambulatory Pediatric Association, and the American Academy of Pediatrics.
In 2002, the National Heart, Lung, and Blood Institute recommended a number of policies and practices for asthma management in schools, including ensuring that written asthma management plans were in place for each student and providing appropriate equipment for monitoring children's status and administering medications.
NHLBI also recommended schoolwide emergency plans for handling severe asthma attacks and access for children to asthma medication during school hours in the least restrictive way possible—including allowing children to carry and self-administer their medications.