Building Asthma Data Blocks as a Foundation for the Future

School Nurse Data Key to Research and Future Asthma Care for Children

from School Health Reporter, Fall 2003

By Arthur MacFarlane II, MS Asthma Program, Colorado Department of Public Health & Environment

Colorado may be the only state attempting to survey all school nurses each year about the impact of asthma on school-age children. With the assistance of school nurse supervisors, school nurses around the state and Judy Harrigan of the Colorado Department of Education (CDE), we have built three years of data about this vulnerable population. The goal has been and continues to be, better management of asthma and a clearer understanding of the size of the impacted population. The information collected may reveal trends that are important to understanding asthma in the school setting.

The national news is peppered with articles about the increases in asthma prevalence and morbidity, but the news stories rarely address school-aged children specifically. When they do, the stories address real or potential asthma triggers or the latest medication, not the crucial question of how many asthmatic school-age children there are and whether that number on the rise. Articles in the past several years have noted numbers as low as seven percent and as high as 25 percent when talking about asthma in children. Virtually all the articles mention the steep increase in asthma, particularly for the period from 1980 to 1998 when solid national survey data supported the anecdotal perception of many nurses, teachers, administrators and parents that “it seems like every child has an inhaler.” More recent survey data hints at a potential flattening of the strong upward trend. So what is the reality and how do we help the children already diagnosed with this potentially deadly disease?

Survey Background

Although the survey is far from a scientific assessment of the school-age population, over time its consistent use will allow us to outline trends in both numbers of children with asthma and to identify resources available and accessible to school personnel. We believe, as Marielena Lara, Sara Rosenbaum, et al, note in Improving Childhood Outcomes in the United States: A Blueprint for Policy Action, that, “effective management of childhood asthma may require not only improving guideline-based therapeutic interventions, but also addressing social and physical environmental risk factors.” This includes self-management education, extending continuous health insurance coverage to all children and implementing school-based asthma initiatives.

In order to achieve reductions in missed school days, number of exacerbations, number of visits to the emergency department and number of hospitalizations, it is critical that we deliver timely, focused messages and information. That will only be possible if we have good data about our target population.

Survey data were collected each year for January, February and March.  These three months of the school year were chosen to avoid holidays and focus on months when children are most likely to experience asthma exacerbations. The survey asked school nurses to track four main characteristics of asthmatic students:  the number of students with a healthcare plan, the number of students using a rescue inhaler, the number of students using an anti-inflammatory inhaler or other similar medication, and the number of students who carry their own inhalers. There were six other survey questions about students for which school nurses indicated it difficult to provide reliable data.  Additionally, nurses were asked about the existence of and service from a school-based health center, their challenges managing students with asthma, available resources for asthma education and whether there were any materials that would be helpful in managing students with asthma.

Survey Results

Chart 1 shows the numbers and categories of the surveys returned in the three years the survey was conducted. The results of the four primary questions asked about students with asthma are summarized in the Chart 2. The survey was modified in 2002 with the assistance of the School Health and Childcare committee of the Colorado Asthma Coalition.  Questions were added to the survey addressing school-based health centers, number of years in school nursing, challenges managing students with asthma, available resources for asthma education and materials that would be helpful in managing students with asthma.

Results from those questions for 2002 were:

• 27 schools were covered by school-based health centers.
• Nurses have served an average of nine years on the job.
• Of those responding, 63 percent indicated the greatest challenge is parent/guardian non-compliance, 44 percent noted lack of parent/ guardian education and 22 percent noted lack of health insurance.
• Of those responding, 67 percent indicated they have access to NAEPP publications, 62 percent have access to the Asthma in Schools Resource Guide and 52 percent have the EPA Open Airways for Schools tool available to them as resources.
• Valuable information about educational materials helpful in managing students with asthma is available in the survey with 170 nurses making comment on that question. Examples of materials needed include spacers, peak-flow meters, parental information in Spanish and other languages.

Results from those questions for 2003 were:

• 47 schools were covered by school-based health centers.
• Nurses have served an average of seven years on the job.
• Of those responding, 43 percent indicated the greatest challenge is parent/guardian non-compliance, 25 percent noted lack of parent/ guardian education and 19 percent noted lack of health insurance. Additionally, student non-compliance was noted by 29 percent of the nurses
• Of those responding, 54 percent indicated they have access to