Asthma screening, case identification and treatment in school-based programs

PURPOSE OF REVIEW: Asthma is an important health problem in school-aged children and schools seem an obvious site to find and work with under-recognized and under-treated asthma. Teachers and coaches often must deal with asthma-related symptoms or emergencies requiring knowledge, skills, and written plans and policies. In 2005, school-based asthma work focused on two areas: identification of unrecognized asthma and management of under-treated asthma. RECENT FINDINGS: Effective school-based screening requires a simple, effective screening tool. Three new asthma screening tools continue to identify more false-positive than true positive cases of asthma. Public health experts question whether asthma even fits the usual criteria for 'screening' because it does not have an asymptomatic phase. 'Case-finding' is presented as a better use of resources, allowing schools to focus on children with asthma that has been diagnosed but remains symptomatic. No school-based program based on letters, reminders, or recommendations sent to parents or community physicians changed asthma care. Three reports describe programs designed to supplement usual asthma care by providing in-school interventions, but none appeared ready for implementation in all schools in the USA. A major barrier was the continuing lack of school nurses, who must have asthma-related education and medical support to provide school-based asthma management. SUMMARY: Schools continue to be a site for asthma interventions but few of the programs, even the most intensive, influence children's asthma-related health. Most programs require modifications and further evaluation, and all require careful assessment of the burden on schools.