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Breaking down silos to improve asthma care for children

Published online: July 25, 2018

Children with asthma are at increased risk for experiencing health and educational disparities because of increased school absence. Asthma is the leading cause of disease-related school absenteeism and children with asthma miss 13.8 million days of school each year. Socioeconomically disadvantaged children and minority children are disproportionately affected by asthma and, in addition, have higher rates of school absenteeism. School nurses are well-positioned to support asthma management and improve school attendance.

In a recent study published in The Journal of Allergy and Clinical Immunology (JACI), Dr. Stanley Szefler from the Children’s Hospital Colorado and his colleagues in Denver, Colorado and Hartford, Connecticut, reported on the implementation of their Building Bridges for Asthma Care Program. This program was funded by GlaxoSmithKline and intended to train school nurses to identify, assess, and monitor school attendance and measures of asthma control and correspond with the participant’s health care provider. The school nurses in the Denver Public School System enrolled 240 children with asthma, ages 5 through 14 years, and nurses in the Hartford Public School System enrolled 223 students during the 2013-2014 and the 2014-2015 school years and followed them in the program until the end of their second school year. The primary goal of the program was to reduce school absence, improve asthma control, and assure availability of rescue inhaler in the school.

Children in the Building Bridges Program experienced a 22% absolute decrease in school absenteeism as compared to a similar group of children who decided not to become part of the program. Participating children showed a marked improvement in overall asthma control as indicated by a significant reduction in rescue inhaler use and other measures of asthma control. Nurses in both school systems continue to maintain elements of the program. A limitation of the study was the absence of a true control group. Perhaps, the participants that did not enroll were less engaged in their self-care and thus suffered greater school absence. Another limitation was the inability to obtain school absence data specific for asthma as the reason.

This study clearly demonstrated the benefits for children enrolled in the Building Bridges Program through a reduction in school absence and improved asthma control.  More importantly, this study by Dr. Szefler and his colleagues in Denver and Hartford demonstrated that a systematic, school-centered asthma program implemented in a partnership among school nurses, families, primary care clinicians and asthma specialists can significantly reduce asthma morbidity and improve asthma control. They continue to expand this program to other school systems in Colorado and Connecticut, and they are hopeful that more schools throughout the United States will adapt this model to help children with asthma achieve their maximum academic potential.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

Building bridges for asthma care: reducing school absence for inner city children with health disparities
Stanley J. Szefler, MD