National school teachers' knowledge of asthma and its management

Abd A, Adnan Fawzi H. Awareness of asthma and its management in primary school teachers in Baghdad, Iraq

Background: Asthma is a major global health issue characterized by chronic airway inflammation. It is linked to a high disease burden and disproportionately high healthcare utilization in severe, uncontrolled cases compared to non-severe asthma. We aimed to conduct this survey among primary school teachers in Baghdad, Iraq, to assess their level of knowledge about asthma and confidence in managing school children with asthma. Methods: This was a cross-sectional study conducted in Baghdad. The study adopted a questionnaire for assessing the asthma knowledge and confidence scores regarding the management of asthmatic children. This questionnaire contained 29-multiple true-false questions based on different aspects, including facts about asthma and the management of asthma by teachers. The questionnaire for testing teachers’ knowledge of asthma and confidence scores regarding the management of asthmatic children was distributed to 150 teachers. Results: The questionnaire was completed by 103 teachers.. Approximately 71% of teachers answered the question ‘What are the three main symptoms of asthma?’ correctly i.e., answering either one symptom (35.9%) or two symptoms (35.9%) correctly. A relatively smaller number of teachers (16.5%) mentioned all three symptoms correctly. Across the 29-multiple true-false questions, more than 75% of teachers answered 11 questions correctly, 50-74% of teachers answered the rest of eight questions appropriately, and <50% of teachers answered the remaining 10 questions properly. The statistical evaluation indicated that the mean total knowledge score about asthma for all the teachers was 20.27 ± 2.97 and the mean total confidence score regarding the management of asthmatic children was 72.44 ± 13.61. Conclusions: This study suggests that teachers from the schools in Baghdad appear to be self-confident in their ability and knowledge to help and manage children with asthma.

Abd A, Adnan Fawzi H. Awareness of asthma and its management in primary school teachers in Baghdad, Iraq

Background: Asthma is a major global health issue characterized by chronic airway inflammation. It is linked to a high disease burden and disproportionately high healthcare utilization in severe, uncontrolled cases compared to non-severe asthma. We aimed to conduct this survey among primary school teachers in Baghdad, Iraq, to assess their level of knowledge about asthma and confidence in managing school children with asthma. Methods: This was a cross-sectional study conducted in Baghdad. The study adopted a questionnaire for assessing the asthma knowledge and confidence scores regarding the management of asthmatic children. This questionnaire contained 29-multiple true-false questions based on different aspects, including facts about asthma and the management of asthma by teachers. The questionnaire for testing teachers' knowledge of asthma and confidence scores regarding the management of asthmatic children was distributed to 150 teachers. Results: The questionnaire was completed by 103 teachers.. Approximately 71% of teachers answered the question 'What are the three main symptoms of asthma?' correctly i.e., answering either one symptom (35.9%) or two symptoms (35.9%) correctly. A relatively smaller number of teachers (16.5%) mentioned all three symptoms correctly. Across the 29-multiple true-false questions, more than 75% of teachers answered 11 questions correctly, 50-74% of teachers answered the rest of eight questions appropriately, and <50% of teachers answered the remaining 10 questions properly. The statistical evaluation indicated that the mean total knowledge score about asthma for all the teachers was 20.27 ± 2.97 and the mean total confidence score regarding the management of asthmatic children was 72.44 ± 13.61. Conclusions: This study suggests that teachers from the schools in Baghdad appear to be self-confident in their ability and knowledge to help and manage children with asthma.

School practices in supporting children with asthma in Malta

OBJECTIVE

The objective of this study was to obtain information about teachers' knowledge, attitudes, practices and beliefs about medication related to working with children having asthma in state primary schools in Malta. This study provides information about management in a country with a high prevalence of asthma among children, and limited availability of school nurses.

METHODS

A cross-sectional electronic survey investigating beliefs about medicines, asthma knowledge, attitude toward students with asthma, self-efficacy and practice in an asthma exacerbation, current practices, views, experiences and training relating to asthma was sent to all participating state primary schools in Malta.

RESULTS

A total of 167 teachers from 26 schools answered the questionnaire. The majority of respondents (56%) were unaware of children's conditions and limited information about children's asthma was provided to them. Only 20% of teachers reported receiving training on how to support children with asthma. Overall, teachers reported low asthma knowledge scores (mean score of 5.5 ± 3.3 out of a possible maximum of 14), and poor self-efficacy with only 6% agreeing that they can support a student having an asthma exacerbation on their own rather than sending the student to hospital. The study also demonstrated a strong interest by teachers to receive asthma education.

CONCLUSIONS

Interventions with regard to identifying students with asthma, asthma training for teachers, individualized asthma action plans, enhanced communication between school staff, parents and the medical team, and standard guidelines/policy are needed to provide a supportive school environment for primary school children with asthma.

Current Asthma Management Practices by Primary School Teaching Staff: A Systematic Review

BACKGROUND

The likelihood of children with asthma experiencing an exacerbation at school is significantly high when considering that they spend a substantial part of their day at school. This study, therefore, aimed to systematically review the literature to determine current asthma management practices by primary school teaching staff and any existing supporting legislation/policies/guidelines.

METHODS

Search terms were adapted to search literature across databases: CINAHL, Cochrane Library, Education Database-ProQuest, IPA, MEDLINE, SCI. Primary research studies, reviews, systematic reviews, and meta-analyses in English about primary school teaching staff dated between 2007 and 2017 were included. Primary outcomes comprised teaching staff' practices regarding asthma management and supporting guidelines, policies, or legislation.

RESULTS

Analysis of the 13 papers eligible for full review identified that: teachers were unable to deal with an asthma exacerbation; they lacked knowledge regarding exercise-induced asthma and that there was poor communication between schools and parents of children with asthma. The only documented relevant asthma legislation found pertained to New York schools.

CONCLUSIONS

Limited evidence regarding asthma management practices and inadequate asthma management knowledge amongst teaching staff highlight the need for supporting teaching staff with asthma policies and guidelines to minimize risks associated with inappropriate asthma management.

Asthma management in New York City schools: A physical education teacher perspective

OBJECTIVE

Physical education (PE) teachers may be the first to assist students with asthma attacks during PE class. This study explores the PE teachers' perspectives on in-school asthma management and barriers to physical activity (PA) in children with asthma attending urban elementary schools.

METHODS

We conducted qualitative semi-structured interviews with 16 PE teachers from 10 Bronx, NY elementary schools. Interviews were recorded, transcribed, and independently coded. Content analysis was used to identify 10 major themes common across interviews which were then categorized into 3 domains.

RESULTS

Three domains were identified: 1) school procedures and policies for asthma management; 2) role of PE teachers in asthma management; and 3) barriers to PA for students. Most PE teachers were unaware of written procedures for acute asthma management and did not receive asthma-specific training. Many PE teachers expressed confidence regarding asthma management. PE teachers identified students with asthma most commonly through communication with students. The PE teachers utilized various methods to manage asthma but all relied on the nurse to handle acute asthma symptoms. Several barriers to PA were determined, including PE teachers' unawareness of NYS PE requirements, lack of gym facilities, inclement weather, inconsistent PE class time, asthma diagnosis, and having no asthma inhalers at the nurse's office.

CONCLUSIONS

PE teachers' perspectives on asthma management may influence the way asthma is handled at school. The results from this study highlight several barriers that can be targeted in future interventions to improve asthma management.

Assessment of the knowledge of teachers about asthma and the availability of facilities for asthma care in public secondary schools in Lagos, Nigeria

Background

Asthma is a common chronic illness affecting young people. Asthma management at schools may be influenced by teachers' knowledge of the condition and the availability of treatment facilities.

Objectives

To assess the knowledge of secondary school teachers in Lagos, Nigeria, regarding asthma and to evaluate management options available at schools.

Methods

A descriptive cross-sectional study was conducted. Schools were selected by proportional sampling of the educational districts, followed by stratified single-stage cluster sampling. All consenting teachers in the 54 selected schools were recruited. A self-administered questionnaire was used for data collection. A composite score was calculated, with 32 as the maximum possible. Knowledge was regarded as poor if scores were <16, fair for scores between 16 and 21, and good if scores were ≥22.

Results

Results show that 475 (48.1%) of the respondents had poor knowledge, 414 (41.9%) had fair knowledge, and only 99 (10%) had good knowledge. Better knowledge about asthma was associated with personal experience (χ² =16.466; p=0.001) or history of a family member with the condition (χ² =6.412; p=0.04). Of the 54 schools surveyed, only 9 (16%) had a school clinic, while a school nurse was available at only 4 (7.41%) of the schools. None of the schools had access to a nebuliser in case of an asthma emergency.

Conclusion

Teachers in secondary schools in Lagos have unsatisfactory knowledge about asthma and are not equipped to support affected students during an asthma episode.

Development and evaluation of a school-based asthma educational program

OBJECTIVES

To develop, implement, and evaluate the effects of a school-based asthma educational program on Saudi primary school teachers' asthma awareness and competence in delivering asthma-related first aid interventions.

METHODS

An asthma educational intervention program entitled "School Asthma Action Program" (SAAP) was designed based on pedagogical principles and implemented among teachers randomly selected from girls' primary schools in Riyadh, Saudi Arabia. This pilot study employed a pre-test/post-test experimental design. A previously tested asthma awareness questionnaire and a custom-designed asthma competence score sheet were used to evaluate the effects of the educational intervention program on teacher's asthma awareness and competence in providing asthma-related first aid interventions at schools.

RESULTS

Forty-seven teachers from five different primary schools participated in the program. Of the 47 teachers, 39 completed both the pre- and post-program questionnaires. The SAAP improved teachers' awareness of asthma (teachers' median pre-program score was 11 (range 5-18) and their post-program score was 15 (range 7-18), p < 0.001) and their attitudes toward asthma management at schools (teachers' median pre-program score was 74 (range 15-75) and their post-program score was 75 (range 15-75), p = 0.043). Further, it improved teachers' competence in providing asthma-related first aid interventions (teachers' mean pre-program score was 1.4 ± 2.3 and their mean post-program score was 9.8 ± 0.5, p < 0.001). After completing the SAAP, a high proportion of teachers reported increased confidence in providing care to children with asthma at school.

CONCLUSION

School-based asthma educational programs can significantly improve teachers' knowledge of asthma and their competence in providing asthma-related first aid interventions during emergencies.

Health-care conditions in elementary schools and teachers' knowledge of childhood asthma

BACKGROUND

For the adequate control of asthma in school-age children, it is recommended that teachers, school health personnel and administrators should have sufficient knowledge of how to manage asthma during school hours.

AIM

To investigate asthma health care in elementary schools, and teachers' knowledge of childhood asthma and its management.

METHODS

The extent of knowledge of childhood asthma in 2779 teachers in 141 elementary schools (children aged 6-14, grades 1-8) in Bursa, the fourth largest city in Turkey, was evaluated. Section I comprised questions about asthma health-care in schools, Section II teachers' knowledge of the main characteristics of asthma and Section III (Likert Scale) teachers' detailed knowledge of the signs, triggering factors, treatment and general knowledge of asthma.

RESULTS

The findings of Section I demonstrated that the organisation of health-care for asthma in schools was insufficient. Of the teachers questioned, 14·7% were not even aware and only 1% and 9·6% of the teachers had been made aware by school health personnel and school records, respectively, of asthmatic children. Only 27·3% of the teachers stated that they were responsible for the health of an asthmatic child. The majority of teachers (70%) said that asthmatic children could use the medication (e.g. inhalers) themselves. In Section II, there were between 44·1% and 75·5% correct answers, while in Section III this figure ranged from 3·3% to 78·4%. The correct answer rate was 60·4% for Sections II and III combined. The results of Sections II and III showed that the teachers' knowledge of asthma was poor in many respects. Teachers who stated that they had asthma or had first-degree relatives with asthma, or those with 10 or more years' experience provided significantly more correct answers in Sections II and III combined than did those without these characteristics (P<0·001).

CONCLUSIONS

There is a need to improve and standardise health care for asthma (asthma management policies) in schools. The implementation of asthma education programmes for teachers and other staff responsible for pupils' health should result in better control of this common disease.

The assessment of new drugs for asthma and COPD: a Delphi study examining the perspectives of Italian payers and clinicians

BACKGROUND

Asthma and chronic obstructive pulmonary disease (COPD) are disorders of the lungs characterized by airflow obstruction, inflammation and tissue remodeling. Management of patients with these diseases is complex and the improvement of diagnostic-therapeutic strategies represents a critical challenge for the healthcare system. In this context, investigating the criteria and information needed for an appropriate and effective evaluation of incoming treatment options is crucial to ensure that clinicians and policy-makers are provided with the best available evidence to make decisions aimed at improving patient outcomes. Therefore, the objective of this study was to investigate the degree of agreement among Health Technology Assessment (HTA) experts on issues crucial to the evaluation of new drugs for asthma and COPD and to appropriately manage the clinical pathway for patients.

METHOD

This research was conducted using an e-Delphi technique organized in three subsequent rounds and involving a panel of ten experts (six regional and local payers and four clinicians). Panelists were asked to comment in written form on a set of statements, explaining qualitatively the extent to which they agreed or disagreed with the assertions. Statements were subsequently modified and resubmitted for assessment.

RESULTS

Panelists expressed their opinions during each round and, after round III, a consensus document was finalized. The degree of consensus was high among experts and concerned five main topics: (a) the need to address current unmet needs of patients with asthma or COPD, (b) the importance of further studies and real-life information in the evaluation of treatments, (c) existing evidence and evidence needed to assess drugs, (d) critical issues in obtaining a positive evaluation from regional and local authorities for new treatments to be included in regional formularies and to have an important place in therapeutic categories, and (e) the major obstacles to the appropriate administration of drugs and management of patients.

CONCLUSION

The final document highlights that no proof of difference among drugs exists, that evidence on final endpoints (and particularly on mortality) should be strengthened and that actions regarding risk factors, appropriate diagnosis, patient staging and adherence to therapy are particularly important for a better clinical management.

Skill development regarding use of metered dose inhaler (MDI) amongst school teachers of northern India

OBJECTIVE

To evaluate the impact of a booklet based training by a nurse on the development of skills regarding use of metered dose inhaler (MDI) among the teachers of the selected schools of Chandigarh, India.

METHODS

The present study was undertaken by randomly selecting government schools of Chandigarh from where 91 school teachers were enrolled. A booklet on asthma management containing information regarding asthma, its triggers, signs and symptoms, treatment, types of inhalers and steps of using MDI with spacer was used for training the subjects. Their knowledge and skills were evaluated through observation checklist. Three return demonstrations were taken from each teacher on three successive days. Main outcome measure was skill development of the teachers in the use of MDI with spacer. Pre and post tests scores were compared by repeated measures ANOVA.

RESULTS

Most of the teachers didn't know theoretical or practical aspects of MDI. After training all the teachers performed correctly most of the steps of MDI use. Some teachers performed poorly in giving instruction to breathe in/out slowly and hand washing before/after MDI administration. There was a statistical significant improvement in the performance scores of the teachers after each return demonstration (p < 0.0005).

CONCLUSIONS

Training strategy used in the study involving nursing personnel was successful in improving teachers' skills in MDI use for asthma management. More focus should be given on breathe in/out instructions and on hand washing before/after MDI use.

Exercise-induced asthma in adolescents: challenges for physical education teachers

Asthma is the most common chronic medical condition that school-teachers are likely to encounter among their pupils. This study aimed to identify the needs of physical education teachers in dealing with adolescents with exercise-induced asthma, study their self-reported knowledge of asthma and identify future topics for education about exercise-induced asthma. A questionnaire was drawn up on the basis of the requirements that had emerged in the course of interviews with 18 physical education teachers. One hundred and six physical education teachers at secondary schools in the city of Trondheim and colleges in Sør-Trøndelag County in Norway answered the questionnaire (65% response rate). Eighty-two physical education teachers (78.1%) had pupils with asthma in their sports classes, and 89.4% answered positively regarding their need for advice on teaching pupils with asthma. Twenty-seven (25.9%) reported that they had sufficient knowledge to teach adolescents with asthma. Topics about asthma, its management and activities suitable for asthmatics were given high priority by the teachers.

Evaluation of the feasibility of a school-based asthma management programme in Taiwan

AIMS AND OBJECTIVES

To investigate the feasibility of a school-based asthma management programme for middle school children.

BACKGROUND

Asthma rates are increasing among school-aged children. Successful asthma treatment in children depends in part on clear communication and effective education.

DESIGN

This feasibility study employed a one-group only longitudinal design with four time points over 18 months.

METHODS

Nineteen female and twelve male (n = 31) seventh-grade children with asthma (13 SD 0·71 years) were identified using a six-stage asthma case-finding approach. Teachers and school staff were trained in the principles and methods of the proposed school-based asthma management programme. An individualised guided asthma self-management programme was developed for each child by a clinical team at a major academic medical centre. We assisted teachers in implementing the school programme; building a support network and monitoring children's activities. Outcome measures included lung function tests (at 0, six, 12 and 18 months), disease-related symptoms, psychosocial status and impact of asthma on learning (at 0 and 18 months). School provided data on academic achievement and school absences at 0, six, 12 and 18 months.

RESULTS

Significant improvements were noted at six, 12 and 18 months on forced vital capacity (FVC)% of predicted (p = 0·001, 0·015, 0·015, respectively), forced expiratory volume in one second (FEV(1) )% of predicted (p = 0·001, 0·006, 0·088, respectively) and FEV(1) /FVC% of predicted (p = 0·001, 0·015, 0·099, respectively). There was a trend towards improved asthma symptoms (p = 0·050) and a significant decrease in positive perception of curriculum (p = 0·017) at 18 months after adjustment for covariates.

CONCLUSIONS

This programme was associated with respiratory benefits on physiological asthma markers commonly, with a trend for symptom control. Academic and psychosocial outcomes are subject of further inquiry.

RELEVANCE TO CLINICAL PRACTICE

School-based asthma management holds promise as a feasible clinical option for middle school children with asthma in the Taiwanese school system.

Low exercise among children with asthma: a culture of over protection? A qualitative study of experiences and beliefs

BACKGROUND

Research shows that children are insufficiently active in most affluent societies. Although children with asthma may particularly benefit from physical activity, they are less active than their peers.

AIM

To explore the reasons for low physical activity levels among children with asthma and to identify strategies to improve activity.

DESIGN OF STUDY

A qualitative study using in-depth interviews and focus groups.

SETTING

Six GP practices, a Paediatric Respiratory Unit, and four schools in Tayside, Scotland.

METHOD

Purposive sampling identified 30 children with asthma, their parents (n = 38) and school staff (n = 28), who were interviewed or took part in focus groups. Data were examined using constant comparative analysis.

RESULTS

The lower level of activity among children with asthma was supported by a climate of fear among parents and teachers about what was safe and possible for the child. Restrictions were imposed because of perceived dangers of exercising in the presence of 'triggers'. Physical activity was regarded as a threat to be managed rather than something beneficial. Teachers found it difficult to distinguish between children who were physically incapable of exercise due to asthma and those who were unmotivated. GPs were unknowingly drawn into the controversy by children and parents who cite medical advice to sanction exemption from exercise.

CONCLUSION

GPs and asthma nurses need to provide clear management plans explaining what is appropriate and safe in terms of exercise on a child-by-child basis, to counter the considerable misunderstanding and disagreement among children, parents, and teachers.

Relationships of asthma knowledge, self-management, and social support in African American adolescents with asthma

Despite nationwide efforts to manage asthma, the adverse outcomes of asthma continue to increase, especially in African American adolescents. The purpose of this study was to examine the relationships among asthma knowledge, self-management, and social support in African American adolescents with asthma. A correlational descriptive study was conducted using a convenience sample of 53 identified asthmatic adolescents from the Southern metropolitan school system in Alabama. Asthma knowledge was measured by the Parcel Knowledge about Asthma Questionnaire, social support by the Norbeck Social Support Questionnaire, and asthma self-management behaviors by the Asthma Behavioral Assessment Questionnaire. Both asthma knowledge and social support had significant positive relationships (r=0.31, r=0.30, respectively) with asthma self-management behaviors and accounted for 14% of self-management behaviors variability. Further studies are needed to understand how to better manage asthma in adolescents.

Emergency asthma inhalers in school

Despite there being a lack of direct evidence of the effectiveness of providing emergency inhalers to schools, the balance of evidence at present suggests the benefits outweigh any possible harm. However, unless UK prescribing law or its interpretation is changed, this will remain an action which opens teachers, nurses, and doctors to possible legal and professional sanctions, and may nullify their institutional or professional indemnity. As a consequence, provision will remain patchy and research into the value of emergency inhalers will be inhibited. A position statement from one or more responsible organisations such as the Royal College of Paediatrics and Child Health, the British Thoracic Society, or the British Paediatric Respiratory Society could persuade a reassessment from the Medicines Control Agency. This is also an issue which could be addressed in the forthcoming National Service Framework for children.