What do school teachers know about 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.

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.

Knowledge of asthma in school teachers in nine Spanish cities

OBJECTIVE

To analyze the knowledge of asthma and its management in Spanish school teachers using the Newcastle Asthma Questionnaire (NAKQ).

DESIGN

Descriptive, observational prevalence study, using a self-report questionnaire on knowledge about childhood asthma and its management by teachers in pre-school, primary, and secondary schools in nine Spanish cities. Age, sex, academic training, teaching experience, courses in which they taught, and personal and family history of asthma, were collected from each teacher. For knowledge determination, the validated Spanish version of the NAKQ was used.

RESULTS

A total of 208 centers participated, including 7,494 teachers. The questionnaire was completed by 4,679 teachers (62.4%). The mean score of correct responses was 16.0 ± 4.8 points out of 31 (median = 17, range: 0-30). Only 6.8% of teachers were capable of pointing out the three main symptoms of the disease; 1.5% knew the triggering factors of an asthma attack; 8.6% knew two medicines useful during an asthma attack; 32.7% knew that inhaled medications had less side effects than pills, and only 3.8% knew of ways to prevent asthma attacks during exercise. In the multivariate analysis, variables significantly associated with a higher questionnaire score were a "lower age" (Beta coefficient = -0.09), "male gender" (Beta = 0.77), "being asthmatic" (Beta = 2.10), or "having close relatives with asthma" (Beta = 1.36) and "teaching in a private school" (Beta = 0.66) or in "compulsory secondary education" (Beta = 0.59).

CONCLUSIONS

Teachers have a low level of knowledge about asthma, with an important limitation in some aspects of the disease. They should be trained to recognize the main symptoms of the disease, on how to act in the event of symptoms, and the early identification of situations in which the pupils require health care assistance. Pediatr Pulmonol. 2016;51:678-687. © 2015 Wiley Periodicals, Inc.

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.

What do child daycare center teachers know about atopic dermatitis?

Atopic dermatitis (AD) is the most common childhood inflammatory skin disorder. The purpose of this study was to elucidate the knowledge level of daycare center teachers about AD and related factors. Study subjects were 297 teachers (287 female, 10 male) from 20 randomly selected daycare centers in Istanbul. The knowledge level of teachers was assessed using a questionnaire with 21 questions about AD. The teachers were asked nine additional questions about demographic and other characteristics of the child care centers and about themselves. The mean age of the teachers was 26.4 ± 8.1 years (range 20-53 yrs). The mean score for the 21 questions was 71.4 ± 12.1 (68%) from a maximum of 105 points. The response rate of teachers rate for each question ranged from 54% to 90%. The completely true response rate for each question ranged from 3.0% to 66.7%. The knowledge level of the teachers was related to the number of children in the daycare center, but not to sex, age, education level, family history of atopy, teacher's monthly salary, location, or whether the daycare center was public or private. Although teachers in daycare centers have some knowledge about AD, widespread educational programs for teachers about AD may help to improve the understanding of the disease and the quality of life of affected children in daycare centers.

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.

Knowledge and attitudes of adolescents towards asthma: questionnaire results before and after a school-based education program

BACKGROUND

Previous studies on school-based education programs have reported that asthmatic and nonasthmatic adolescents, teachers and school personnel do not have enough information on asthma. However, the number of education programs including adolescents without asthma is not sufficient. The aim of the present study was to determine the knowledge of school children about asthma and to investigate whether their knowledge of asthma can be increased by an education program through a booklet distributed as a handout.

METHODS

This cross-sectional prospective questionnaire survey was carried out in a private school in Ankara, Turkey, between February and April 2006. 720 adolescents in grades 6, 7 and 8 were included. Knowledge about asthma was evaluated by a scoring system before and after the education offered by means of a booklet.

RESULTS

The final analysis was conducted on 642 students in total. The number of right answers in 5 categories, percentage of right answers and total questionnaire score improved significantly after the education received (p < 0.001). The total questionnaire scores of the girls (p = 0.002), those students with a university graduate mother (p = 0.006) and those with a physician parent (p = 0.041) were higher than those of the other pupils.

CONCLUSION

Theoretical material in the form of a booklet can be used in a school-based asthma education program in order to improve the knowledge of adolescents about asthma.

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.

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.

Asthma knowledge and asthma management behavior in urban elementary school teachers

BACKGROUND

Although schools are an important setting for asthma care in youth, teachers' asthma knowledge and symptom management is poor. This study investigated the knowledge, prevention and management behaviors, and communication regarding asthma of teachers of low-income, ethnic minority students. It was hypothesized that relative to colleagues whose students did not have active asthma (i.e., did not have symptoms during the day), teachers of students with active asthma would have better asthma knowledge and that more would take asthma prevention steps and communicate with parents and school nurses.

METHODS

Drawing from 25 elementary schools in New York City, 320 pre-Kindergarten through 5th grade classroom teachers with at least one student with asthma completed measures assessing their asthma knowledge, steps taken to manage asthma, communication with the school nurse or parents, information they received about asthma, and whether or not they had at least one student in their class experience asthma symptoms. t test and chi-square were used to test hypotheses.

RESULTS

Asthma knowledge varied among teachers. Most could identify potential triggers, yet few knew that medication taken prior to exercise could prevent symptoms and that students with asthma need not avoid exercise. Communication between teachers and school nurses and between teachers and parents was lacking. Relative to colleagues whose students did not have active asthma, teachers whose students had active asthma had better asthma knowledge, more took steps to prevent students from having asthma symptoms, communicated with parents, and more initiated communication with the nurse.

CONCLUSIONS

Teachers' knowledge about asthma and asthma management is limited, especially among those whose students did not have active asthma. Teachers respond reactively to students who have symptoms in class by increasing prevention steps and communications with parents and the school nurse. A more proactive approach to managing asthma in schools is warranted.

Asthma care issues in kindergarten teachers: an evaluation on knowledge, attitudes, and self-efficacy of asthma

As frequently there is no school nurse in a kindergarten setting, teachers receiving non-medical training take the primary roles of symptom assessment and management of young children with asthma. This article presents the knowledge, attitudes, and self-efficacy of asthma in kindergarten teachers in Taiwan. A total valid sample of 460 teachers was recruited from 70 kindergartens. Results showed most teachers understood the basic facts about asthma rather than the complex issues; they demonstrated positive attitudes toward having asthmatic children in class. Regarding self-efficacy, teachers lacked confidence in their ability to manage asthma attacks. Teachers' asthma knowledge showed a significant positive correlation with attitude (r = 0.27, p < 0.001) and self-efficacy knowledge (r = 0.23, p < 0.001). Given the need to help kindergarten teachers take care of children with asthma, the implications of kindergarten teachers' in-service education and training to asthma care are also discussed.

Educational camp for children with asthma

OBJECTIVE

To evaluate the impact of a 5-day educational camp program for children with asthma in terms of improving their knowledge of asthma and enhancing their performance in the use of inhaled medication and in physical activities.

METHODS

Every day, the children received 20-min interactive educational sessions, the technique for using the metered-dose inhaler was reviewed, two peak flow readings were recorded, and the children performed physical activities that included breathing and relaxation exercises. A questionnaire regarding knowledge of asthma, as well as asthma triggers, asthma medications, misconceptions regarding asthma, and the use of spacers, was administered before and after the intervention. Correct use of inhaled medication and exercise-related symptoms were also evaluated before and after the intervention.

RESULTS

A total of 37 children with asthma, aged 8-10 years (15 females and 22 males), were included in this study. Of those, 25% showed an improvement in the level of knowledge of asthma after the educational camp program, as evidenced by the greater number of correct answers on three of the twelve questions analyzed (p < 0.05). The exercise-related dyspnea scores decreased significantly (p < 0.05). The ability to use inhaled medication correctly was significantly improved after the intervention (p < 0.05).

CONCLUSIONS

The asthma educational camp program can improve knowledge about specific questions, encourage participation in physical activities, and improve the asthma management skills of children.

Exploring and explaining low participation in physical activity among children and young people with asthma: a review

Background

Asthma is the most common chronic illness among children and accounts for 1 in 5 of all child GP consultations. This paper reviews and discusses recent literature outlining the growing problem of physical inactivity among young people with asthma and explores the psychosocial dimensions that may explain inactivity levels and potentially relevant interventions and strategies, and the principles that should underpin them.

Methods

A narrative review based on an extensive and documented search of search of CinAHL, Embase, Medline, PsycINFO and the Cochrane Library.

Results & Discussion

Children and young people with asthma are generally less active than their non-asthmatic peers. Reduced participation may be influenced by organisational policies, family illness beliefs and behaviours, health care advice, and inaccurate symptom perception and attribution. Schools can be reluctant to encourage children to take part in physical education or normal play activity due to misunderstanding and a lack of clear corporate guidance. Families may accept a child's low level of activity if it is perceived that breathlessness or the need to take extra inhalers is harmful. Many young people themselves appear to accept sub-optimal control of symptoms and frequently misinterpret healthy shortness of breath on exercising with the symptoms of an impending asthma attack.

Conclusion

A multi-faceted approach is needed to translate the rhetoric of increasing activity levels in young people to the reality of improved fitness. Physical activity leading to improved fitness should become part of a goal orientated management strategy by schools, families, health care professionals and individuals. Exercise induced asthma should be regarded as a marker of poor control and a need to increase fitness rather as an excuse for inactivity. Individuals' perceptual accuracy deserves further research attention.

Asma em escolares de 13 e 14 anos do Município de Nova Iguaçu, Rio de Janeiro, Brasil: estimativas de prevalência, gravidade e diferenças de gênero

O objetivo deste estudo foi descrever a prevalência, a gravidade e os sintomas associados à asma e sua relação com o gênero em escolares de 13 e 14 anos do Município de Nova Iguaçu, Rio de Janeiro, Brasil. Trata-se de estudo transversal, no qual se utilizou o questionário escrito auto-aplicável para asma do International Study of Asthma and Allergies in Childhood (ISAAC). Participaram 3.033 escolares de 37 escolas públicas e privadas selecionadas aleatoriamente. A prevalência de sibilância alguma vez na vida foi de 26% e nos últimos 12 meses (asma atual) de 11,7%, sendo essas taxas maiores entre as meninas (razão de prevalência - RP = 1,46; IC95%: 1,31-1,62 e RP =1,72; IC95%: 1,35-2,21, respectivamente). Sintomas associados à gravidade da doença, como distúrbio do sono e limitação da fala por sibilos, também se associaram positivamente com o gênero feminino (RP = 2,57; IC95%:1,77-3,73 e RP = 2,07; IC95%:1,25-3,43). A prevalência da asma mostrou-se menor quando comparada com as de outras cidades brasileiras, porém ainda é alta entre adolescentes de Nova Iguaçu, sendo mais freqüente e mais grave no gênero feminino. Outros estudos são necessários para explicar tais diferenças.

Teachers' perceptions in central Turkey concerning epilepsy and asthma and the short-term effect of a brief education on the perception of epilepsy

This study was aimed at assessing and comparing schoolteachers' perceptions of epilepsy and asthma in central Turkey. Two-hundred seventy-five schoolteachers completed a questionnaire on their knowledge, attitudes, and practice. There were 18 pairs of questions on the questionnaire (one question in each pair pertained to epilepsy, and the other to asthma). One month later, following a brief education program on epilepsy, participants completed the epilepsy section of the questionnaire a second time. Among the teachers, initial rates of acceptance of children with epilepsy were significantly lower than the rates for asthma. Children with epilepsy were less encouraged by teachers to play with others and were perceived as more aggressive. More teachers were worried about other parents objecting to having a child with epilepsy in the class. Following the brief education program, there was a significant positive change in the teachers' perception of epilepsy.

Teacher capability and school resource scale for asthma management

This paper presents the design and evaluation of the Teacher Capability and School Resource Scale for Asthma Management. Based on a sample of 589 kindergarten to eighth grade teachers, the scale yielded two factors: the Teacher Capability in Social and Emotional Aspects of Asthma Management factor (alpha = 0.83) and the School Resources/Institutional Capability for Asthma Management (alpha = 0.86). This scale fills a needed gap in the literature regarding assessment tools for school-based asthma management that focus on teacher efficacy.

Using school staff to establish a preventive network of care to improve elementary school students' control of asthma

School-based asthma interventions delivered by nonschool staff have been successful but are limited in their reach because of the cost and effort of bringing in outside educators and their inability to establish improved communication about asthma between schools, families, and primary care providers (PCPs). To address these problems, Columbia University and the New York City Department of Education and the New York City Department of Health and Mental Hygiene undertook a randomized controlled trial to test the efficacy of a comprehensive school-based asthma program. In this intervention, school nurses were trained to facilitate the establishment of a preventive network of care for children with asthma by coordinating communications and fostering relationships between families, PCPs, and school personnel. PCPs also received training regarding asthma management. There was limited support for this model. While case detection helped nurses identify additional students with asthma and nurses increased the amount of time spent on asthma-related tasks, PCPs did not change their medical management of asthma. Few improvements in health outcomes were achieved. Relative to controls, 12-months posttest intervention students had a reduction in activity limitations due to asthma (-35% vs -9%, p < .05) and days with symptoms (26% vs 39%, p = .06). The intervention had no impact on the use of urgent health care services, school attendance, or caregiver's quality of life. There were also no improvements at 24-months postintervention. We faced many challenges related to case detection, training, and implementing preventive care activities, which may have hindered our success. We present these challenges, describe how we coped with them, and discuss the lessons we learned.

The child with asthma at school: results from a national asthma survey among schoolchildren in Israel

PURPOSE

To evaluate school absence and restriction in school activities of children with asthma, and to estimate the involvement of the school staff in asthma disabilities.

METHODS

A modified version of the International Study of Asthma and Allergies in Childhood written questionnaire was administered to a national sample of 13-14-year-old schoolchildren across Israel. Questions regarding social and demographic factors, school absence owing to asthma symptoms, and school staff involvement were added.

RESULTS

There were 10,057 complete questionnaires available for analysis; 710 children reported having asthma. Children with asthma were absent on the average 7.3 +/- 9.8 days in the past school year compared with 3.9 +/- 6.3 days in children without (p = .0001). Absenteeism owing to respiratory symptoms was significantly more common in children with asthma and associated with a more severe asthmatic condition. Four percent of the children with asthma were absent from school more than 30 days. Of the children reporting asthma, 25.9% were not allowed to participate in one or more school activities for medical reasons, compared with 4.2% of children without asthma. Of the children with asthma, 44.3% reported that the school nurse knew about their asthma, and only 13.8% reported that the nurse discussed their asthmatic condition with them; 38.2% of children with asthma reported that no one at school knew about their illness.

CONCLUSIONS

Children with asthma are absent annually on average 3.4 days more than children without asthma. School absence is associated with the severity of asthma. A significant percentage of asthmatic children participate less in school activities. School staff awareness of the children illness is not satisfactory.

Clinical and therapeutic aspects of allergic asthma in adolescents

Little is known about the management of asthma in adolescents. We aimed at evaluating these aspects, through a specific questionnaire, in the real life of adolescents with allergic asthma. The questionnaire was administered to a group of adolescents after a diagnosis of allergic asthma. The diagnosis was based on history, clinical examination, pulmonary function tests and allergy tests. One hundred and fifteen adolescents (65 males, mean age 16.5 years) fulfilled the criteria for allergic asthma. The questionnaire explored demography, family history, clinical history, previous diagnosis, therapy, attitude towards therapy and social aspects. The mean actual FEV1 was 87 +/- 10%. Methacholine challenge was carried out in 79 patients and was always positive (PD20 < 1,200 microg), whereas 36 patients underwent reversibility test. According to GINA guidelines, severity of asthma resulted intermittent in 62, mild persistent in 31, moderate in 19 and severe in three patients. In 61% of cases teachers were not aware of the disease. Asthma was managed by general practitioners, allergists and pulmonologists, but PFT/allergy tests had never been performed in 14% of patients. Forty-two per cent of the adolescents received no therapy at all, and only 15% of those with persistent asthma were receiving a stable treatment. Seventy-four per cent of adolescents preferred the inhaled, as against the oral, route. From a clinical and functional point of view, asthma in adolescents did not differ from other age ranges. Nevertheless, the management (diagnosis and therapy) emerged to be unsatisfactory from many points of view.

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.

Strengthening asthma education to enhance disease control

This article focuses on reducing the barriers to effectively applying what is known about asthma patient education. One barrier to effective asthma control in individuals and populations is failure to recognize the range of influences on patients trying to manage their disease, including actions of family, clinicians, friends and neighbors, work or school mates, and significant people and organizations in the wider social environment. Another deterrent is failing to assist patients in developing their self-regulation skills. Other barriers are the lack of attention to the patients' asthma management goals (as opposed to clinical objectives) and overlooking signs that indicate follow-up education is needed. Five actions taken by health-care professionals could significantly enhance the effectiveness of asthma education: (1) make messages to patients and core skills taught consistent with national asthma guidelines; (2) focus on developing the patient's ability to self-regulate; (3) develop comprehensive plans for treatment and education that assign clinicians to appropriate educative roles; (4) use clinician communication techniques demonstrated to enhance asthma management by patients; and (5) ensure that all providers of education are themselves trained to achieve actions 1 to 4.

Asthma and allergies at school--a Swedish national position paper

The marked rise in allergies during the past decade has been increasingly perceptible for school personnel. A quarter of Swedish parents of children with allergies are unsatisfied with the school environment and how the schools are organized around their children. The Association of School Physicians has, together with six other medical, teaching and patient organizations, developed written guidelines for the management of asthma and allergies in Swedish schools. The aim was to regulate the responsibility of the school and its personnel for students with asthma and allergies, and to strengthen safety arrangements within schools. A secondary aim was to describe how the curriculum, teaching equipment, excursions, and other school activities, could be arranged appropriately and safely for students with asthma and allergies. Five-hundred copies of the document were circulated to all of Sweden's municipalities, county councils and pediatric departments. There was general agreement regarding the schools' responsibility that no child should risk becoming ill or having exacerbation of symptoms due to conditions at school. Recommendations regarding smoking on school premises and the use of perfumes were criticised. The strength of this document is that all organizations actively involved with schools have agreed upon these recommendations. This document serves to suggest a minimum level of activities thus ensuring that even students with asthma and allergies will receive appropriate schooling.

Perceptions of asthma: the views of young people

Over 1,000 secondary school students (ages 11‐16) completed a closed‐form questionnaire about the nature, causes and consequences of asthma. The questionnaire contained items which related to conceptions about asthma which had emerged in previous work, and also items relating to the known scientific issues surrounding asthma. In general, most students knew about many of the triggers which can cause an asthma attack, although fewer recognised the allergenic properties of nuts and the possible role of emotional upset. More than half thought that people with asthma could not perform well at sport, and a fifth saw them as somehow “weaker”. A fifth thought of asthma as being simply inconvenient, but not serious. These ideas persisted in the oldest students, and it seems likely that they will exist in the adult population to a similar extent. In general, girls seemed to be better informed about asthma than boys.

[Pilot study on knowledge about asthma and its treatment among Spanish teachers]

This was a study aimed to know the knowledge about asthma.

SUBJECTS AND METHOD

933 teachers of 27 schools from 7 cities (children aged between 4 and 15 years) using a self-administered questionnaire Half of them knew asthma prevalence and its hereditary nature. Nearly all related asthma with allergy, 38% with exercise, 25%had students who suffered from asthma attacks in the school, and 91% admitted to have limited information and wish to improve it.

CONCLUSION

Our survey reveals that Spanish teachers have a limited information about asthma.

Choices of therapy for exercise-induced asthma in children

Cough and wheezing interferes with sport and other forms of physical activity in half of asthmatic children. Airway obstruction can be induced by a standard exercise test in over 70% of children with asthma. A beta-adrenergic agonist or cromone taken by inhalation beforehand will usually inhibit bronchoconstriction provoked by a free running exercise test. The duration of protective effect with salbutamol, terbutaline and cromones is less than 4 h. The long acting beta-adrenergic agonists formoterol and salmeterol give protection against exercise-induced airway obstruction for up to 12 h, which implies that treatment given in the morning will offer protection from the effects of physical activity throughout the day. However, the duration of protective effect after a morning dose declines if these compounds are given regularly. Leukotriene receptor antagonists (LRAs) also provide good protection against exercise-induced asthma. Regular administration of LRAs is not associated with tolerance and loss of protective effect. The oral route makes for unobtrusive administration and this may help adherence to prescribed regimens.

Helping patients to master correct inhaler techniques: nursing role

The use of inhalers is widespread for asthma and conditions such as chronic obstructive pulmonary disease and yet many people have difficulties in mastering correct inhaler technique. Elderly people and children have specific problems with inhaler use and require both targeted and appropriate help in order to improve their inhaler technique and minimize waste of inhaled medication and therefore lack of therapeutic effect. Nurses need to be able to not only demonstrate correct inhaler technique themselves, but also identify what is going wrong and be knowledgeable concerning the various options available. Frequent assessment of inhaler technique needs to become a regular feature of health promotion for all patients using these devices.

Primary schoolteachers' knowledge of asthma: the impact of pharmacist intervention

The Newcastle Asthma Knowledge questionnaire was used to determine primary schoolteachers' knowledge of asthma. The mean score achieved (20.71 +/- 3.20), was representative of a reasonable degree of knowledge. However, knowledge of symptoms associated with asthma and of medications used to manage the condition was poor. Teachers who had contact with an asthmatic individual or who had received previous training on asthma had a significantly greater knowledge of asthma. An asthma training session, delivered by a pharmacist, was found to significantly improve primary schoolteachers' knowledge of the condition, however, the extent of the improvement was low.

School preparation for the asthmatic student

Questionnaires given to school nurses were used to collect data regarding emergency asthma equipment and plans. Sixty-three percent reported <10 asthmatic visits per month, 25% reported 10-50, and 12% reported >50. Only 20% of school nurses reported that 75%-100% of asthmatic students had an emergency plan, and 24% did not know if asthmatic students had a plan. Only half of the nurses had input into the plan. Equipment varied: 16% had oxygen, 45% had peak flow meters, 0% had MDIs, and 20% had nebulizers available. Many asthmatic students lack emergency plans, and many school nurses are not involved in the plans.

[Cross-sectional study of school integration of asthmatic children in a general population sample]

AIMS

Asthma is one of the most frequently encountered chronic illnesses in children. The aim of the present study was to investigate the problem of integration of asthmatic subjects at school by assessing the reactions of parents and teachers, and also by considering the medical aspects.

POPULATION AND METHODS

A cross-sectional random study was carried out during autumn 1994 including 4,251 primary school children aged between five and 14 years, and including teachers from 188 classes and 26 schools in Grenoble and its inner suburbs. The first screening questionnaire was completed by the parents, and data on 3,799 children were obtained; from this, 191 currently asthmatic children were identified. One hundred and forty-six parents of the identified asthmatics subsequently answered a second questionnaire on the severity of the illness and its effects on school attendance and educational activities. The 186 teachers from the schools involved were interviewed about their knowledge of the disorder, and about what they knew of the treatment and management of asthmatic children in school.

RESULTS

It was found that the cumulative prevalence of asthma amounted to 7.6%, and that the prevalence over the previous 12-month period was 4.3%. Sixteen percent of the asthmatic children reported an asthma-associated school absence of more than six days during the six preceding months. In 45.2% of cases, physical exercise was responsible for an asthmatic attack, but premedication was used in only 21% of cases. Nine percent of the children had obtained a medical certificate which exempted them from participating in sports activities and physical exercise. Seventy-three percent of the parents had informed the teachers of their child's illness, but the information communicated was incomplete. It was found that the teachers did not have a thorough knowledge of the disorder, but that many of them (92.7%) would appreciate further information on the subject and on its management. Eighty-three percent of the teaching staff were unaware that the ministerial circular No. 93-248 of 22 July 1993 had been issued on the proposed management of chronic disorders at school, advocating a combined effort on the part of the parents, the child's physician, the school doctors and the teachers in setting up a concerted plan of action.

CONCLUSIONS

This study has demonstrated that the school integration of asthmatic children remains problematical both as regards treatment and the pursuit of indoor and outdoor school activities. Integration could be improved by using parent-doctor-teacher liaison forms, thereby maintaining closer communication regarding the child's needs. When this is not sufficient, an individualized asthma management plan could be introduced in collaboration with the parents, doctors and teachers, which might result in improved treatment and integration of asthmatic children in school.

Development of a survey of asthma knowledge, attitudes, and perceptions: the Chicago Community Asthma Survey. Chicago Asthma Surveillance Initiative Project Team

Little is known about the general public's perception of the diagnosis of asthma and the impact of asthma on individuals, their families, and their communities. In addition, there appear to be no published survey instruments specifically designed to gain insights into how the general public perceives asthma. The purpose of this paper is to describe the development of such an instrument, the Chicago Community Asthma Survey (CCAS)-32. Development began with two qualitative steps. First, a review of the published literature guided the initial instrument construction (Step 1). Content domains were chosen based on clinical input and the Health Belief Model. Most items were derived from existing instruments. To assess content validity, cognitive interviews and expert reviews were conducted (Step 2). Items were added, modified, and deleted based on the information gathered at each of these steps. In the next step, item performance measurement (Step 3), testing of two samples provided quantitative data to further inform item reduction. Items with uniform correct responses or responses lacking in variability were excluded. The result of this three-step process was a 32-item survey of asthma knowledge, attitudes and perceptions, the CCAS-32. The introduction to the survey was subsequently modified to minimize respondent bias (Step 4). In conclusion, the CCAS-32 was constructed with input from experts in asthma and individuals from the Chicago area. The items in the CCAS-32 appear to have both face validity and acceptable performance characteristics.

National school teachers' knowledge of asthma and its management

Asthma is the most common chronic medical condition that school teachers may encounter among their pupils. However management of asthma in schools and the role school teachers adopt in this condition has only recently been explored. The aim of this study was to determine teachers' knowledge of asthma and its management. A postal questionnaire was circulated to 199 school teachers from 46 schools in Dublin City. A 74 per cent response rate was obtained. The number of children with asthma as identified by teachers was 7.8 per cent which suggests that asthma may be unrecognised in a number of pupils. Knowledge on signs and symptoms of asthma, provoking factors of asthma and the nature of the disease was generally satisfactory. However, knowledge on asthma medications, the purpose of inhalers and teachers' understanding of the treatment and management of asthma was considered poor. Knowledge on exercise-induced asthma was limited. There is a need to provide school teachers with education on asthma and its management. School policies on asthma also need to be developed with particular reference to action necessary in the event of an acute severe attack of asthma.

Western Australian primary school teachers' knowledge about childhood asthma and its management

A total of 164 primary school teachers from Perth, Western Australia anonymously completed a survey of their knowledge and attitudes about asthma. These teachers were active in assisting children with asthma management but most (91.5%) felt that they did not know enough about asthma. Attitudes toward children with asthma were positive; 97% agreed that such children should be encouraged to participate in sporting activities. Specific knowledge about asthma management and medications was, however, poor. This large sample of Western Australian teachers knew more than their European counterparts but asthma training is needed and should be targeted at improving knowledge of both regular and emergency treatments for asthma.

Foundations for a healthy future

Health promotion activities with children and young people are important as they take messages about health seriously and can be influential in spreading messages about healthy living to their friends and families. Child health professionals have an important role to play in passing on messages of positive health to children and young people. Peer education is a useful way of passing on messages about health to young people. This article shares examples of three health promotion projects with children in a community trust, looking at asthma, sex education and testicular examination.

Achieving treatment goals for schoolchildren with asthma

OBJECTIVES

To identify problems in managing asthmatic children in school, which if dealt with would help reduce absenteeism and improve participation in school activities.

DESIGN

A survey by questionnaire to headteachers.

SETTING

Schools in Merthyr and Rhondda Cynon Taff, South Wales.

SUBJECT

Asthmatic schoolchildren in areas studied.

MAIN OUTCOME MEASURES

Facilities in schools to manage asthma, headteachers' perceptions of knowledge of asthma management by teachers, possession of written policies, and desire for further training.

RESULTS

There are 216 schools in the area studied, with 55,166 schoolchildren. A total of 191 (88%) headteachers returned the completed questionnaire. Five hundred and twenty seven (17%) children were reported absent from school during one term because of asthma, with an average of nine days of schooling lost per asthmatic child per term (range 2-16 days). Only 76 (40%) schools allowed children to be responsible for their inhalers, and 12 (6%) schools required parents to administer inhalers. In 115 (60%) schools, headteachers believed their staff were familiar with the management of asthma. A total of 174 (91%) headteachers expressed interest in further training.

CONCLUSION

This study highlights the need to train teachers and provide an agreed joint education and health policy on managing asthma in school.

Children with chronic conditions: educators' views

The purpose of this qualitative, exploratory study was to identify the concerns and resource needs of educators for effectively teaching children with chronic health conditions, Semistructured audiotaped telephone interviews were conducted with 23 teachers and six principals from urban and rural public schools, grades K-12. The interview included questions in four areas: (a) experiences with children with chronic health conditions, (b) concerns in providing educational services to these children, (c) resources used by educators, and (d) recommendations regarding how information and services can best be provided to educators. The most common concerns were unanticipated medical emergencies and increased absence rates. The major resource for these educators was the school nurse. Educators preferred information specific to a child in their class, provided to them by the school nurse. Results suggest that interventions for teachers are more likely to be effective when they are coordinated with the school nurse and focus on the impact of the condition on a child's ability to function in the classroom. Subsequent research is necessitated to determine effective strategies for specialty nurses to aid school nurses in providing optimum care for these children.

Issues in adolescent asthma: what are the needs?

In the UK most children with asthma do not attend hospital clinics and continuity of care is provided by their general practitioner. However, those with severe asthma, most of whom will not grow out of their symptoms, need hospital-based care as well. As they progress through adolescence teenagers become increasingly uncomfortable in paediatric wards and outpatient clinics. They need clinics where they can meet the chest physician who will take on their care before they transfer to a clinic for adults (table 5). Adolescent asthmatic patients are a distinct group of patients with different treatment requirements from either paediatric or adult patients. It is important that physicians recognise adolescent needs and the importance of regular health checks, smoking, peer pressure, and the negotiation of treatment plans in this group of patients.

Teacher initiated improvement of asthma policy in schools

OBJECTIVE

To assess whether information about asthma acquired by individual teachers, following attendance at an inservice seminar, would be communicated to other school staff, and whether policies about asthma management would be subsequently developed in schools.

METHODOLOGY

A telephone interview was conducted of 50 primary school teachers in the Hunter Region who were selected randomly from those who had represented their school at an inservice seminar about asthma.

RESULTS

All 48 respondents had provided feedback to their colleagues, mostly at a staff meeting. After the seminar the number of schools with a written policy about the management of asthma had increased from 1 to 20. Initially the school's first aid kits contained a bronchodilator inhaler in 25 schools (increasing to 43 after the seminar), a spacer device in six schools (increasing to 47) and written guidelines for management of an asthma attack in seven schools (increasing to 32). Teachers from four schools indicated that all school staff knew how to recognize an acute attack prior to the seminar compared with 22 schools afterwards. Before the seminar 18 schools asked parents to supply written instructions for the management of their children at school but this increased to 44 after the seminar.

CONCLUSIONS

A programme of one-off seminars attended by one teacher from each primary school resulted in large increases in the proportion of schools with appropriate policies for the management of asthma in the school environment.

Two hour seminar improves knowledge about childhood asthma in school staff

Teachers and support staff are often called upon to manage asthma at school but may have little knowledge and understanding of the condition. The aim of this study was to determine whether a short seminar would improve knowledge in non-health professionals. Seventy school staff attended one of five 2 h seminars presented by an asthma educator. Participants completed the Newcastle Asthma Knowledge Questionnaire (AKQ) before, and 2 months after, the seminar. The mean initial score (maximum possible 31) was 16.4 (range 4-26), increasing to 23 (range 13-29, P = 0.0001). There was a large increase in knowledge about symptoms, pathophysiology, preventive medications and side effects of medications. Initially almost all of the participants had deficiencies in knowledge about reliever medications and the management of exercise-induced asthma. After the seminar, knowledge in these areas was still poor, with only one-third of the participants answering them correctly. The results have been used to modify the content of the 2 h seminar with increased emphasis on those areas in which deficiencies in knowledge were demonstrated. No data are available yet as to whether this improved knowledge has improved management.

Educating teachers about asthma

The objectives of this project were to investigate teachers' knowledge of asthma and to evaluate the effectiveness of an information session similar to the asthma programs for schools developed and offered by an organization charged with educating the community about asthma. A questionnaire consisting of 24 multiple-choice questions on asthma and its management was created for this project. There were no significant differences in knowledge of asthma between teachers who attended an information session about asthma and teachers who did not. Teachers with asthma had more knowledge of asthma than nonasthmatic teachers, but knowing someone with asthma made no significant difference to teachers' knowledge. There were no significant differences between teachers who had or had not received training in asthma from some other source prior to our intervention. Ninety-three percent of teachers indicated they wanted more information on asthma prior to the intervention session. Seventy-nine percent of teachers wanted further information after the intervention session. Methods of improving the effectiveness of the transmission of information concerning asthma and its management are explored.

Educating school personnel about asthma

Teachers, administrators, and other nonmedical personnel are frequently responsible for managing students with asthma during school hours. We determined that the school secretary is the most likely person to manage asthma at school. We developed an educational program for both nonmedical and medical school personnel entitled "Asthma Management in the Schools." A questionnaire designed to evaluate knowledge and obtain information about asthma care at school was mailed to participants several weeks before they attended the program and was administered again after the program was presented. Nonmedical personnel had lower mean preclass test scores than nurses, but mean postclass test scores were similar. Programs designed to improve asthma care in school should meet the needs of nonmedical personnel.

Teachers' perceptions of epilepsy

A questionnaire survey undertaken among 142 schoolteachers in North Staffordshire revealed most of the respondents did not feel confident when teaching children who had epilepsy and a minority considered their knowledge of the subject to be adequate. Only four teachers had received recent specific instruction on childhood epilepsy and the majority requested training on epilepsy and other medical conditions. Despite this lack of confidence and specific training, the respondents demonstrated good general knowledge of epilepsy and adequate awareness of the difficulties encountered by epileptic schoolchildren. If optimal care is to be achieved for children with epilepsy, then teachers must feel confident with this subject. School health services have a clear role in ensuring that teachers have sufficient knowledge of childhood epilepsy, that they have adequate support, and that communication between teachers, parents, and paediatricians is encouraged.

Schoolteachers' perceptions and knowledge of asthma in primary schoolchildren

Schoolteachers are known to be concerned about asthma in their pupils but their opinions about the best method of addressing this concern have not previously been investigated. Eleven headteachers and 76 class teachers from 11 primary schools in the Southampton area--eight from the state sector and three private day schools--completed questionnaires. These inquired about the organization of care for asthmatic pupils, the teachers' knowledge, concerns and training regarding the disease, and their perceptions of the need for and source of further education for teachers about asthma. All 10 National Health Service school health services in the Wessex region and 16 teacher training colleges responded to questions about their provision of such education for teachers. The results demonstrated that asthma care in the 11 schools was generally disorganized, with the responsibility for keeping and administering inhalers falling on the school secretary in seven of the schools. All but two of the 11 headteachers and 89% of the class teachers were concerned about asthma, primarily in managing emergencies. Levels of knowledge were low, particularly regarding exercise, and education about asthma was almost non-existent. The great majority of class teachers (86%) wanted more information about asthma and most (67%) looked to the school health services to provide this. None of the school health services in Wessex and only one teacher training college had any planned education about asthma for teachers. Clearly, schools need to receive more information about asthma, both to enable them to cope more ably with their asthmatic pupils and to allay the anxieties of teachers.(ABSTRACT TRUNCATED AT 250 WORDS)

Management of asthma in pre-school children

The management of asthma in pre-school children often presents physicians with challenging problems. This article addresses the diagnostic criteria by which the diagnosis may be made, discusses the prognosis of untreated asthma and states the principles underlying the treatment of asthma in this age group. The management according to a stepwise protocol is discussed with reference both to maintenance therapy, and the treatment of acute severe asthma. The methods by which appropriate medication may be delivered are also described.