childhood asthma and student performance at school
TRANSCRIPT
Childhood Asthma and Student Performance at School Howard Taras, William Potts-Datema
ABSTRACT: To better understand what is known about the association between childhood asthma, school attendance, and academic outcomes, the authors reviewed published studies investigating this topic. Tables with brief descriptions of each study’s research methodology and outcomes are included. Research reveals evidence that rates of absenteeism are higher among students with asthma. The exact magnitude of absenteeism is dificult to ascertain. However; the studies have helped to identifj, characteristics of children with asthma that are most likely to be associated with the highest absenteeism rates. Some interventions to improve rates of absenteeism among school-aged children with asthma show promise, but it cannot yet be concluded that students who adhere to medical routines for controlling asthma will as a result increase their rates of attendance. Studies thus far have shown that there is either only a weak or nonexistent association between asthma and school achievement. Further studies are required to verifj, if certain subpopulations of children with asthma (eg, those with severe and ongoing symptoms, those with disturbed sleep, kindergarten children) are at higher risk for poor school achievement. ( J Sch Health. 2OO5;75(8):296-3 12)
ealth professionals frequently remind educators of H the correlation between children’s health and their academic potential. Such generalizations are not always accompanied by specific examples and more rarely accompanied by evidence.
To clarify and quantify the relationship between health and child performance and ability at school, the National Coordinating Committee on School Health and Safety (NCCSHS) called for a review of the state of this re- search. The project involves a literature search of peer- reviewed, published research reporting on the relationship between students’ health and their performance in school. The NCCSHS is an organization that comprises represen- tatives from several federal departments and national non- governmental organizations. This article summarizes what is known through data collection about the association of asthma among school-aged children with attendance and academic outcomes. The associations of school perfor- mance with other chronic diseases are summarized in a separate article.
Criteria for an article to be selected for review were that the article had to have been published within the past 15 years (1989 or later), the subjects of study were school-aged children (ages 5-18 years), and the research included school attendance or academic achievement. Studies were identified using MedLine and similar Inter- net-based searches. If a full article could not be retrieved, studies with detailed abstracts were included. Many stud- ies cited here had major outcome measures other than those pertinent to the objectives of this project. These alternative outcomes may not be described at all or are briefly mentioned.
Howard Taras, MD, Professor ([email protected]), Division of Community Pediatrics, University of California, San Diego, Gilman Drive #0927, La Jolla, CA 92093-0927; and William Potts-Datema, MS, Director. ([email protected]), Partnerships for Children’s Health, Har- vard School of Public Health, 677 Huntington Ave, 7th Floor; Boston, MA 02115. This article is I of 6 articles that are part of a project of the National Coordinating Committee on School Health and Safety (NCCSHS). This NCCSHS project was funded by the US Department of Health and Human Services, Department of Education, and US Depart- ment of Agriculture. Opinions expressed in this article are not necessarily shared by these federal agencies or other institutions that comprise NCCSHS membership.
ASTHMA AND SCHOOLS Children with asthma are conceivably at risk for
decreased school functioning due to acute exacerbations of this disease, increased absenteeism secondary to symp- toms, iatrogenic effects of students’ asthma medication (eg, oral steroids), poor medical management of the dis- ease, and/or the stress associated with having a chronic illness.’ Although teachers generally have accepting atti- tudes toward students with asthma, their knowledge about asthma is low2 and they do not feel adequately prepared to assist children with the management of asthma in the class- r00m.~ To help address this situation, many federal agen- cies and national organizations in the fields of health services, education, health education, and air quality have developed resources to assist schools to manage students with asthma and minimize symptoms of asthma by opti- mizing the school environment. These resources are listed on the Web site of the NCCSHS at http://www.healthy- students.org/resources/.
Absenteeism Of the 66 reviewed studies addressing asthma and
school attendance, virtually all showed a correlation between this disease and high rates of student absentee- ism. The number of missed school days that a child with a given severity of asthma is still unknown, as is the cause for missed school days (ie, doctor’s appointments, symp- toms of asthma, avoidance of environmental triggers). A little is known about the timing of missed school days (eg, season of the year, prevalence of flu) (Table I) . Although the relationship between asthma and school attendance may not have changed over the past couple of decades (Anthracopoulos et a1 2001; Centers for Disease Control and Prevention 2002; Table I), the increased number of school-aged children with asthma has meant that the abso- lute number of school days missed is larger (Weiss et al 2000; Table 1).
One reason for the inconsistency on the expected num- ber of days absent for a student with asthma is that stud- ies have used various definitions of asthma. Some studies define asthma based on respiratory symptoms. Others use a parental report of a diagnosis of asthma. Yet others use evidence found on medical chart review. Many articles do not have control groups (ie, there is no comparison of attendance among children with asthma against
296 Journal of School Health October 2005, Vol. 75, No. 8
Tabl
e 1
Pub
lishe
d R
esea
rch
Art
icle
s Th
at A
ddre
ss A
sthm
a an
d A
bsen
ce F
rom
Sch
ool (
Con
tinue
d on
nex
t pag
e)
Cita
tion
(Ori
gin
of P
rim
ary
Aut
hor)
R
esea
rch
Des
ign
Maj
or F
indi
ngs
Rel
ated
to A
bsen
teei
sm
Ad
am
RJ,
Wei
ss S
T, F
uhlb
rigge
A. H
ow
and
by w
hom
car
e is
del
iver
ed in
fluen
ces
anti-
infla
mm
ator
y us
e in
ast
hma:
resu
lts
of a
nat
iona
l pop
ulat
ion s
urve
y. J
Alle
rgy
Clin
lmm
unol
. 2003;112(2):445-50.
(US
A)
Al-D
awoo
d KM
. Sch
oolb
oys w
ith b
ronc
hial
as
thm
a in
Al-K
hoba
r City
, Sau
di A
rabi
a:
are
they
at i
ncre
ased
risk
of s
choo
l ab
sent
eeis
m? J
Ast
hma.
2002;39(5):
(Sau
di A
rabi
a)
413-420.
Al-G
ham
dy Y
S, A
l-Had
dad
NS
, Ade
lgad
ir M
H, Q
ures
hi N
A, S
aleh
MA
, Kha
lil M
M.
Soc
io-c
linic
al pr
ofile
of c
hild
ren
with
as
thm
a in
Al-M
ajm
aah
heal
th p
rovi
nce.
S
audi
Med
J. 2000;21(9):847-851.
(Sau
di A
rabi
a)
Ant
hrac
opou
los
M, K
arat
za A
, Lio
lios
E,
Trig
a M
, Tria
ntou
K, P
riftis
K. P
reva
lenc
e of
ast
hma
amon
g sc
hool
child
ren
in
Pat
ras,
Gre
ece:
thre
e su
rvey
s ov
er
20 y
ears
. Tho
rax.
2001 ;56:569-571.
(Gre
ece)
Bau
er E
J, L
urie
N, Y
eh C
, Gra
nt E
N.
Scr
eeni
ng fo
r ast
hma
in a
n in
ner-
city
el
emen
tary
sch
ool i
n M
inne
apol
is,
Min
neso
ta. J
Sch
Hea
lth. 1999;69(1):
12-16.
(US
A)
Bau
man
LJ,
Wrig
ht E
, Lei
ckly
FE
, et a
l. R
elat
ions
hip
of a
dher
ence
to p
edia
tric
asth
ma
mor
bidi
ty a
mon
g in
ner-
city
ch
ildre
n. P
edia
trics
. 2002;110(1):el-e7.
(US
A)
Dat
a de
rived
from
a n
atio
nal s
ampl
e of
par
ents
of c
hild
ren
with
as
thm
a (a
nd a
dults
with
ast
hma)
, inc
lude
d 519
child
ren
aged
6-15
year
s. N
umbe
r of m
isse
d sc
hool
day
s in
the
past
yea
r and
ast
hma
diag
nosi
s wer
e de
term
ined
by in
terv
iew
(ask
ed a
bout
dia
gnos
is
and
med
icat
ion i
n th
e pa
st y
ear).
The
pur
pose
was
to in
vest
igat
e ch
arac
teris
tics t
hat i
nflu
ence
d ant
i-inf
lam
mat
ory u
se.
Par
ents
of 1482
mal
e st
uden
ts (a
ges 6-15) c
ompl
eted
qu
estio
nnai
res t
hat a
scer
tain
ed di
agno
sed
asth
ma
and
asth
ma
sym
ptom
s no
t pre
viou
sly
diag
nose
d. S
choo
l re
cord
s w
ere
used
to a
sses
s da
ys a
bsen
t.
Dat
a w
ere
colle
cted
from
mul
tiple
sour
ces
rega
rdin
g 606 c
hild
ren
(0-1 3 ye
ars)
, rec
ruite
d fro
m p
edia
tric c
linic
s and
hos
pita
ls. P
aren
ts
wer
e in
terv
iew
ed ab
out s
ympt
oms,
ast
hma
was
det
erm
ined
from
hi
stor
y (d
iagn
osis
, med
icat
ion,
or s
ympt
oms)
, and
chi
ldre
n re
ceiv
ed a
full
phys
ical
exam
inat
ion
and
peak
flow
rat
e m
easu
rem
ent.
In th
e m
onth
s of
Jan
uary
and
Feb
ruar
y of
1978,1991, an
d 1998,
stud
ents
(age
s 8-10 ye
ars)
in 3
rd a
nd 4
th g
rade
s w
ere
surv
eyed
(p
aren
ts of
bet
wee
n ap
prox
imat
ely 3000-4000 s
tude
nts
resp
onde
d to
que
stio
nnai
res i
n ea
ch o
f the
se y
ears
). Th
ose
with
a
posi
tive
hist
ory o
f ast
hma
wer
e th
en in
terv
iew
ed in
1991
and
1998. O
ne q
uest
ion w
as, '
How
man
y sc
hool
day
s w
ere
lost
be
caus
e of
ast
hma
and/
or w
heez
ing
durin
g th
e pr
evio
us 2 ye
ars?
" Th
is re
sear
ch w
as d
one
prim
arily
to s
tudy
the
prac
tice
of id
entif
ying
st
uden
ts w
ith a
sthm
a as
par
t of a
sch
ool-b
ased
hea
lth ce
nter
's
outre
ach.
Sch
ool-w
ide
asth
ma
scre
enin
g (5 sy
mpt
oms
ques
tions
fo
r par
ents
) occ
urre
d ov
er 2 ye
ars
in 1
elem
enta
ry s
choo
l with
ab
out 1200
stud
ents
. Par
ent r
epor
t of s
choo
l atte
ndan
ce w
as
com
pare
d to
par
ent r
epor
t of a
sthm
a hi
stor
y.
Par
ents
of 1199
child
ren
(age
s 4-9) with
ast
hma,
recr
uite
d fro
m
emer
genc
y de
partm
ents
and
rese
arch
cent
ers i
n m
ultip
le ci
ties,
w
ere
inte
rvie
wed
4 tim
es o
ver a
9-m
onth
per
iod.
Incl
uded
in th
e in
terv
iew
wer
e qu
estio
ns to
mea
sure
adh
eren
ce to
med
ical
re
gim
ens
and
risk
for n
onad
here
nce
(cha
ract
eris
tics t
hat r
esea
rch
has
dem
onst
rate
d to
be a
ssoc
iate
d with
non
adhe
renc
e) a
nd
pare
nt re
port
of n
umbe
r of s
choo
l day
s m
isse
d as
a re
sult
of
asth
ma
in th
e pr
evio
us 3 m
onth
s.
Mis
sing
6 or
mor
e da
ys fr
om s
choo
l was
one
of t
he fa
ctor
s in
a
mul
tiple
logi
stic
regr
essi
on m
odel
that
was
ass
ocia
ted w
ith u
se
of a
n an
ti-in
flam
mat
ory,
cont
rolle
r med
icat
ion.
Gre
ater
ast
hma
mor
bidi
ty (i
nclu
ding
lost
sch
ool d
ays)
, you
ng a
ge,
whi
te, r
ecen
t hos
pita
lizat
ion,
and
regu
lar d
octo
r vis
its w
here
as
thm
a is
wel
l tau
ght a
re a
ll as
soci
ated
with
us
e of
ant
i-inf
lam
mat
ory c
ontro
ller m
edic
atio
ns.
Stu
dent
s with
ast
hma
sym
ptom
s, b
ut n
o pr
evio
us p
hysi
cian
di
agno
sis,
wer
e ab
sent
13.6 d
ays
per y
ear.
Stu
dent
s w
ith
phys
icia
n-di
agno
sed a
sthm
a w
ere
abse
nt 3.7 da
ys p
er y
ear.
You
nger
chi
ldre
n lo
st m
ore
scho
ol d
ays
than
old
er c
hild
ren,
as
did
stu
dent
s with
low
er s
ocio
econ
omic
cla
ss, p
ets a
t hom
e,
smok
ers
at h
ome,
and
abs
ence
of a
n ap
prop
riate
con
trolle
r m
edic
atio
n and
his
tory
of h
ospi
taliz
atio
n or e
mer
genc
y vi
sit.
The
perc
enta
ges
of c
hild
ren
mis
sing
bet
wee
n 1
and 3
wee
ks o
f sc
hool
and
mis
sing
grea
ter t
han 3
wee
ks o
f sch
ool,
resp
ectiv
ely,
w
ere 6% a
nd 7%
for s
tude
nts w
ith m
ild a
sthm
a, 23% a
nd 12% f
or
thos
e w
ith m
oder
ate
asth
ma,
and
39% a
nd 17% f
or th
ose
with
se
vere
ast
hma.
The
prev
alen
ce of
a c
urre
nt d
iagn
osis
of a
sthm
a in
crea
sed f
rom
4.6% t
o 6% b
etw
een 1991 a
nd 1998; th
e m
ean
num
ber o
f sch
ool
days
lost
bec
ause
of a
sthm
a di
d no
t cha
nge
sign
ifica
ntly
betw
een
1991 (6.75 da
ys o
ver 2 ye
ars)
and
1998 (5.7 da
ys o
ver 2 ye
ars)
am
ong
thos
e w
ith a
sthm
a.
Bet
wee
n 26%
and 30%
of a
ll stu
dent
s wer
e re
porte
d abs
ent a
t lea
st
1 da
y in
the
prev
ious
mon
th, c
ompa
red
to 40% o
f tho
se w
ith
mon
thly
ast
hma
sym
ptom
s.
On
aver
age,
chi
ldre
n m
isse
d 6.5 d
ays
in th
e pr
evio
us 100
days
. C
hild
ren
of p
aren
ts w
ho a
dmitt
ed to
hig
h no
nadh
eren
ce to
m
edic
al re
gim
ens
mis
sed 8.9 da
ys v
ersu
s on
ly 5.4 da
ys fo
r ch
ildre
n of
par
ents
with
low
non
adhe
renc
e. C
hild
ren
of p
aren
ts w
ho h
ad h
igh
risk
of n
onad
here
nce
mis
sed
8.1
days
as
com
pare
d to
onl
y 4.1
days
for c
hild
ren
of p
aren
ts at
low
risk
for n
onad
here
nce.
CD
C, C
ente
rs fo
r Dis
ease
Con
trol a
nd P
reve
ntio
n; E
R, E
mer
genc
y ro
om.
Tabl
e 1
Pu
blis
hed
Res
earc
h A
rtic
les
That
Add
ress
Ast
hma
and
Abs
ence
Fro
m S
cho
ol
(Con
tinu
ed f
rom
pre
viou
s p
age)
Cita
tion
(Ori
gin
of P
rimar
y A
utho
r)
Res
earc
h D
esig
n M
ajor
Fin
ding
s R
elat
ed to
Abs
ente
eism
Ben
er A
, Abd
ulra
zzaq
YM
, Deb
use
P, A
bdin
AH
. Ast
hma
and
whe
ezin
g as
the
caus
e of
sch
ool a
bsen
ce. J
Ast
hma.
(Uni
ted
Ara
b E
mira
tes)
19
94;3
1(2)
:93-
98.
Bla
nc F
X, P
oste
CVi
nay
N, B
ouco
t I,
De
Blic
J, S
chei
nman
n P.
The
AlR
E
stud
y: d
ata
anal
ysis
of 7
53 E
urop
ean
child
ren
with
ast
hma.
Rev
Ma1
Res
pir.
(Wes
tern
Eur
ope)
B
rito
A, W
urm
G, D
elam
ater
AM
, et a
l. S
choo
l-bas
ed id
entif
icat
ion
of a
sthm
a in
a lo
w-in
com
e po
pula
tion.
Ped
iab
Pulm
onol
. 2O
00;3
0:29
7-30
1.
2002
; 19:
585-
592.
(US
A)
Cas
sino
C. E
ffect
of m
ater
nal a
sthm
a on
pe
rform
ance
of p
aren
ting
task
s an
d ch
ildre
n's
scho
ol a
ttend
ance
. J A
sthm
a.
1997
;34(
6):4
99-5
07.
(US
A)
Cen
ters
for D
isea
se C
ontro
l and
Pre
vent
ion.
S
urve
illanc
e fo
r ast
hma-
Uni
ted
Sta
tes
1980
-199
9. M
MW
R M
orb
Mor
tal W
kly
Rep
. 2O
O2;
51 (S
SO1)
:l-1
3.
(US
A)
Chr
istia
nsen
SC
, Mar
tin S
B, S
chle
iche
r NC
, K
ozio
l JA,
Mat
hew
s KP
, Zur
aw B
L.
Cur
rent
pre
vale
nce
of a
sthm
a-re
late
d sy
mpt
oms
in S
an D
iego
's p
redo
min
antly
H
ispa
nic
inne
r-city
chi
ldre
n. J
Ast
hma.
19
96;3
3(1)
:17-
26.
(US
A)
Dou
ll IJ,
Willi
ams
AA, F
reez
er N
J, H
olga
te
ST. D
escr
iptiv
e st
udy
of c
ough
, whe
eze,
an
d sc
hool
abs
ence
in c
hild
hood
. Th
ora
. 19
96;5
1:63
0-63
1.
(W
30 s
choo
ls in
1 c
ity w
ere
chos
en to
repr
esen
t the
gen
eral
pop
ulat
ion;
19
10 s
tude
nts
(age
s 6-
14) w
ere
eith
er d
eter
min
ed to
hav
e as
thm
a fro
m s
choo
l hea
lth re
cord
s or
rep
orte
d to
hav
e sy
mpt
oms
of w
heez
ing.
73,8
80 ho
useh
olds
in F
ranc
e, S
pain
, UK,
Net
herla
nds,
Ital
y,
Sw
eden
, and
Ger
man
y w
ere
cont
acte
d by
tele
phon
e, a
nd th
e 75
3 ho
useh
olds
with
a c
hild
(und
er a
ge 1
6) w
ith a
sthm
a w
ere
inte
rvie
wed
.
Par
ents
of 1
54 c
hild
ren
with
a h
isto
ry o
f ast
hma
sym
ptom
s wer
e in
terv
iew
ed. S
tude
nts
(age
s 5-
9 ye
ars)
all
atte
nded
1 of
9
elem
enta
ry s
choo
ls a
ssoc
iate
d w
ith a
mob
ile c
linic
.
Cas
e-co
ntro
lled
stud
y of
24
mot
hers
with
ast
hma
mat
ched
with
27
mot
hers
with
out a
sthm
a. S
choo
l abs
ente
eism
was
de
term
ined
by
repo
rt.
CD
C's
Nat
iona
l Cen
ter f
or H
ealth
Sta
tistic
s co
nduc
ts th
e N
atio
nal
Hea
lth In
terv
iew
Sur
vey
(NH
IS) a
nnua
lly, w
hich
incl
udes
que
stio
ns
rega
rdin
g ast
hma
and
limita
tions
of a
sthm
a. A
ppro
xim
atel
y 12
0,00
0 ho
useh
olds
are
reac
hed.
Dat
a re
porte
d her
e ar
e fo
r age
s 5-1
7 ye
ars.
Th
e nu
mbe
r of a
sthm
a-as
soci
ated
scho
ol a
bsen
ce d
ays
in th
e pr
evio
us 2
wee
ks w
as c
olle
cted
for c
hild
ren
aged
6-1
6 yea
rs d
urin
g 19
80-1
982 a
nd fo
r tho
se a
ged
5-1 7
yea
rs d
urin
g 19
85-1
996.
99
8 4t
h-gr
ade
stud
ents
in a
n im
pove
rishe
d ur
ban
area
wer
e su
rvey
ed. T
he s
tudy
was
larg
ely
done
to c
ompa
re a
sthm
a di
agno
sis
and
sym
ptom
s be
twee
n et
hnic
gro
ups.
que
stio
nnai
re
on s
ympt
oms
led
to a
cat
egor
izat
ion
of p
roba
ble
asth
ma,
po
ssib
le a
sthm
a, a
nd u
nlik
ely
to h
ave
asth
ma.
Par
ents
wer
e as
ked
abou
t sch
ool a
bsen
ces
with
in th
e pa
st y
ear.
Iden
tifie
d fro
m ro
ster
s of
prim
ary
care
phy
sici
ans,
483
0 pa
rent
s of
ch
ildre
n (a
ges
7-9
year
s) re
spon
ded
to m
aile
d qu
estio
nnai
res.
The
med
ian
days
of a
bsen
ce fr
om s
choo
l am
ong
thos
e w
ith a
sthm
a w
as 5
day
s a
year
(6
days
for t
hose
with
dia
gnos
ed a
sthm
a, 5
da
ys a
mon
g th
ose
repo
rting
whe
ezin
g w
ithou
t a d
iagn
osis
). S
tude
nts
aged
6-9
wer
e m
ore
likel
y to
mis
s at l
east
1 d
ay th
an
thos
e w
ho w
ere
10-1
4 yea
rs (5
7% vs
43%
). A
bsen
tee
rate
s am
ong
nona
sthm
atic
s are
not
pro
vide
d.
of a
sthm
a. A
larg
e nu
mbe
r of s
tude
nts
rece
ived
inad
equa
te
treat
men
t, ba
sed
on th
e se
verit
y of
sym
ptom
s.
In th
e pr
eced
ing
12 m
onth
s, 4
3% of
stu
dent
s m
isse
d sc
hool
bec
ause
Ast
hma
was
con
firm
ed in
145
chi
ldre
n. P
aren
ts re
porte
d th
at th
eir
child
ren
mis
sed
a m
ean
of 2
.4 sc
hool
day
s in
the
prev
ious
2
wee
ks.
Chi
ldre
n of
mot
hers
with
ast
hma
had
a si
gnifi
cant
ly im
paire
d abi
lity
to
atte
nd s
choo
l com
pare
d to
chi
ldre
n of
con
trol m
othe
rs. 22%
of
mot
hers
with
ast
hma
repo
rted t
hat t
heir
own
heal
th ca
used
thei
r ch
ild's
abs
ence
at l
east
onc
e pe
r mon
th, a
nd 2
7% re
porte
d the
ir ch
ildre
n w
ere
regu
larly
late
for t
hat r
easo
n (c
ompa
red
to 5
%
and
0% fo
r non
asth
mat
ic m
othe
rs).
Sch
ool a
bsen
ce d
ays
amon
g ch
ildre
n de
crea
sed
from
198
0/19
82
(ave
rage
of 4
.9 d
aydy
ear)
to 1
994/
1996
(3.7
dayd
year
). Th
e pe
rcen
tage
of c
hild
ren w
ith 1
or m
ore
abse
nce
for a
sthm
a in
the
prev
ious
2 w
eeks
was
8%
in 1
980/
1982
and
5.4
% in
199
41 99
6.
Dro
ps in
abs
ente
eism
rate
s ov
er th
ese
year
s w
ere
not
stat
istic
ally
sign
ifica
nt.
77 (
15%
) His
pani
c st
uden
ts a
nd 3
2 (2
4%) b
lack
stu
dent
s w
ere
dete
rmin
ed to
'pro
babl
y ha
ve a
sthm
a" a
nd th
ese
stud
ents
m
isse
d an
ave
rage
of 1
.8 an
d 0.
9 da
ys o
f sch
ool,
resp
ectiv
ely.
E
thni
c gr
oup
was
a w
eak
pred
icto
r of a
ctua
l num
ber o
f day
s ab
sent
from
sch
ool,
whe
reas
ast
hma
cate
gory
(pro
babl
e as
thm
a,
poss
ible
asth
ma,
and
unl
ikel
y to
hav
e as
thm
a) s
trong
ly p
redi
cted
da
ys a
bsen
t.
of th
ese
had
mis
sed
5 or
mor
e da
ys o
f sch
ool i
n pr
eced
ing
year
fo
r res
pira
tory
sym
ptom
s, 1
% m
isse
d m
ore
than
20
days
. Cou
gh,
not w
heez
e, w
as th
e m
ost c
omm
on s
ympt
om a
mon
g st
uden
ts
mis
sing
mor
e th
an 5
day
s of
sch
ool.
15%
of r
espo
nden
ts h
ad b
een
diag
nose
d w
ith a
sthm
a. 7
.2%
CD
C, C
ente
rs fo
r Dis
ease
Con
trol a
nd P
reve
ntio
n; E
R, E
mer
genc
y ro
om.
Tabl
e 1
Pub
lishe
d R
esea
rch
Art
icle
s Th
at A
ddre
ss A
sthm
a an
d A
bsen
ce F
rom
Sch
ool
(Con
tinue
d fr
om p
revi
ous
pag
e)
Cita
tion
(Ori
gin
of P
rimar
y A
utho
r)
Res
earc
h D
esig
n M
ajor
Fin
ding
s R
elat
ed to
Abs
ente
eism
Find
ley
S, L
awle
r K, B
indr
a M
, Mag
gio
L,
Pen
achi
o M
M, M
ayla
hn C
. Ele
vate
d as
thm
a an
d in
door
env
ironm
ent
expo
sure
s am
ong
Pue
rto R
ican
ch
ildre
n of
Eas
t Har
lem
. J A
sthm
a.
2003
;40(
5):5
57-5
69.
(US
A)
Font
aine
V, D
enia
ud F
, Lef
ort F
, Lec
outo
ur
X, B
run
J. E
pide
mio
logy
of c
hild
hood
as
thm
a in
the
depa
rtmen
t of C
alva
dos.
R
ev fn
eum
ol C
lin. 1
999;
55:5
-11.
(F
ranc
e)
Gar
tland
HJ,
Day
HD
. Fam
ily p
redi
ctor
s of
the
inci
denc
e of
chi
ldre
n's
asth
ma
sym
ptom
s: e
xpre
ssed
em
otio
n,
med
icat
ion,
par
ent c
onta
ct, a
nd li
fe
even
ts. J
Clin
fsyc
hol.
1999
;55(
5):
573-
584.
(U
SA
) G
orel
ick
MH
, Scr
iban
o P
V, S
teve
ns M
W,
Sch
ultz
TR
. Con
stru
ct v
alid
ity a
nd
resp
onsi
vene
ss o
f the
Chi
ld H
ealth
Q
uest
ionn
aire
in c
hild
ren
with
acu
te
asth
ma.
Ann
Alle
rgy
Ast
hma
Imm
unol
. 20
03;9
0(6)
:622
-628
. (U
SA
) Jo
seph
CL,
Fox
man
B, L
eick
ly F
E, P
eter
son
E, O
wnb
y D
. Pre
vale
nce
of p
ossi
ble
undi
agno
sed
asth
ma
and
asso
ciat
ed
mor
bidi
ty a
mon
g ur
ban
scho
olch
ildre
n.
J fe
diaf
r. 1
996;
129:
735-
742.
(U
SA
)
Kat
tan
M, M
itche
ll H, E
ggle
ston
P, e
t al.
Cha
ract
eris
tics
of i
nner
-city
child
ren
with
as
thm
a: th
e na
tiona
l coo
pera
tive
inne
r-
city
ast
hma
stud
y. fe
diaf
r ful
mon
ol.
1997
;24:
253-
262.
(U
SA
)
In 2
ele
men
tary
sch
ools
, 131
9 pa
rent
s wer
e su
rvey
ed o
n ch
ild
asth
ma
sym
ptom
s us
ing
ISA
AC
(Int
erna
tiona
l Stu
dy o
f Ast
hma
and
Alle
rgie
s in
Chi
ldre
n), o
n as
thm
a-re
late
d sch
ool a
bsen
ce
and
excl
usio
n fro
m p
hysi
cal a
ctiv
ity, a
nd o
n ho
me
envi
ronm
ent.
Ave
rage
age
of c
hild
was
7.4
yea
rs.
1707
6th
-gra
de s
tude
nts c
ompl
eted
a qu
estio
nnai
re in
1 F
renc
h re
gion
.
32 tw
o-pa
rent
fam
ilies
who
had
a c
hild
with
ast
hma
(age
s 5-
1 1) w
ere
recr
uite
d fro
m a
sthm
a ed
ucat
ion
grou
ps. F
amili
es w
ere
give
n m
easu
res
of e
xpre
ssed
emot
ion,
life
eve
nts,
and
fam
ily fu
nctio
n an
d w
ere
also
ask
ed a
bout
med
icat
ion c
ompl
ianc
e an
d sc
hool
ab
senc
es a
ssoc
iate
d with
ast
hma
in th
e pr
evio
us 1
2 m
onth
s.
A pr
ospe
ctiv
e co
hort
stud
y at
2 p
edia
tric
emer
genc
y dep
artm
ents
ove
r 12
mon
ths e
nrol
led
732
child
ren
(age
s 5-
18);
pare
nts w
ere
cont
acte
d 14
day
s af
ter E
R v
isit
to re
spon
d to
a s
tand
ardi
zed
aqua
lity o
f life
" qu
estio
nnai
re.
Sur
veys
wer
e se
nt h
ome
to p
aren
ts of
eac
h ch
ild in
gra
des
3-5
of 2
sch
ools
to in
quire
abou
t dia
gnos
ed a
sthm
a an
d w
heez
ing
sym
ptom
s. S
choo
l atte
ndan
ce w
as d
eriv
ed fr
om s
choo
l rec
ords
. P
ulm
onar
y fu
nctio
n te
sts
wer
e pe
rform
ed at
sch
ool b
efor
e an
d af
ter p
hysi
cal e
xerc
ise.
230
chi
ldre
n co
mpl
eted
the
stud
y.
1528
chi
ldre
n w
ith a
sthm
a (a
ges
4-9)
wer
e en
rolle
d in
a b
road
-bas
ed
stud
y th
at in
volv
ed a
base
line
asse
ssm
ent (
hist
ory,
hom
e vi
sits
, pu
lmon
ary
func
tion
test
s) a
nd in
terv
al as
sess
men
ts a
t 3, 6
, and
9
mon
ths
late
r. P
aren
ts w
ere
aske
d to
rec
all "
perc
ent o
f sch
ool d
ays
mis
sed"
in th
e pr
eced
ing
3-m
onth
per
iod.
32%
repo
rted
a di
agno
sis o
f ast
hma,
25%
had
repo
rted s
ympt
oms
in th
e pa
st 1
2 m
onth
s. O
f tho
se w
ith c
urre
nt a
sthm
a, 5
6% w
ere
abse
nt fr
om s
choo
l at l
east
onc
e du
e to
ast
hma
in th
e pr
evio
us
mon
th a
nd 3
8% h
ad li
mite
d pa
rtici
patio
n in
phy
sica
l act
ivity
in th
e pr
evio
us m
onth
. Poo
r hom
e en
viro
nmen
t (eg
, dus
t, co
ckro
ache
s,
mic
e) w
as a
pre
dict
or of
hig
h as
thm
a ra
te. P
uerto
Ric
an ch
ildre
n w
ere
sign
ifica
ntly
(1.6
times
) m
ore
likel
y to
hav
e m
isse
d sc
hool
th
an o
ther
eth
nic
grou
ps.
15%
of s
tude
nts
had
asth
ma,
with
4.5
% h
avin
g m
ore
than
3 w
heez
ing
epis
odes
per
wee
k. 1
8.5%
of s
tude
nts
with
ast
hma
mis
sed
scho
ol
days
with
in th
e pa
st s
choo
l yea
r bec
ause
of a
sthm
a sy
mpt
oms-
w
ith a
n av
erag
e of
2.2
day
s re
porte
dly
mis
sed.
Chi
ldre
n w
ith a
sthm
a w
ho h
ad fa
ther
s w
ho s
core
d as
bei
ng m
ore
criti
cal o
f the
ir ch
ildre
n an
d ex
pres
sing
mor
e em
otio
n w
ere
mor
e lik
ely t
o be
freq
uent
ly a
bsen
t fro
m s
choo
l (w
ith s
tatis
tical
ly
sign
ifica
nt co
rrel
atio
ns of
.46
and
52
, res
pect
ivel
y).
Mis
sing
5 o
r mor
e da
ys o
f sch
ool i
n th
e pr
evio
us w
eek
was
cor
re-
late
d w
ith o
ther
mea
sure
s of
poo
r out
com
e.
17%
had
a d
iagn
osis
of a
sthm
a, a
nd 1
4% h
ad a
dia
gnos
is a
nd
sym
ptom
s in
the
past
yea
r. A
n ad
ditio
nal 1
4% h
ad u
ndia
gnos
ed
asth
ma
base
d on
sym
ptom
s or
pul
mon
ary
test
s. A
bsen
tee
rate
s fo
r the
ent
ire p
opul
atio
n wer
e 4.
5% o
f day
s. C
hild
ren
who
had
un
diag
nose
d as
thm
a ba
sed
on re
porte
d sy
mpt
oms
had
high
er
rate
s of
abs
ente
eism
(6.6
%).
Phy
sici
an-d
iagn
osed
asth
mat
ics
mis
sed
7.7%
of d
ays.
Chi
ldre
n w
ith u
ndia
gnos
ed a
sthm
a w
ere
mor
e lik
ely t
o m
iss
phys
ical
edu
catio
n cl
asse
s tha
n th
ose
with
out
asth
ma.
P
aren
ts, a
t bas
elin
e, re
porte
d th
eir c
hild
mis
sed
10%
of s
choo
l day
s.
This
dec
reas
ed to
7%
, 6%
, and
6%
at a
sses
smen
ts 3
, 6, a
nd 9
m
onth
s la
ter,
resp
ectiv
ely.
CD
C, C
ente
rs fo
r D
isea
se C
ontro
l and
Pre
vent
ion;
ER
. Em
erge
ncy
room
.
Tabl
e 1
Pu
blis
hed
Res
earc
h A
rtic
les
Th
at A
dd
ress
Ast
hma
and
Abs
ence
Fro
m S
cho
ol
(Con
tinu
ed f
rom
pre
viou
s p
age)
Cita
tion
(Ori
gin
of P
rimar
y A
utho
r)
Kon
ig P
, Sha
ffer J
. The
effe
ct o
f dru
g th
erap
y on
long
-term
out
com
e of
ch
ildho
od a
sthm
a: a
pos
sibl
e pr
evie
w o
f th
e in
tern
atio
nal g
uide
lines
. J A
llerg
y C
lin
Imm
unol
. 199
6;98
:110
3-11
11.
(US
A)
Kue
hni C
E, F
rey
U. A
ge-re
late
d di
ffere
nces
in
per
ceiv
ed a
sthm
a co
ntro
l in c
hild
hood
: gu
idel
ines
and
real
ity. E
ur R
espi
r J.
(Sw
itzer
land
) 20
02;2
0:88
0-88
9.
Kun
zli N
, McC
onne
ll R, B
ates
D, e
t al.
Bre
athl
ess
in L
os A
ngel
es: t
he e
xhau
stin
g se
arch
for c
lean
air.
Am
J P
ublic
Hea
lth.
2003
;93(
9):1
494-
1499
. (U
SA
)
Lai C
K, D
e G
uia
TS, K
im Y
Y, e
t al.
Ast
hma
cont
rol i
n th
e A
sia-
Pac
ific
regi
on: t
he
asth
ma
insi
ghts
and
real
ity in
Asi
a-P
acifi
c st
udy.
J A
llerg
y C
lin Im
mun
ol.
(Asi
a-P
acifi
c)
Lodh
a R
, Pur
anik
M, K
atta
l N, K
abra
SK.
S
ocia
l and
eco
nom
ic im
pact
of c
hild
hood
as
thm
a. ln
dian
Ped
iatr
. 200
3;40
(9):
(Indi
a)
2003
;111
:263
-268
.
874-
879.
Le L
ouam
A, H
aan
MC
, Don
ato
L. A
sthm
a am
ong
child
ren
atte
ndin
g ki
nder
garte
n in
A
lsac
e, F
ranc
e 19
98: p
reva
lenc
e an
d he
alth
car
e. A
rch
Pedi
atr.
2002
;9:
(Fra
nce)
10
17-1
024.
Res
earc
h D
esig
n M
ajor
Fin
din
gs
Rel
ated
to A
bsen
teei
sm
A re
trosp
ectiv
e re
view
of t
he c
harts
of 1
75 ch
ildre
n w
as p
erfo
rmed
(m
ean
age
of fi
rst c
hart
reco
rd w
as 6
.5 y
ears
). B
etw
een
2 an
d 17
year
s of
cha
rt re
cord
s w
ere
revi
ewed
. An
end-
of-s
tudy
qu
estio
nnai
re w
as c
ondu
cted
on
thos
e w
hose
cha
rts w
ere
revi
ewed
.
572
mem
bers
from
a m
ajor
org
aniz
atio
n fo
r par
ents
of a
sthm
atic
ch
ildre
n co
mpl
eted
and
retu
rned
a m
aile
d qu
estio
nnai
re a
bout
as
thm
a. C
hild
ren
olde
r tha
n ag
e 16
wer
e ex
clud
ed.
App
roxi
mat
ely
6000
pub
lic s
choo
l chi
ldre
n en
rolle
d in
Chi
ldre
n's
Hea
lth S
tudy
from
12
Los
Ang
eles
com
mun
ities
rece
ived
initi
al
and
annu
al q
uest
ionn
aire
s on
dem
ogra
phic
s, p
hysi
cal a
ctiv
ities
, an
d fa
mily
hea
lth h
abits
. Ann
ual l
ung f
unct
ion
test
s; s
choo
l ab
senc
es a
lso
mea
sure
d. M
easu
res
of c
omm
unity
air
qual
ity
wer
e ob
tain
ed.
Face
-to-fa
ce in
terv
iew
s w
ere
cond
ucte
d w
ith h
eads
of o
ver
108,
000
hous
ehol
ds in
8 m
ajor
citi
es o
f Chi
na, H
ong
Kon
g,
Kor
ea, M
alay
sia,
Phi
lippi
nes,
Sin
gapo
re, T
aiw
an, a
nd
Vie
tnam
. Am
ong
othe
r que
stio
ns, p
aren
ts w
ere
aske
d if
child
ren
had
any
lost
sch
ool d
ays
in th
e pa
st
12 m
onth
s be
caus
e of
ast
hma.
asth
ma
bein
g tre
ated
in a
hos
pita
l's o
utpa
tient
che
st c
linic
; par
ent
inte
rvie
ws
elic
ited
leve
l of a
sthm
a se
verit
y an
d co
ntro
l and
leve
l of
scho
ol a
bsen
teei
sm.
Cro
ss-s
ectio
nal d
escr
iptiv
e st
udy
of 1
62 ch
ildre
n (2
-16
year
s) w
ith
Par
ents
of a
rand
omiz
ed sa
mpl
e of
276
5 ki
nder
garte
n st
uden
ts (a
ges
5-6)
wer
e su
rvey
ed fo
r dia
gnos
ed a
sthm
a,
asth
ma
sym
ptom
s, a
nd s
choo
l abs
ente
eism
. Par
ents
wer
e as
ked
if th
eir c
hild
ren
had
been
abs
ent m
ore
than
7 d
ays
in th
e pa
st 1
2 m
onth
s (th
e m
edia
n/av
erag
e for
the
popu
latio
n fro
m p
revi
ous
stud
ies)
. Tho
se p
aren
ts w
ith a
ch
ild w
ho h
ad a
sthm
a or
ast
hma
sym
ptom
s w
ere
also
que
stio
ned
on c
linic
al p
atte
rns,
hea
lth c
are,
an
d ho
spita
lizat
ions
.
Chi
ldre
n w
ith m
oder
ate
asth
ma
repo
rted
mis
sing
2.4
sch
ool d
ays
per y
ear,
sign
ifica
ntly
mor
e th
an 2
day
s fo
r tho
se w
ith m
ild
asth
ma
and
sim
ilar t
o 2.
3 da
ys fo
r tho
se w
ith s
ever
e as
thm
a.
Ove
r tim
e, th
e fre
quen
cy o
f sch
ool d
ays
mis
sed
decr
ease
d fo
r ch
ildre
n w
ith m
ild, m
oder
ate,
and
sev
ere
asth
ma
to
appr
oxim
atel
y 1.
25 d
ays
per y
ear.
In a
dditi
on to
oth
er s
igns
of s
ubop
timal
man
agem
ent,
17%
of p
aren
ts re
porte
d ab
senc
e fro
m s
choo
l bec
ause
of
asth
ma
sym
ptom
s for
bet
wee
n 1
and
6 da
ys in
the
prev
ious
12
mon
ths;
11%
of p
aren
ts re
porte
d sc
hool
abs
ence
s of
be
twee
n 1
and
2 w
eeks
/yea
r, an
d 3%
repo
rted
mor
e th
an
2 w
eeks
of a
ccum
ulat
ive
scho
ol a
bsen
ce b
ecau
se o
f ast
hma
sym
ptom
s.
Sch
ool a
bsen
ce ra
tes
incr
ease
d w
ith d
aily
fluc
tuat
ions
of o
zone
le
vels
, par
ticul
arly
whe
n le
vels
rose
in c
omm
uniti
es w
ith lo
w
conc
entra
tions
of o
ther
pol
luta
nts
(par
ticul
ate
pollu
tion
[PM
l 01
and
nitro
gen
diox
ide)
. A m
odes
t inc
reas
e in
20
ppb
of o
zone
was
as
soci
ated
with
an
83%
incr
ease
in s
choo
l abs
ence
s.
Abs
ence
from
sch
ool b
ecau
se of
ast
hma
was
rep
orte
d by
36.
5% o
f par
ents
of c
hild
ren
with
ast
hma.
Of 1
45 c
hild
ren
with
ast
hma
atte
ndin
g sc
hool
, a m
edia
n of
4 s
choo
l da
ys in
the
prev
ious
6 m
onth
s w
ere
mis
sed
beca
use
of a
sthm
a.
Med
ian
abse
nce
for m
ild in
term
itten
t was
0 d
ays,
and
for s
ever
e pe
rsis
tent
, 5.5
day
s. M
edia
n ab
senc
e in
wel
l-con
trolle
d as
thm
a w
as z
ero;
med
ian
abse
nce
amon
g th
ose
with
poo
rly c
ontro
lled
asth
ma
was
27.
5 da
ys.
Pre
vale
nce
of th
e di
agno
sis
of a
sthm
a w
as 6
.5%
. Pre
vale
nce
of a
sthm
a sy
mpt
oms
with
out a
dia
gnos
is w
as 7
.2%
. 37%
of
stu
dent
s w
ho h
ad a
sthm
a sy
mpt
oms
in th
e pr
evio
us
12 m
onth
s w
ere
repo
rted
abse
nt fr
om s
choo
l mor
e th
an 7
day
s pe
r yea
r (as
com
pare
d to
16%
with
out a
sthm
a sy
mpt
oms)
.
CD
C, C
ente
rs fo
r Dis
ease
Con
trol a
nd P
reve
ntio
n; E
R, E
mer
genc
y ro
om.
L
0 5 EL 4 x 5 0 o_
T
rD 5 s 0
2 e 0
0-
Iu 0 0
ul g -I
ul
2
P ca
W s
Tabl
e 1
Pub
lishe
d R
esea
rch
Art
icle
s Th
at A
ddre
ss A
sthm
a an
d A
bsen
ce F
rom
Sch
ool
(Con
tinue
d fr
om p
revi
ous
page
) ~ C
itatio
n (O
rigi
n of
Prim
ary
Aut
hor)
R
esea
rch
Des
ign
Maj
or F
ind
ing
s Rel
ated
to A
bsen
teei
sm
Mai
er W
C, A
rrigh
i HM
, Mor
ray
B, L
lew
llyn C
, R
eddi
ng G
J. T
he im
pact
of a
sthm
a an
d as
thm
a-lik
e illn
ess i
n S
eattl
e sc
hool
ch
ildre
n. J
Clin
Epi
dem
iol.
1998
;51(
7):
557-
568.
(U
SA
) M
cCow
an C
, Bry
ce F
P, N
eville
RG
, Cro
mbi
e IK
, Cla
rk R
A. S
choo
l abs
ence
-a v
alid
m
orbi
dity
mar
ker f
or a
sthm
a? H
ealth
Bull
(Edi
nb).
1996
;54(
4):3
07-3
13.
(UK
)
Mel
linge
r-Bird
song
AK,
Pow
ell K
E, l
atrid
is T
, B
ason
J. P
reva
lenc
e an
d im
pact
of
asth
ma
in c
hild
ren,
Geo
rgia
, 200
0. A
m J
P
rev
Med
. 200
3;24
(3):2
42-2
48.
(US
A)
Mem
on IM
, Lof
tus
BG
. Spe
ctru
m o
f ch
ildho
od a
sthm
a in
Gal
way
. lr
Med
J. 19
93;8
6(6)
:194
-195
. (Ir
elan
d)
Mitc
hell E
A, S
tew
art A
W, R
ea H
H, e
t al.
Mea
surin
g m
orbi
dity
from
ast
hma
in
child
ren.
NZ M
ed J. 1
997;
110(
1036
):3-6
. (N
ew Z
eala
nd)
New
ache
ck P
W, H
alfo
n N
. Pre
vale
nce,
im
pact
, and
tren
ds in
chi
ldho
od d
isab
ility
du
e to
ast
hma.
Arc
h P
edia
tr A
dole
sc
Med
. 200
03 54
(3):2
87-2
93.
(US
A)
Hea
lth in
form
atio
n was
obt
aine
d fro
m p
aren
ts o
f 166
5 1 s
t and
2nd
gr
ader
s (a
ges 5
-9).
Thos
e w
ith d
iagn
osed
asth
ma
(1 1%
) and
th
ose
with
out d
iagn
osis
but
with
a h
isto
ry o
f whe
ezin
g in
the
past
12
mon
ths
(7%
) wer
e co
mpa
red w
ith e
ach
othe
r and
with
thos
e w
ithou
t ast
hmds
ympt
oms.
Of o
ver 1
0,00
0 chi
ldre
n re
gist
ered
in 1
2 pr
actic
es (a
ges
1-1 5
), 33
73
wer
e se
lect
ed fo
r stu
dy b
ased
on
som
e ev
iden
ce o
f pos
sibl
e as
thm
a in
med
ical
reco
rd. O
f the
se, 1
563
who
rece
ived
stan
dard
m
edic
al ca
re w
ere
sele
cted
(bal
ance
wer
e pa
rt of
an
anot
her
inte
rven
tion)
. Con
trol g
roup
was
bas
ed o
n cl
ass
regi
ster
s (ne
xt
child
of s
ame
sex
on ro
ster
); sc
hool
reco
rds w
ere
used
for
dete
rmin
ing a
bsen
ces.
A s
ocia
l dep
rivat
ion i
ndex
was
as
sign
ed to
chi
ldre
n, b
ased
on
thei
r hom
e ad
dres
ses.
A ra
ndom
-dig
it dia
l sur
vey
of 1
503
hous
ehol
ds w
ith a
t lea
st 1
child
ag
ed 0
-17
year
s w
as c
ondu
cted
. 270
0 ch
ildre
n w
ere
repr
esen
ted.
A
sthm
a w
as d
efin
ed a
s a
curr
ent d
iagn
osis
, use
of a
sthm
a m
edic
atio
n, o
r a p
revi
ous d
iagn
osis
of a
sthm
a w
ith s
ympt
oms
in
the
past
12
mon
ths.
One
of t
he q
uest
ions
for p
aren
ts w
as “
how
m
any
days
of s
choo
l did
the
child
mis
s be
caus
e of
ast
hma?
” 11
8 4t
h-gr
ade
stud
ents
who
had
whe
ezed
in p
rece
ding
12
mon
ths
wer
e id
entif
ied t
hrou
gh a
sur
vey.
The
se c
hild
ren
wer
e m
atch
ed
with
11 8 co
ntro
ls. S
tude
nts
wer
e cl
inic
ally
exa
min
ed a
nd p
aren
ts
prov
ided
info
rmat
ion o
n sy
mpt
oms
and
scho
ol a
bsen
ces.
381
child
ren
with
ast
hma
(6-1
1 ye
ars)
wer
e se
lect
ed; a
sthm
a w
as
defin
ed a
s ha
ving
rece
ived
an
antia
sthm
a dr
ug w
ithin
the
past
yea
r. C
hild
ren
wer
e re
crui
ted
via
hosp
ital a
dmis
sion
s, p
hysi
cian
pr
actic
es, s
choo
ls, a
nd p
revi
ous s
tudi
es. P
aren
t, ph
ysic
ian,
and
te
ache
r sur
veys
and
sch
ool a
nd h
ospi
tal r
ecor
ds w
ere
used
to g
et
data
. Par
ent q
uest
ionn
aire
cate
goriz
ed ch
ild a
s ei
ther
sev
ere
or n
ot
seve
re. P
urpo
se of
stu
dy w
as to
com
pare
this
mor
bidi
ty m
easu
re
agai
nst m
ore
tradi
tiona
l mor
bidi
ty le
vels
.
unde
r age
18
year
s. T
his
is a
n in
terv
iew
sur
vey
whe
re a
n ad
ult
answ
ers
for c
hild
ren
unde
r age
17.
Dat
a w
ere
deriv
ed fr
om th
e 19
94-1
995
NH
lS o
f 62,
171
child
ren
48%
of s
tude
nts w
ith a
dia
gnos
is of
ast
hma
had
at le
ast 1
sch
ool
abse
nce
in th
e pa
st m
onth
, as
com
pare
d to
45%
for t
hose
with
sy
mpt
oms
only
, and
33%
for c
hild
ren
with
nei
ther
a d
iagn
osis
nor
w
heez
ing
sym
ptom
s.
Ther
e w
ere
no s
igni
fican
t diff
eren
ces b
etw
een
thos
e w
ith a
sthm
a sy
mpt
oms
not o
n m
edic
atio
ns an
d co
ntro
l stu
dent
s. C
hild
ren
with
as
thm
a on
med
icat
ion w
ere
abse
nt a
ppro
xim
atel
y onl
y 2
days
per
ye
ar m
ore
than
chi
ldre
n in
con
trol g
roup
s. S
choo
l abs
ence
is n
ot
a va
lid m
arke
r of a
sthm
a m
orbi
dity
. Am
ong
thos
e w
ith a
sthm
a re
ceiv
ing m
edic
atio
n, s
econ
dary
sch
ool c
hild
ren
wer
e ab
sent
for
a m
ean
of 8
day
s, c
ompa
red t
o 4
days
for e
lem
enta
ry s
choo
l ch
ildre
n. S
ocia
l dep
rivat
ion
has
a st
rong
er in
fluen
ce on
sch
ool
abse
nce
than
ast
hma.
Abs
ence
s am
ong
child
ren
with
ast
hma
may
be
mor
e du
e to
und
erly
ing s
ocia
l fact
ors
than
med
ical
one
s.
54%
of s
choo
l-age
d chi
ldre
n w
ith a
sthm
a m
isse
d sc
hool
bec
ause
of
asth
ma.
The
est
imat
ed m
ean
num
ber o
f sch
ool d
ays
lost
per
yea
r fo
r a c
hild
with
ast
hma
was
6.1
day
s. S
choo
l day
s m
isse
d du
e to
as
thm
a ac
coun
ts fo
r 5%
of t
otal
day
s m
isse
d by
all s
tude
nts f
or
any
reas
on.
8% o
f stu
dent
s with
ast
hma
wer
e ab
sent
from
sch
ool f
or m
ore
than
10
ast
hma
epis
odes
in p
ast y
ear;
19%
wer
e ab
sent
for b
etw
een 4
an
d 10
ast
hma
epis
odes
per
yea
r, an
d 25
% a
bsen
t fro
m s
choo
l fo
r few
er th
an 4
epi
sode
s pe
r yea
r. Th
e re
mai
nder
did
not
repo
rt ab
senc
es.
sign
ifica
ntly
corr
elat
ed w
ith s
choo
l abs
ente
eism
(26
vs 1
8 da
ys).
Par
ents
’ mea
sure
of s
ever
ity u
sing
2 q
uick
que
stio
ns w
as
1.4%
of U
S c
hild
ren
youn
ger t
han
18 ye
ars
expe
rienc
e so
me
degr
ee
of d
isab
ility
due
to a
sthm
a. C
hild
ren
with
dis
ablin
g as
thm
a ha
d an
av
erag
e of
9.7
sch
ool a
bsen
ce d
ays
annu
ally
. In
com
paris
on,
child
ren
with
oth
er d
isab
ility
cond
ition
s lo
st an
ave
rage
of 5
.3
scho
ol d
ays
due
to th
eir d
isab
ility.
An
estim
ated
40%
of c
hild
ren
with
dis
ablin
g ast
hma
wer
e re
porte
d as
bein
g ei
ther
una
ble
or li
mite
d in
thei
r abi
lity t
o en
gage
in s
choo
l act
iviti
es.
CD
C, C
ente
rs fo
r Dis
ease
Con
trol a
nd P
reve
ntio
n; E
R, E
mer
genc
y ro
om.
Tabl
e 1
Pub
lishe
d R
esea
rch
Art
icle
s Th
at A
ddre
ss A
sthm
a an
d A
bsen
ce F
rom
Sch
ool
(Con
tinue
d fr
om p
revi
ous
pag
e)
Cita
tion
(Orig
in o
f Prim
ary
Aut
hor)
R
esea
rch
Des
ign
Maj
or F
indi
ngs
Rel
ated
to A
bsen
teei
sm
Ngu
yen
L, R
aher
ison
C, V
emej
oux
JM,
Tuno
n-D
e-La
ra JM
, Tay
tard
A.
Impa
ct o
f sm
okin
g ha
bits
on
the
ever
y da
y lif
e of
as
thm
atic
ado
lesc
ents
. Rev
Ma1
R
espi
r. 20
02;1
9:30
1-30
9.
(Fra
nce)
N
riagu
J, R
obin
s T, G
ary
L, e
t al.
Pre
vale
nce
of a
sthm
a an
d re
spira
tory
sym
ptom
s in
so
uth-
cent
ral D
urba
n, S
outh
Afri
ca. E
urJ
Epid
erni
ol. 1
999;
15(8
):747
-755
. (S
outh
Afri
ca)
Ran
d C
S, B
utz
AM, K
olod
ner K
, Hus
s K,
E
ggle
ston
P, M
alve
aw F
.Em
erge
ncy
depa
rtmen
t vis
its b
y ur
ban
Afri
can
Am
eric
an ch
ildre
n w
ith a
sthm
a. J
Alle
rgy
Clin
lrnm
uno1
2000
;105
:83-
90.
(USA
) R
osie
r MJ,
Bis
hop
J, N
olan
T, R
ober
tson
C
F, C
arlin
JB, P
hela
n PD
. Mea
sure
men
t of
func
tiona
l sev
erity
of a
sthm
a in
ch
ildre
n. A
m J
Res
pir C
rit C
are
Med
.
(Aus
tralia
) 19
943 4
9343
4-1 4
41.
Spee
-van
der
Wek
ke J
, Meu
lmee
ster
JF,
R
adde
r JJ,
Ver
loov
e-V
anho
rick SP.
Sch
ool a
bsen
ce a
nd tr
eatm
ent i
n sc
hool
ch
ildre
n w
ith re
spira
tory
sym
ptom
s in
The
N
ethe
rland
s: d
ata
from
the
Chi
ld H
ealth
M
onito
ring
Sys
tem
. J E
pide
mio
l C
omm
unity
Hea
lth. 1
998;
52(6
):359
-363
. (N
ethe
rland
s)
Tayl
or W
R, N
ewac
heck
PW
. im
pact
of
asth
ma
on h
ealth
. Ped
iatr
ics.
199
2;
90(5
) 165
7-66
2.
(US
A)
3302
chi
ldre
n ag
ed 1
3-1 4
yea
rs w
ere
surv
eyed
for r
espi
rato
ry
sym
ptom
s, s
choo
l abs
ente
eism
, as
wel
l as
on s
mok
ing
habi
ts
and
expo
sure
to th
e to
bacc
o sm
oke
of o
ther
s.
Reg
ress
ion
anal
ysis
that
adj
uste
d fo
r con
foun
ding
fact
ors
foun
d th
at
activ
e sm
okin
g am
ong
adol
esce
nt a
sthm
atic
s co
ntrib
uted
to m
ore
scho
ol a
bsen
ces.
Hea
ds o
f 21 3
hou
seho
lds
in 2
hea
vily
pol
lute
d com
mun
ities
wer
e in
terv
iew
ed a
bout
ast
hma
diag
nosi
s, s
ympt
oms
of a
sthm
a,
hous
ehol
d ris
k fa
ctor
s. a
nd m
isse
d sc
hool
.
Par
ents
of 3
92 m
ostly
Afri
can
Am
eric
an c
hild
ren
(K-6
) wer
e in
terv
iew
ed if
thei
r sch
ool h
ealth
em
erge
ncy
card
iden
tifie
d the
m
as h
avin
g as
thm
a. N
umbe
r of s
choo
l day
s m
isse
d be
caus
e of
as
thm
a w
as o
ne q
uest
ion
aske
d of
par
ents
.
A su
rvey
on
asth
ma
sym
ptom
s w
as s
ent t
o pa
rent
s of
a ra
ndom
sa
mpl
e of
919
2 ch
ildre
n in
2nd
, 7th
, and
10t
h gr
ades
(mea
n ag
es
8, 1
3, a
nd 1
6 ye
ars)
. Par
ents
of 1
267
child
ren w
ho h
ad sy
mpt
oms
wer
e in
terv
iew
ed, a
nd p
ulm
onar
y fun
ctio
n te
sts
wer
e pe
rform
ed.
Sch
ool a
bsen
ce w
as m
easu
red
usin
g pa
rent
repo
rt of
'abs
ence
s du
e to
whe
eze
in p
rece
ding
12
mon
ths.
" Pur
pose
of s
tudy
was
to
deve
lop
a st
anda
rdiz
ed in
stru
men
t for
mea
surin
g se
verit
y of
ch
roni
c as
thm
a in
chi
ldre
n.
Ove
r 500
0 ch
ildre
n (a
ges
4-15
yea
rs) w
ho w
ere
elig
ible
for r
outin
e sc
hool
-bas
ed h
ealth
ass
essm
ents
wer
e sc
reen
ed fo
r rec
ent/
curre
nt re
spira
tory
sym
ptom
s.
Dat
a ba
sed
on 1
988
NH
lS of
4.3
% o
f 17,
000
hous
ehol
ds w
ho
repo
rted
a ch
ild w
ho h
ad a
sthm
a in
the
prev
ious
12
mon
ths.
B
oth
thos
e w
ith a
nd w
ithou
t ast
hma
wer
e as
ked
Yun
ctio
nal
stat
us" q
uest
ions
, inc
ludi
ng pa
rent
s' e
stim
ate
of n
umbe
r of
day
s th
eir c
hild
was
abs
ent f
rom
sch
ool in
the
prev
ious
yea
r.
Of 3
67 c
hild
ren
unde
r age
1 17
yea
rs, 1
0% h
ad a
dia
gnos
is o
f as
thm
a. P
reva
lenc
e of
sym
ptom
s was
not
ass
ocia
ted
with
ho
useh
old
risks
(sm
oke,
dam
pnes
s, c
arpe
ts, p
ets,
pes
ticid
es).
Ast
hma
prev
alen
ce w
as s
trong
ly c
orre
late
d w
ith m
issi
ng
of s
choo
l by
child
ren
with
an
odds
ratio
of 44.
Par
ents
of s
tude
nts
with
ast
hma
repo
rted
thei
r chi
ldre
n w
ere
abse
nt fr
om s
choo
l an
aver
age
of 9
.7 s
choo
l day
s pe
r yea
r be
caus
e of
ast
hma.
Ast
hma
sym
ptom
que
stio
ns u
sed
in th
is s
urve
y de
mon
stra
ted
that
sy
mpt
oms
of a
sthm
a co
rrela
ted
sign
ifica
ntly
with
"sch
ool a
bsen
ce
due
to w
heez
e" (w
ith a
cor
rela
tion
coef
ficie
nt o
f .35
).
Res
pira
tory
sym
ptom
s w
ere
a m
ajor
cau
se o
f abs
ente
eism
. Am
ong
child
ren
with
resp
irato
ry s
ympt
oms
sugg
estiv
e of
ast
hma (7%),
abse
nce
from
sch
ool w
as n
ot s
tatis
tical
ly di
ffere
nt fr
om s
choo
l ab
senc
e ra
tes a
mon
g ch
ildre
n w
ith o
ther
resp
irato
ry s
ympt
oms.
A
bsen
ce fr
om s
choo
l is
high
er in
thos
e (w
ith a
nd w
ithou
t ast
hma)
w
ho h
ad re
ceiv
ed a
med
icat
ion
in th
e pr
evio
us m
onth
-indi
catin
g se
verit
y of
res
pira
tory
sym
ptom
s.
Bla
ck ch
ildre
n w
ith a
sthm
a m
isse
d a
mea
n of
6.5
day
s of
sch
ool,
whi
te c
hild
ren
with
ast
hma
mis
sed
a m
ean
of
4 da
ys o
f sch
ool (
mea
n fo
r all
race
s w
as 4
.5 d
ays)
. Chi
ldre
n w
ith m
ild a
sthm
a m
isse
d 2.
1 da
ys, t
hose
with
mod
erat
e as
thm
a, 3
day
s, a
nd th
ose
with
sev
ere
asth
ma,
5.2
day
s.
Low
inco
me
was
a s
igni
fican
t pre
dict
or o
f sch
ool
days
lost
.
CD
C, C
ente
rs fo
r Dis
ease
Con
trol a
nd P
reve
ntio
n; E
R, E
mer
genc
y ro
om.
Tabl
e 1
Pub
lishe
d R
esea
rch
Art
icle
s Th
at A
ddre
ss A
sthm
a an
d A
bsen
ce F
rom
Sch
ool
(Con
tinue
d fr
om p
revi
ous
pag
e)
Cita
tion
(Ori
gin
of P
rimar
y A
utho
r)
Res
earc
h D
esig
n M
ajor
Fin
din
gs
Rel
ated
to A
bsen
teei
sm
War
man
KL,
Silv
er E
J, M
cCou
rt M
P, S
tein
R
EK. H
ow d
oes
hom
e m
anag
emen
t of
asth
ma
exac
erba
tions
by
pare
nts o
f in
ner-
city
child
ren
diffe
r fro
m N
HLB
I gu
idel
ine
reco
mm
enda
tions
? P
edia
trics
. 19
99;1
03:4
22-4
27.
(US
A)
Wei
ss K
B, S
ulliv
an S
D, L
yttle
CS
. Tre
nds
in th
e co
st o
f illn
ess
for a
sthm
a in
the
Uni
ted
Sta
tes,
198
5-1 9
94. J
Alle
rgy
Clin
Im
mun
ol. 2
0003
06:4
93-4
99.
(US
A)
Woo
d P
R, H
idal
go H
A, P
rihod
a TJ
, Kro
mer
M
E. H
ispa
nic
child
ren
with
ast
hma:
m
orbi
dity
. Ped
iatri
cs. 1
993;
91:6
2-69
. (U
SA
)
Yea
tts K
, Shy
C, S
otir
M, M
usic
S, H
erge
t C.
Hea
lth co
nseq
uenc
es fo
r chi
ldre
n w
ith
undi
agno
sed
asth
ma-
like
sym
ptom
s. A
rch
Ped
iatr
Ado
lesc
Med
. 200
3; 1
5754
0-54
4.
(US
A)
Yea
tts K
B, S
hy C
M. P
reva
lenc
e an
d co
nseq
uenc
es o
f ast
hma
and
whe
ezin
g in
Afri
can-
Am
eric
an a
nd W
hite
ad
oles
cent
s. J
Ado
lesc
Hea
lth.
2001
;29(
5):3
14-3
19.
(US
A)
Par
ents
of 2
20 c
hild
ren
(age
s 2-
12) w
ho h
ad b
een
hosp
italiz
ed w
ith
asth
ma
wer
e su
rvey
ed b
y te
leph
one.
P
aren
ts re
porte
d an
ave
rage
of
18 d
ays
of s
choo
l abs
ence
in th
e pr
evio
us sc
hool
year
, with
a m
edia
n of
12
days
abs
ent.
Thi
s st
udy
look
ed a
t cos
t est
imat
es of
ast
hma
from
an
econ
omic
ev
alua
tion
publ
ishe
d in
199
2 re
gard
ing
1985
cos
ts. A
stu
dy o
f 19
94 d
ata
was
bas
ed o
n th
e pr
evio
us a
naly
tical
met
hods
. Num
ber
of s
choo
l day
s lo
st w
as e
quat
ed w
ith th
e nu
mbe
r of d
ays
lost
from
w
ork
for t
he p
aren
ucar
etak
er. N
HlS
dat
a w
ere
used
to c
alcu
late
th
e nu
mbe
r of w
ork
days
lost
. C
hild
ren
(age
s 6-
16) w
ith a
sthm
a w
ere
iden
tifie
d fro
m 1
hos
pita
l's
emer
genc
y an
d ho
spita
lizat
ion r
ecor
ds. O
nly
thos
e w
ith a
t lea
st
2 ac
ute
visi
ts o
r 1
hosp
italiz
atio
n wer
e en
rolle
d in
the
stud
y.
Sta
ndar
dize
d que
stio
nnai
res,
pea
k flo
w, a
nd s
choo
l atte
ndan
ce
reco
rds w
ere
incl
uded
in th
e m
easu
rem
ents
.
scho
ols
via
a st
anda
rdiz
ed as
thm
a qu
estio
nnai
re an
d ad
ditio
nal
ques
tions
on
asth
ma
cons
eque
nces
.
Ove
r 12
2,00
0 ch
ildre
n (a
ges
12-1
4) w
ere
surv
eyed
in 4
99 m
iddl
e
Whe
ezin
g sy
mpt
oms
and
phys
icia
n-di
agno
sed a
sthm
a w
ere
mea
sure
d in
205
9 8t
h gr
ader
s in
an
inte
rnat
iona
l stu
dy s
ampl
e.
Ado
lesc
ents
ans
wer
ed qu
estio
ns a
bout
thei
r ast
hma,
sch
ool
atte
ndan
ce, a
nd s
leep
dis
turb
ance
s se
cond
ary
to
asth
ma
sym
ptom
s.
It w
as c
alcu
late
d th
at in
199
4, c
hild
ren
aged
5-1
7 lo
st a
n es
timat
ed
11.8
mill
ion
scho
ol d
ays
beca
use
of a
sthm
a, a
s co
mpa
red t
o 7.
2 m
illio
n sc
hool
day
s lo
st in
198
5.
Am
ong
the
findi
ngs
in th
e st
udy
was
that
the
rate
of s
choo
l ab
sent
eeis
m w
as 1
3 of
175
day
s (7
.4%
of t
otal
). S
mok
ers
in
hous
ehol
d and
low
kno
wle
dge
of a
sthm
a w
ere
the
larg
est
cont
ribut
ors t
o m
orbi
dity
from
ast
hma.
17%
of t
he p
opul
atio
n re
porte
d ast
hma-
like s
ympt
oms
in th
e pa
st 1
2 m
onth
s w
ith n
o di
agno
sis
of a
sthm
a. 1
1 % re
porte
d ph
ysic
ian-
diag
nose
d ast
hma.
20%
of t
hose
with
und
iagn
osed
as
thm
a sy
mpt
oms
mis
sed
at le
ast a
hal
f day
of s
choo
l in
the
prec
edin
g m
onth
bec
ause
of s
ympt
oms.
Of c
hild
ren
with
ph
ysic
ian-
diag
nose
d ast
hma,
47%
mis
sed
at le
ast a
hal
f day
in
the
prec
edin
g m
onth
. 9%
of t
hese
ado
lesc
ents
had
phy
sici
an-d
iagn
osed
asth
ma,
and
an
othe
r 27%
repo
rted w
heez
ing
with
out a
phy
sici
an di
agno
sis o
f as
thm
a. T
hose
with
phy
sici
an-d
iagn
osed
asth
ma
mis
sed
2.6
times
mor
e sc
hool
day
s th
an th
ose
with
out a
sthm
a. T
hose
w
ithou
t a d
iagn
osis
but
with
his
torie
s of w
heez
ing
mis
sed
1.8
times
mor
e sc
hool
day
s th
an h
ealth
y ad
oles
cent
s.
~
CD
C, C
ente
rs fo
r D
isea
se C
ontro
l and
Pre
vent
ion;
ER
, Em
erge
ncy
room
.
attendance among children without asthma). Days absent for symptoms of asthma are not typically distinguished from days absent for other reasons. And absenteeism is measured differently across studies. For example, some studies elicit the number of days absent per year, whereas others frame the question by asking whether a child has missed more than a certain number of days in the past month, quarter, or year.
Despite the fact that current research cannot easily come to a consensus on the number of school days missed secondary to asthma, a great deal of information has been learned about the factors that may influence school absenteeism rates. The studies demonstrate links between absenteeism and ethnicity that range from mere weak influences when comparing American Hispanics to African Americans in one study to relatively high rates of absenteeism among African Americans in another study and relatively high rates of absenteeism among Puerto Ricans with asthma in New York compared to other eth- nic groups with asthma, in a third study (Christiansen et a1 1996; Taylor and Newacheck 1992; Findley et a1 2003; Table 1).
Parenting and income (Gartland and Day 1999; McCo- wan et a1 1996; Taylor and Newacheck 1992; Table 1) predict rates of school absences among children with asthma as does the severity of the disease (Wood et a1 1993; Warman et a1 1999; Tablel). The contribution of one’s adherence to prescribed medical regimens may play a significant role in rates of absenteeism (Bauman et a1 2002; Table 1). Not surprisingly, these studies allude to the possibility that the physical home environment, access to health care, and/or the importance placed on attending school may mediate the effects of ethnic and social factors on school attendance. But this is still not well understood.
With the exception of a study in Saudi Arabia (Al- Dawood 2002; Table l), studies demonstrate that children with a physician’s diagnosis of asthma are absent more school days than children who have symptoms of asthma but do not have a physician’s diagnosis (Joseph et a1 1996; Maier et a1 1998; Yeatts et a1 2003; Table 1). Stud- ies are mixed on whether younger elementary students with asthma or adolescents in high school with asthma are most likely to miss school.
Various studies have examined environmental factors affecting school attendance among children with asthma. Studies have found that missed school days are associated with adolescents who smoke, students without asthma who have mothers with asthma, and children with asthma living in areas with high ozone levels. More studies are required to confirm these associations.
Achievement Approximately two thirds of the published studies that
address school performance and students with asthma (Table 2) demonstrate no difference in levels of academic achievement or ability. Among those showing a difference, the difference was limited to students with severe and per- sistent symptoms or to other contributing social factors such as income (Gutstadt et a1 1989; Fowler et a1 1992; Table2). Of interest is the finding that kindergarten stu- dents with asthma had poorer school readiness scores and that asthma-related interruptions in sleep for children with
asthma, rather than the severity of the condition per se, may affect school performance (Halterman et a1 2001; An- nett et al 2000; Table 2).
Interventions to Mediate Asthma Effects on Attendance Twenty-five published articles described interventions
for school-aged children with asthma and measured how rates of school attendance varied based on that interven- tion. Interventions described in these articles included re- ferrals to primary care doctors, education on asthma management, student attendance at asthma camp, exis- tence of a school-based clinic, comprehensive medication management, a swimming program for children with asthma, medication delivery in school, and interventions at the level of the primary care physician. Unfortunately, the design of many of these studies did not include mea- surement of absenteeism rates at 2 points in time among those students who did not receive the intervention. This would have increased the validity of these figures. Studies that did use a control group clearly demonstrate their importance in this field, rendering outcomes without a control group almost meaningless. In a number of stud- ies, very significant improvements in attendance occurred in children who received no intervention (control chil- dren) (Hill et a1 1991; McGhan et a1 2003; Taras et a1 2004; Table 3) and sometimes these improvements were of a magnitude larger than the beneficial effect of the intervention.
Education for children and/or parents on management of their asthma was the primary intervention in 7 studies, some in school-based settings, others at health care set- tings, and 1 by pharmacists. Evidence that education on asthma management improves school attendance is weak, although evidence that this intervention can improve con- trol of the disease is encouraging. This paradox supports the view that symptoms of children with asthma are less responsible for missed school days than are various socio- cultural causes. The Open Airways for Schools program, sponsored by the American Lung Association, is one educational intervention shown, in a controlled study pub- lished in 1987, to successfully improve student knowl- edge, self-management skills, and asthma m~rb id i ty .~ Interestingly, school grades improved for those taking the course, but there was no change in number of school days missed. Success is dependent on the program curricula, mode of delivery, and type of training and experience of the person(s) delivering the e d u ~ a t i o n . ~ . ~ Two asthma camp studies demonstrated improved student attendance (Kelly et a1 1998; Meng et a1 1998; Table3), which should have heralded further research with control groups and other tighter methodological designs, but unfortunately did not.
Controlled studies that included special precautions to assure proper medication regimens (with or without com- prehensive education on management) were mixed in their demonstrated effect on student attendance. School- based delivery of inhaled steroids (Millard et a1 2003; Halterman et a1 2004; Table3) and lof 3 interventions that provided children with comprehensive asthma care in a spe- cialized clinic (Battleman et a1 2001; Table3) improved attendance. Referring school-aged children with asthma to a primary care provider (Hill et a1 1991; Lurie et a1 2001; Zorc et a1 2003; Table 3) and improving the habits of regular
304 Journal of School Health October 2005, Vol. 75, No. 8
Tabl
e 2
Pu
blis
hed
Res
earc
h A
rtic
les
Th
at A
ddre
ss A
sthm
a an
d S
cho
ol P
erfo
rman
ce a
nd/o
r C
og
niti
ve A
bili
ty in
Sch
oo
l-Ag
ed C
hild
ren
(Con
tinue
d on
nex
t pag
e)
Maj
or F
ind
ing
s R
elat
ed to
Ach
ieve
men
t (E
ffec
ts
on
Abs
ente
eism
Als
o R
epor
ted,
If A
pplic
able
) C
itatio
n (O
rigi
n of
Prim
ary
Aut
hor)
R
esea
rch
Des
ign
Ann
ett R
D, A
ylw
ard
EH
, Lap
idus
J, B
ende
r BG
, DuH
amel
T.
Neu
roco
gniti
ve fu
nctio
ning
in c
hild
ren
with
mild
and
m
oder
ate
asth
ma
in th
e ch
ildho
od as
thm
a m
anag
emen
t pr
ogra
m. T
he C
hild
hood
Ast
hma
Man
agem
ent P
rogr
am
(CA
MP
) Res
earc
h G
roup
. J A
llerg
y C
lin lm
mun
ol.
2000
;105
(4):7
17-7
24.
(US
A)
Die
tte G
B, M
arks
on L
, Ski
nner
EA
, Ngu
yen
TT,
Alg
att-B
ergs
trom
P, W
u A
W. N
octu
rnal
asth
ma
in c
hild
ren
affe
cts
scho
ol a
ttend
ance
, sch
ool
perfo
rman
ce, a
nd p
aren
ts' w
ork
atte
ndan
ce.
Arc
h Pe
diaf
r Ado
lesc
Med
. 200
0; 15
4(9)
:923
-928
. (U
SA
)
Fow
ler M
G, D
aven
port
MG
, Gar
g R
. Sch
ool f
unct
ioni
ng
of U
S c
hild
ren
with
ast
hma.
Ped
iatr
ics.
19
92;9
0(6)
:939
-944
. (U
SA
)
Gut
stad
t LB
, Gill
ette
JW, M
raze
k D
A, F
ukuh
ara J
T,
LaB
recq
ue J
F, S
trunk
RC
. Det
erm
inan
ts of
sch
ool
perfo
rman
ce in
chi
ldre
n with
chr
onic
ast
hma.
Am
J D
is
Chi
ld. 1
989;
143(
4):4
71-4
75.
(US
A)
Hal
term
an JS
, Mon
tes
G, A
ligne
CA
, Kac
zoro
wsk
i JM
, H
ight
ower
AD
, Szi
lagy
i PG
. Sch
ool r
eadi
ness
am
ong
urba
n ch
ildre
n w
ith a
sthm
a. A
mbu
l Ped
iatr
. 200
1 ;1(
4):2
01-2
05.
(US
A)
Sub
ject
s w
ere
1041
child
ren
(mea
n ag
e 8.
9 ye
ars)
enr
olle
d in
the
Chi
ldho
od A
sthm
a M
anag
emen
t Pro
gram
(a
rand
omiz
ed tri
al c
ompa
ring 2
ant
i-inf
lam
mat
ory a
gent
s).
WlS
C (i
ntel
ligen
ce sc
ale)
, Woo
dcoc
k-Jo
hnso
n (a
chie
vem
ent),
WR
AM
L (m
emor
y/le
arni
ng), G
DS
(s
tand
ardi
zed "
atte
ntio
n ta
sk" d
evic
e), a
nd lu
ng fu
nctio
n as
sess
men
ts w
ere
colle
cted
dur
ing
base
line
scre
enin
g, a
s w
as a
sthm
a se
verit
y (v
ia a
28-
day
asth
ma
diar
y). C
hild
ren
with
no
asth
ma
and
seve
re a
sthm
a w
ere
excl
uded
. Onl
y th
ose
with
mild
and
mod
erat
e as
thm
a w
ere
stud
ied.
C
ross
-sec
tiona
l sur
vey
(mai
l and
tele
phon
e) o
f 438
pare
nts
of a
sthm
atic
chi
ldre
n in
3 m
anag
ed-c
are
orga
niza
tions
(ide
ntifi
ed v
ia p
harm
acy
data
and
vis
its).
Mis
sed
scho
ol d
ays
and
effe
ct o
n ch
ild's
edu
catio
n w
ere
deriv
ed fr
om p
aren
t rep
orts
of t
he p
revi
ous
4 w
eeks
.
Cro
ss-s
ectio
nal d
ata
from
198
8 U
S N
atio
nal H
ealth
Inte
rvie
w
Sur
vey
of p
aren
ts o
n C
hild
Hea
lth.
The
stud
y co
nsis
ted
of 9
9 ch
ildre
n (a
ges
9-17
) with
sev
ere
asth
ma
who
wer
e ad
mitt
ed to
hos
pita
l to re
ceiv
e an
ext
ensi
ve
eval
uatio
n an
d re
habi
litat
ion
of s
ever
e ch
roni
c as
thm
a. T
his
was
a p
reve
ntiv
e pr
ogra
m, n
ot h
ospi
taliz
atio
n w
ith a
n ac
ute
epis
ode.
Sta
ndar
dize
d tes
ts o
f pul
mon
ary f
unct
ion,
aca
dem
ic
perfo
rman
ce, g
rade
s (w
hen
avai
labl
e), i
ntel
ligen
ce te
sts
(Slo
sson
Inte
lligen
ce T
est),
sch
ool a
ttend
ance
reco
rds,
and
ps
ycho
logi
cal a
sses
smen
ts (C
hild
Beh
avio
r Che
cklis
t) w
ere
dete
rmin
ed in
the
first
2 w
eeks
of t
he p
reve
ntiv
e in
terv
entio
n.
A s
tepw
ise
regr
essi
on a
naly
sis
was
use
d to
exa
min
e re
la-
tions
hips
bet
wee
n th
ese
and
othe
r var
iabl
es.
Roc
hest
er, N
Y, o
f whi
ch 1
03 h
ad a
sthm
a (9
%).
Par
ents
w
ere
surv
eyed
for c
hild
ast
hma
sym
ptom
s in
the
past
12
mon
ths,
lim
itatio
ns of
act
ivity
, and
dev
elop
men
tal s
kills
. V
alid
ated
sur
vey
tool
was
use
d.
Cro
ss-s
ectio
nal s
tudy
of 1
058
kind
erga
rten c
hild
ren
in
The
re w
ere
no s
igni
fican
t diff
eren
ces b
etw
een
publ
ishe
d no
rmat
ive v
alue
s an
d th
e st
udy
popu
latio
n with
mild
and
m
oder
ate
asth
ma
for
IQ, m
emor
y, a
ttent
ion,
and
aca
dem
ic
achi
evem
ent.
Chi
ldre
n w
ith a
sthm
a sc
ored
bet
wee
n tw
o-th
irds
and
1 st
anda
rd d
evia
tion
belo
w n
orm
s fo
r a m
ea-
sure
of i
mpu
lse
cont
rol-i
ndic
atin
g th
ere
may
be
diff
icul
ty w
ith m
odul
atio
n and
con
trol o
f im
puls
ive
beha
vior
s.
40%
of c
hild
ren
with
ast
hma
wer
e aw
aken
ed a
t lea
st o
nce
in
the
prev
ious
mon
th; 3
5% m
isse
d at
leas
t 1 d
ay o
f sch
ool;
36%
repo
rted t
hat s
choo
l per
form
ance
suffe
red
beca
use
of
asth
ma
sym
ptom
s. A
sig
nific
ant tr
end
exis
ted
betw
een
nigh
t aw
aken
ings
and
bot
h re
porte
d sc
hool
per
form
ance
an
d da
ys m
isse
d fro
m s
choo
l. N
ight
aw
aken
ing
was
su
gges
ted
as a
n in
depe
nden
t det
erm
inan
t of a
bsen
teei
sm.
Of o
ver
10,0
00 fa
mili
es s
urve
yed,
5%
of c
hild
ren
(536
) had
as
thm
a in
the
prev
ious
12
mon
ths.
Afte
r adj
ustin
g fo
r de
mog
raph
ic fa
ctor
s, th
ere
was
no
diffe
renc
e in
gra
de
failu
re o
r in
susp
ensi
on/e
xpul
sion
; tho
se w
ith a
sthm
a ha
d 1.
7 tim
es ri
sk o
f lea
rnin
g di
sabi
lity-
high
er
amon
g th
ose
repo
rting
to h
ave
asth
ma
and
be in
fair
to p
oor h
ealth
. A
mon
g fa
mili
es w
ith lo
w in
com
e, th
ose
with
ast
hma
had
twic
e od
ds o
f gra
de fa
ilure
.
soci
oeco
nom
ic s
tatu
s, o
lder
age
, his
tory
of c
ontin
uous
ora
l st
eroi
d us
e (e
very
oth
er d
ay u
se fo
r at l
east
1 y
ear p
rior t
o ev
alua
tion)
, and
pre
senc
e of
em
otio
naV
beha
vior
al
prob
lem
s. S
choo
l abs
ente
eism
, use
of m
edic
al re
sour
ces,
th
e do
se o
f ora
l ste
roid
s, o
ther
ast
hma
med
icat
ions
, and
pu
lmon
ary
func
tion
wer
e no
t ass
ocia
ted w
ith a
cade
mic
pe
rform
ance
.
Low
per
form
ance
sco
res
wer
e as
soci
ated
with
low
Chi
ldre
n w
ith a
sthm
a w
ho a
lso
had
a lim
itatio
n of
act
ivity
(63
of 1
03 a
sthm
atic
chi
ldre
n) h
ad s
igni
fican
tly lo
wer
sch
ool
read
ines
s sk
ills
com
pare
d to
chi
ldre
n w
ithou
t ast
hma,
ad
just
ing f
or m
ultip
le, p
oten
tially
conf
ound
ing v
aria
bles
. D
evel
opm
enta
l pro
blem
s fo
r ur
ban
child
ren
with
sig
nific
ant
asth
ma
may
beg
in b
efor
e sc
hool
ent
ry.
-
GD
S, G
ordo
n D
iagn
ostic
Sys
tem
; WIS
C, W
echs
ler I
ntel
ligen
ce S
cale
for C
hild
ren;
WR
AM
L, W
ide
Ran
ge A
sses
smen
t of M
emor
y an
d Le
arni
ng; W
RA
T-R
, Wid
e R
ange
-Ach
ieve
men
t Te
st, R
evis
ed.
W
0
aY c
0 5 R $ s ru
s, TT
0 0
a-
* 0
c 0
U
N
0
0
yl
4
VI
2
?
0,
Tabl
e 2
Pub
lishe
d R
esea
rch
Art
icle
s Th
at A
ddre
ss A
sthm
a an
d S
choo
l Per
form
ance
and/
or
Cog
nitiv
e A
bilit
y in
Sch
ool-A
ged
Chi
ldre
n (C
ontin
ued
from
pre
viou
s pa
ge)
Cita
tion
(Orig
in o
f Prim
ary
Aut
hor)
R
esea
rch
Des
ign
Maj
or F
indi
ngs
Rel
ated
to A
chie
vem
ent (
Effe
cts
on A
bsen
teei
sm A
lso
Rep
orte
d, If
App
licab
le)
Lind
gren
S, L
oksh
in 6, Stro
mqu
ist A
, et a
l. D
oes
asth
ma
or
treat
men
t with
theo
phyl
line
limit
child
ren’
s ac
adem
ic
perfo
rman
ce. N
€n
g/J
Med
. 199
2;24
;327
( 13)
:926
-930
.
Nal
l M, C
orbe
tt M
, McL
ough
lin J,
Pet
rosk
o J,
Gar
cia
D, K
arib
o
(US
A)
J. Im
pact
of s
hort-
term
ora
l ste
roid
use
upo
n ch
ildre
n’s
scho
ol a
chie
vem
ent a
nd b
ehav
ior.
Ann
A//e
rgy.
19
!32;
69:2
18-2
20.
(USA
) R
ietv
eld
S, C
olla
nd V
T. T
he im
pact
of s
ever
e as
thm
a on
sc
hool
child
ren.
./A
sthm
a. 1
999;
36(5
):409
-417
. (N
ethe
rland
s)
Ros
sS,G
odde
nD, M
cMur
ray D
. eta
l. Soc
iale
ffect
sofw
heez
ein
child
hood
: a 2
5-ye
ar fo
llow
up.
BM
J. 1
992;
305:
545-
548.
(U
K)
255
child
ren
with
ast
hma
(mea
n ag
e 12
) who
had
take
n a
stan
dard
ized
aca
dem
ic a
chie
vem
ent te
st a
dmin
iste
red
by s
choo
ls; 1
00 h
ad si
blin
gs w
ithou
t ast
hma,
who
wer
e co
ntro
ls.
19 c
hild
ren
(age
s 7-
15) f
rom
one
clin
ic w
ith c
hron
ic a
sthm
a on
non
ster
oid
long
-term
med
icat
ions
; WR
AT-
R (a
chie
ve-
men
t tes
t) an
d B
ehav
ior R
atin
g P
rofil
e. W
ithin
-sub
ject
de
sign
-stu
dent
s te
sted
on
and
off o
ral s
tero
ids.
25 c
hild
ren
(age
s 10
-13)
with
sev
ere
asth
ma
(on
high
dos
es
of c
ortic
oste
roid
s) m
atch
ed w
ith 2
5 ch
ildre
n in
con
trol
grou
p fo
r age
, sex
, and
soc
ioec
onom
ic b
ackg
roun
d;
asth
ma
subj
ects
en
dle
d v
ia p
hysi
cian
s’ o
ffice
s and
co
ntrd
s, v
ia lo
cal n
ewsp
aper
adv
ertis
emen
ts. S
tand
ard
test
s w
ere
used
to m
easu
re m
emor
y an
d co
ncen
tratio
n;
repo
rt ca
rds
wer
e us
ed to
ass
ess
scho
ol p
erfo
rman
ce.
Sub
ject
s id
entif
ied a
s ch
ildre
n w
ith a
dia
gnos
is o
f ast
hma
(97)
, whe
ezin
g on
ly w
ith u
pper
resp
irato
ry in
fect
ions
(1
32).
and
no re
spira
tory
sym
ptom
s (1
31) w
ere
follo
wed
25
year
s la
ter.
Silv
erst
ein
MD
, Mai
r JE
, Kat
usic
SK,
Wol
lan
PC
, Oco
nnel
l E
J, Y
ungi
nger
JW
. Sch
ool a
ttend
ance
and
scho
ol
perfo
rman
ce: a
pop
ulat
ion-
base
d st
udy
of c
hild
ren
with
as
thm
a. J
Ped
iatr
. 200
1 ; 13
9(2)
:278
-283
. (U
SA
)
Wel
don
DP,
McG
eady
SJ. T
heop
hyllin
e ef
fect
s on
cogn
ition
, be
havi
or, a
nd le
arni
ng. A
rch
Pedi
atr A
dole
sc M
ed.
1995
;149
(1):9
0-93
. (U
SA
)
Chi
ldre
n w
ith a
sthm
a w
ere
iden
tiied
thro
ugh
a m
edic
al
reco
rd re
view
sys
tem
. Sch
ool a
ttend
ance
, sta
ndar
dize
d ac
hiev
emen
t tes
t sco
res,
gra
de p
oint
ave
rage
(GP
A),
grad
e pr
omot
ion,
and
clas
s ra
nk o
f gra
duat
ing
stud
ents
for c
hil-
dren
with
ast
hma
and
cont
rol s
ubje
cts
wer
e ob
tain
ed fr
om
thos
e w
ith a
sthm
a w
ho a
lso
atte
nded
the
loca
l pub
lic s
choo
l sy
stem
. 92
stud
ents
with
ast
hma
wer
e co
mpa
red
to s
ex-
and
age-
mat
ched
cont
rol s
ubje
cts.
Sch
ool r
ecor
ds fo
r the
se
stud
ents
wer
e av
aila
ble
for a
n av
erag
e pe
riod
of 6
.6 y
ears
. 63
ast
hmat
ic c
hild
ren
wer
e dr
awn
from
adm
issi
ons t
o a
reha
bilit
atio
n ho
spita
l (ag
es 7
-1 8)
. Ast
hma
base
d on
sp
irom
etry
and
his
tory
of s
ympt
om re
spon
se. A
ll as
thm
atic
ch
ildre
n w
ere
give
n th
eoph
yllin
e (in
add
ition
to o
ther
ast
hma
med
icat
ions
). 46
non
asth
mat
ic co
ntro
l sub
ject
s w
ere
draw
n fro
m th
e Sa
me
reha
bilit
atio
n ho
spita
l. N
o ch
ildre
n w
ith
reta
rdat
ion
or n
euro
logi
cal d
iagn
oses
wer
e in
clud
ed. T
he
WlS
C (i
ntel
ligen
ce sc
ale)
, WR
AT (a
cade
mic
ach
ieve
men
t),
and
a hy
pera
ctiv
ity ch
eckl
ist w
ere
adm
inis
tere
d.
Aca
dem
ic a
chie
vem
ent a
mon
g ch
ildre
n w
ith a
sthm
a w
as
sim
ilar t
o or
bet
ter t
han
norm
ativ
e st
anda
rds.
For
the
101
child
ren
with
sib
ling c
ontro
ls, t
here
wer
e no
sta
tistic
ally
si
gnifi
cant
diff
eren
ces
in te
st s
core
s, in
clud
ing
child
ren
on
theo
phyl
line
for a
sthm
a.
Dur
ing
days
on
shor
t-ter
m o
ral s
tero
ids
(pre
dnis
one)
, the
re
was
no
chan
ge in
read
ing,
spe
lling,
and
arit
hmet
ic s
core
s or
beh
avio
r.
Mem
ory
scor
es, c
once
ntra
tion
scor
es, a
nd s
choo
l pe
rform
ance
wer
e no
t sig
nific
antly
diff
eren
t am
ong
thos
e w
ith a
nd w
ithou
t ast
hma.
Thos
e id
entif
ied
as h
avin
g as
thm
a in
chi
ldho
od w
ere
mor
e lik
ely
to h
ave
resp
irato
ry p
robl
ems d
urin
g th
eir s
choo
l yea
rs.
Des
pite
thes
e re
porte
d pr
oble
ms,
edu
catio
nal a
ttain
men
t su
ch a
s gr
adua
tion
from
hig
h sc
hool
, fur
ther
edu
catio
n, and
high
er ed
ucat
ion w
ere
sim
ilar f
orth
ose w
ith as
thm
a, th
osew
ith
whe
ezin
g du
ring
uppe
r res
pira
tory
infe
ctio
ns, a
nd th
ose
with
no
sym
ptom
s. (T
here
was
als
o no
diff
eren
ce be
twee
n th
ese
3 gr
oups
for e
mpl
oym
ent,
hous
ing,
and
eve
ntua
l soc
ial class.)
(2
7.95
sta
ndar
d de
viat
ion)
, com
pare
d w
ith 6
.74
(5 7.
08)
days
for n
onas
thm
atic
con
trol s
ubje
cts.
(Chi
ldre
n w
ith
asth
ma
had
2.2
mor
e da
ys a
bsen
t per
yea
r.) T
here
wer
e no
sig
nific
ant d
iffer
ence
s in
sta
ndar
dize
d ac
hiev
emen
t tes
t sc
ore
(read
ing,
mat
h, la
ngua
ge),
in G
PA, g
rade
pro
mot
ion,
or
cla
ss ra
nk.
Chi
ldre
n w
ith a
sthm
a ha
d a
mea
n of
8.9
5 da
ys a
bsen
t
Stu
dy d
etec
ted
no s
igni
fican
t beh
avio
ral o
r cog
nitiv
e di
ffere
nces
bet
wee
n th
e th
eoph
yllin
e-tre
ated
gro
up
of a
sthm
atic
chi
ldre
n an
d a
mat
ched
gro
up o
f chi
ldre
n w
ith
othe
r chr
onic
illn
esse
s who
did
not
rece
ive
theo
phyl
line.
GD
S, G
ordo
n D
iagn
ostic
Sys
tem
; WIS
C, W
echs
ler I
ntel
ligen
ce S
cale
for C
hild
ren;
WR
AML,
Wid
e R
ange
Ass
essm
ent o
f Mem
ory a
nd L
earn
ing;
WR
AT-
R, W
ide
Ran
ge-A
chie
vem
ent
Test
, Rev
ised
.
Tabl
e 3
Pu
blis
hed
Res
earc
h A
rtic
les
That
Ad
dre
ss In
terv
enti
on
s Am
ong
Sch
oo
l-Ag
ed C
hild
ren
With
A
sthm
a an
d R
ates
of S
cho
ol A
bse
nte
eism
(Con
tinu
ed o
n ne
xt p
age)
Cita
tion
(Ori
gin
of P
rimar
y A
utho
r)
Res
earc
h D
esig
n M
ajor
Fin
din
gs
Rel
ated
to A
bsen
teei
sm
Bat
tlem
an D
S, C
alla
han
MA
, Silb
er S
, et a
l. D
edic
ated
as
thm
a ce
nter
impr
oves
the
qual
ity o
f car
e an
d re
sour
ce
utili
zatio
n for
ped
iatri
c ast
hma:
a m
ultic
ente
r stu
dy. A
cad
Erne
rg M
ed. 2
001 ;
8(7)
:709
-715
. (U
SA
)
Chr
istia
nsen
SC
, Mar
tin S
B, S
chle
iche
r NC
, Koz
iol J
A,
Mat
hew
s K
P, Z
uraw
BL.
Eva
luat
ion
of a
sch
ool-b
ased
as
thm
a ed
ucat
ion
prog
ram
for
inne
r-ci
ty ch
ildre
n.
JAlle
rgy
Clin
Irnr
nuno
l. 19
97;1
00:6
13-6
17.
Cun
ning
ham
SJ,
Cra
in E
F. R
educ
tion o
f mor
bidi
ty in
as
thm
atic
chi
ldre
n gi
ven
a sp
acer
dev
ice.
Che
st.
(US
A)
1994
;106
(3):7
53-7
57.
(US
A)
Fors
hee
JD, W
hale
n E
B, H
acke
l R, e
t al.
The
effe
ctiv
enes
s of
one-
on-o
ne n
urse
edu
catio
n on
the
outc
omes
of h
igh-
risk
adul
t and
ped
iatri
c pat
ient
s w
ith a
sthm
a. M
anag
Car
e In
terf
ace.
199
8; 1 1
(1 2)
:82-
92.
Geo
rgio
u A
, Buc
hner
DA
, Ers
hoff
DH
, Bla
sko
KM
, Goo
dman
LV
, Fei
gin
J. T
he im
pact
of a
larg
e-sc
ale p
opul
atio
n-ba
sed
asth
ma
man
agem
ent p
rogr
am o
n pe
diat
ric a
sthm
a pa
tient
s an
d th
eir c
areg
iver
s. A
nn A
llerg
y A
sthm
a Im
mun
ol.
(US
A)
2003
;90:
308-
315.
(U
SA
)
a sc
hool
-bas
ed a
sthm
a tre
atm
ent p
rogr
am in
the
abse
nce
of s
econ
dhan
d sm
oke
expo
sure
. Arc
h Pe
diat
r Ado
lesc
M
ed. 2
004;
158:
460-
468.
Hal
term
an J
S, S
zila
gyi P
G, Y
oos
HL,
et a
l. B
enef
its of
(US
A)
A re
trosp
ectiv
e sam
ple
of 7
0 sc
hool
-age
d chi
ldre
n w
ho
rece
ived
asth
ma
care
from
a c
ompr
ehen
sive
ast
hma
cent
er w
ere
mat
ched
by
age
and
asth
ma
seve
rity
with
70
child
ren
with
ast
hma
who
rec
eive
d ca
re in
em
erge
ncy
depa
rtmen
ts. A
par
ent i
nter
view
was
con
duct
ed
to d
eter
min
e da
ys o
f sch
ool m
isse
d, a
mon
g ot
her
mea
sure
s of
ast
hma
sym
ptom
s.
Five
20-
min
ute
asth
ma-
educ
atio
n ses
sion
s wer
e he
ld fo
r 27
4t
h-gr
ade
stud
ents
with
ast
hma
who
wer
e th
en fo
llow
ed
pros
pect
ivel
y for
180
day
s. 1
5 st
uden
ts w
ith a
sthm
a di
d no
t re
ceiv
e the
edu
catio
nal s
essi
ons b
ut w
ere
follo
wed
and
m
easu
red.
emer
genc
y de
partm
ent (
ages
3-1
0; m
ean
age
6) w
ere
sent
ho
me
with
eith
er a
n in
hale
r with
a s
pace
r or a
n in
hale
r or
oral
med
icat
ion
(con
trol);
ran
dom
sel
ectio
n. P
aren
ts
com
plet
ed a
que
stio
nnai
re on
ast
hma
sym
ptom
s an
d de
mog
raph
ics.
Fol
low
-up
by te
leph
one
at 1
wee
k an
d 2,
4, a
nd 6
mon
ths
for s
ympt
oms
sinc
e th
e pr
evio
us ca
ll.
An
asth
ma
self-
man
agem
ent p
rogr
am w
as g
iven
to p
edia
tric
patie
nts
in a
n IP
A m
odel
hea
lth p
lan.
Rec
ruitm
ent w
as fo
r th
ose
with
ast
hma
at h
igh
risk,
risk
bas
ed o
n re
sour
ce
utiliz
atio
n, m
edic
atio
n use
, or l
ack
of u
se. P
artic
ipan
ts
incl
uded
89 c
hild
ren
(mea
n ag
e 8.
5).
401
hous
ehol
ds w
ith a
n as
thm
atic
chi
ld (a
ges
5-13
) wer
e ra
ndom
ly s
elec
ted
from
a h
ealth
pla
n’s
med
ical
/pha
mac
y cl
aim
s da
ta in
dica
ting a
n as
thm
a di
agno
sis.
An
‘ast
hma
heal
th m
anag
emen
t” in
terv
entio
n (ed
ucat
iona
l in
terv
entio
ns ba
sed
on a
sthm
a ris
k an
d se
verit
y). P
aren
ts
wer
e su
rvey
ed p
rior t
o an
d af
ter t
he in
terv
entio
n.
once
-dai
ly in
hale
d co
rtico
ster
oid m
edic
atio
ns.
184
child
ren
(age
s 3-
7) w
ere
rand
omiz
ed in
to
2 gr
oups
: 93
rece
ived
thei
r dai
ly d
ose
of in
hale
d co
rtico
ster
oids
in s
choo
l, an
d 91
wer
e al
loca
ted t
o us
ual p
aren
tal c
are
(con
trol).
Par
ents
adm
inis
tere
d m
edic
atio
ns o
n w
eeke
nds.
An
inde
pend
ent r
esea
rch
team
, blin
ded t
o in
terv
entio
n, c
olle
cted
data
. P
aren
ts w
ere
tele
phon
ed re
gula
rly a
nd a
sked
nu
mbe
r of s
choo
l day
s m
isse
d si
nce
the
prev
ious
tele
phon
e ca
ll.
Par
ents
of 9
8 ch
ildre
n w
ith a
sthm
a w
ho p
rese
nted
to a
n
Sch
ools
wer
e us
ed a
s si
tes
to p
rovi
de a
nd d
eliv
er c
hild
’s
Sch
ool a
bsen
teei
sm w
as lo
wer
(mea
n of
9.5
day
s m
isse
d pe
r ye
ar) a
mon
g th
ose
rece
ivin
g car
e in
a c
ompr
ehen
sive
as
thm
a ce
nter
than
am
ong
thos
e re
ceiv
ing e
mer
genc
y de
partm
ent c
are
(mea
n of
16.
6 da
ys).
No di
ffere
nces
wer
e se
en b
etw
een t
he e
duca
tion
and
cont
rol
grou
ps in
mea
n sc
hool
abs
ence
s, d
espi
te in
crea
sed
asth
ma
know
ledg
e, im
prov
ed sk
ills
for p
eak
flow
met
er a
nd
med
icat
ion u
se, a
nd a
redu
ctio
n in
sev
erity
of a
sthm
a sy
mpt
oms.
asth
ma
was
sig
nific
antly
less
in th
e sp
acer
gro
up th
an in
th
e co
ntro
l gro
up a
t 2 m
onth
s (0
vs
2 da
ys) a
nd 4
mon
ths
(0 v
s 2
days
) afte
r beg
inni
ng th
e tre
atm
ent.
The
re w
as n
o di
ffere
nce
at 1
wee
k an
d 6
mon
ths
mea
sure
men
ts.
The
med
ian
num
ber o
f sch
ool d
ays
mis
sed
beca
use
of
Of t
hose
with
ast
hma,
18%
had
repo
rted
mis
sing
scho
ol in
th
e pr
evio
us 4
wee
ks. A
fter t
he e
duca
tiona
l pro
gram
, day
s m
isse
d in
the
prev
ious
4 w
eeks
dec
reas
ed fr
om 1
.2 d
ays
to
0.7
days
. Thi
s w
as n
ot s
igni
fican
tly di
ffere
nt.
days
bec
ause
of a
sthm
a du
ring
the
prev
ious
yea
r de
crea
sed
sign
ifica
ntly
from
36%
to 2
3%.
The
per
cent
age o
f chi
ldre
n w
ho m
isse
d 1
or m
ore
scho
ol
Com
pare
d to
con
trols
, par
ents
of c
hild
ren
rece
ivin
g the
ir co
rti-
cost
eroi
d m
edic
atio
n at s
choo
l had
gre
ater
impr
ovem
ent i
n qu
ality
-of-l
ife m
easu
rem
ents
, mis
sed
less
sch
ool (
7 vs
9
days
; P =
.43)
, and
had
mor
e sy
mpt
om-fr
ee d
ays
in w
inte
r. Fo
r tho
se n
ot e
xpos
ed to
toba
cco
smok
e, a
dditi
onal
ben
e-
fits
of s
choo
l-bas
ed tre
atm
ent w
ere
few
er d
ays
requ
iring
re
scue
med
icat
ion
and
few
er a
cute
vis
its fo
r ast
hma.
ER, E
mer
genc
y ro
om; I
PA
, Ind
epen
dent
pra
ctic
e as
soci
atio
n.
W 0
cu Ta
ble
3
Pub
lishe
d R
esea
rch
Art
icle
s Th
at A
ddre
ss In
terv
entio
ns A
mon
g S
choo
l-Age
d C
hild
ren
With
A
sthm
a an
d R
ates
of S
choo
l Abs
ente
eism
(C
ontin
ued
from
pre
viou
s p
age)
Cita
tion
(Ori
gin
of P
rimar
y A
utho
r)
Res
earc
h D
esig
n M
ajor
Fin
ding
s R
elat
ed to
Abs
ente
eism
Hill
R, W
illiam
s J,
Brit
ton J
, Tat
ters
field
A. C
an m
orbi
dity
as
soci
ated
with
unt
reat
ed a
sthm
a in
prim
ary
scho
ol
child
ren
be re
duce
d?: a
con
trolle
d in
terv
entio
n st
udy.
BM
J. 19
91;3
03:1
168-
1173
. (U
K)
Hua
ng S
W, V
eiga
R, S
ila U
, Ree
d E
, Hin
es S
. The
effe
ct o
f sw
imm
ing
in a
sthm
atic
chi
ldre
n-pa
rtic
ipat
ing
in a
sw
imm
ing
prog
ram
in th
e ci
ty o
f Bal
timor
e. J
ksth
ma.
19
89;2
6(2)
:117
-121
. ..
(US
A)
Hui
SH
, Leu
ng T
F,
G, W
ong
E, L
i AM
, Fok
TF.
Eva
luat
ion
of a
sthm
a m
anag
emen
t pro
gram
for C
hine
se c
hild
ren
with
mild
-to-m
oder
ate
asth
ma
in H
ong
Kong
. Ped
iatr
Pu
lmon
ol. 2
002;
33:2
2-29
. (C
hina
; Hon
g K
ong)
Kel
ly C
S, S
hiel
d SW
, Gow
en M
A, J
agan
jac N,
Ande
rsen
CL,
S
trope
GL.
Out
com
es a
naly
sis
of a
sum
mer
ast
hma
cam
p. J
Ast
hma.
199
8;35
(2):1
65-1
71.
(US
A)
A s
cree
ning
que
stio
nnai
re a
bout
whe
ezin
g an
d sc
hool
ab
senc
e w
as s
ent t
o pa
rent
s of
ove
r 17,
000
stud
ents
(age
s 5-
1 0 y
ears
) in
102
elem
enta
ry s
choo
ls. C
hild
ren
who
wer
e no
t on
any
cont
rolle
r ast
hma
med
icat
ion
and
had
been
ab
sent
from
sch
ool i
n th
e pa
st y
ear b
ecau
se o
f whe
ezin
g an
d ch
ildre
n w
ith a
sthm
a w
ho w
ere
abse
nt lo
nger
than
10
days
in th
e pr
evio
us y
ear b
ecau
se o
f sym
ptom
s (re
gard
- le
ss o
f tre
atm
ent)
wer
e id
entif
ied.
Sch
ools
wer
e ra
ndom
ly
assi
gned
eith
er to
a c
ontro
l or t
o re
ceiv
e an
inte
rven
tion
(requ
iring
that
par
ents
of t
heir
stud
ents
rece
ive
a le
tter
reco
mm
endi
ng th
at th
eir c
hild
be
seen
by
a do
ctor
an
d th
at s
choo
l nur
ses
be u
pdat
ed o
n as
thm
a).
Par
ents
wer
e as
ked
to e
stim
ate
days
abs
ent f
rom
sc
hool
for a
sthm
a, a
nd d
ays
abse
nt (f
or a
ll re
ason
s)
wer
e ta
ken
from
cla
ss re
gist
ers.
Tw
enty
chi
ldre
n (a
ges
6-1 2
) with
ast
hma
wer
e en
rolle
d in
an
afte
r-sch
ool,
2-m
onth
-long
sw
imm
ing
prog
ram
(1
-hou
r ses
sion
s, 3
tim
es w
eekl
y). A
t enr
ollm
ent,
a pr
evio
us 1
2 m
onth
-his
tory
was
take
n. A
fter e
nrol
lmen
t, hi
stor
y of s
ympt
oms
(sch
ool a
bsen
teei
sm d
ata,
em
erge
ncy
room
vis
its, h
ospi
taliz
atio
n, h
isto
ry o
f sy
mpt
oms)
was
follo
wed
. Stu
dent
s al
so re
ceiv
ed a
ph
ysic
al e
xam
inat
ion
and
peak
flow
mea
sure
men
t at
enro
llmen
t. A
noth
er 2
0 ag
e-m
atch
ed c
hild
ren
with
as
thm
a w
ere
rand
omly
sele
cted
. The
y di
d no
t par
ticip
ate
in th
e sw
imm
ing
prog
ram
(con
trols
). 10
6 ch
ildre
n (a
ges
3-9)
with
ast
hma
and
thei
r par
ents
, re
crui
ted
thro
ugh
thei
r out
patie
nt c
linic
s, w
ere
enro
lled
in
an a
sthm
a m
anag
emen
t pro
gram
(edu
catio
n on
ast
hma
exac
erba
tions
, use
of i
nhal
er d
evic
es, p
lace
men
t on
appr
opria
te c
ontro
ller m
edic
atio
ns w
ith fo
llow
-up)
. Inf
orm
a-
tion
on s
ympt
oms
and
qual
ity of
life
was
giv
en b
y pa
rent
s be
fore
the
prog
ram
and
aga
in a
t 6 m
onth
s an
d 12
mon
ths
afte
r the
pro
gram
. 40
chi
ldre
n (a
ges
8-1 3
) with
mod
erat
e or
sev
ere
asth
ma
wer
e en
rolle
d in
an
asth
ma
cam
p fo
r 1
wee
k.
Cur
ricul
um in
clud
ed d
iscu
ssio
n of
ast
hma
trigg
ers,
ea
rly w
amin
g si
gns,
med
icat
ion u
se a
nd te
chni
ques
, an
d pe
rson
al a
ctio
n pl
ans.
Par
ents
repo
rted
scho
ol d
ays
mis
sed
due
to a
sthm
a in
the
year
be
fore
and
yea
r afte
r atte
ndin
g th
e ca
mp.
Ther
e w
ere
228
stud
ents
with
ast
hma
in th
e in
terv
entio
n sc
hool
s an
d 22
3 in
con
trol s
choo
ls. 6
7% o
f stu
dent
s in
in
terv
entio
n sc
hool
s co
mpl
ied
with
a re
com
men
ded v
isit
to th
eir d
octo
r, an
d 38
% o
f the
se re
ceiv
ed im
prov
ed
med
icat
ion.
The
per
cent
age
of s
tude
nts
inde
pend
ently
go
ing
to th
eir d
octo
r in
the
cont
rol g
roup
and
rece
ivin
g im
prov
ed m
edic
atio
ns w
as n
ot re
porte
d. In
bot
h co
ntro
l an
d in
terv
entio
n sc
hool
s, a
bsen
teei
sm ra
tes f
ell
sign
ifica
ntly
from
one
yea
r to
the
next
, but
the
diffe
renc
e be
twee
n co
ntro
l and
inte
rven
tion
was
insi
gnifi
cant
. Int
er-
vent
ion
scho
ols
wer
e si
gnifi
cant
ly m
ore
likel
y to
have
stu
- de
nts
keep
thei
r ow
n in
hale
rs, h
ave
stud
ents
use
inha
lers
pr
ior t
o ph
ysic
al a
ctiv
ity, a
nd h
ave
cent
ral li
sts o
f stu
dent
s w
ith a
sthm
a.
Dur
ing
the
12 m
onth
s pr
ior t
o th
e sw
imm
ing
prog
ram
, par
ents
re
porte
d a
mea
n of
7 a
bsen
t sch
ool d
ays
per p
atie
nt.
Dur
ing
the
12 m
onth
s af
ter t
he s
wim
min
g pr
ogra
m, p
aren
ts
repo
rted
1.3
abse
nt s
choo
l day
s. T
his
81 %
dec
reas
e in
nu
mbe
rs o
f abs
ent s
choo
l day
s w
as s
igni
fican
tly b
ette
r th
an th
e de
crea
se o
f 13%
amon
g co
ntro
l gro
up a
sthm
atic
st
uden
ts. S
imila
r im
prov
emen
ts o
ccur
red
in s
ympt
oms,
ho
spita
lizat
ions
, and
em
erge
ncy
room
visi
ts.
h.3a
n nu
mbe
r of s
choo
l day
s ab
sent
per
yea
r red
uced
from
2
days
per
yea
r at b
asel
ine
to 0
day
s pe
r yea
r 12
mon
ths
late
r. (A
rticl
e was
not
exp
licit
as to
whe
ther
abs
ent d
ays
wer
e sp
ecifi
cally
for a
sthm
a.)
Tota
l num
ber o
f day
s m
isse
d by
33
of 3
5 ca
mpe
rs in
the
year
pr
ior t
o th
e ca
mp
was
266
. In
the
year
afte
r the
cam
p, o
nly
181
days
of s
choo
l wer
e m
isse
d by
thes
e sa
me
child
ren.
ER, E
mer
genc
y ro
om; I
PA
, Ind
epen
dent
pra
ctic
e as
soci
atio
n.
Tabl
e 3
Pu
blis
hed
Res
earc
h A
rtic
les
Th
at A
dd
ress
Inte
rven
tion
s A
mon
g S
cho
ol-A
ged
Ch
ildre
n W
ith
Ast
hma
and
Rat
es o
f Sch
oo
l Ab
sen
teei
sm (
Con
tinue
d fr
om p
revi
ous
pag
e)
Maj
or F
indi
ngs
Rel
ated
to A
bsen
teei
sm
Cita
tion
(Ori
gin
of P
rimar
y A
utho
r)
Res
earc
h D
esig
n
Lurie
N, B
auer
EJ,
Bra
dy C
. Ast
hma
outc
omes
at a
n in
ner-
city
scho
ol-b
ased
hea
lth ce
nter
. J S
ch H
ealth
. 20
01 ;7
1(1)
:9-1
6.
(US
A)
McE
wen
M. J
ohns
on P
, Nea
ther
lin J,
Mill
ard
MW
, Law
renc
e G
. Sch
ool-b
ased
man
agem
ent o
f chr
onic
ast
hma
amon
g in
ner-
city
Afri
can-
Am
eric
an s
choo
lchi
ldre
n in
D
alla
s, T
exas
. J S
ch H
ealth
. 199
8;68
(5):1
96-2
01.
McG
han
SL,
Won
g E,
Wel
ls H
M, e
t al.
Eva
luat
ion
of a
n
(US
A)
educ
atio
n pr
ogra
m fo
r ele
men
tary
sch
ool c
hild
ren
with
as
thm
a. J
Ast
hma.
200
3;40
(5):5
23-5
33.
(Can
ada)
Men
g A
, Tie
rnan
K, B
erni
er M
J, B
rook
s E
G. L
esso
ns fr
om a
n ev
alua
tion
of th
e ef
fect
iven
ess
of a
n as
thm
a da
y ca
mp.
M
CN
Am
J M
atem
Chi
ld N
urs.
199
8;23
(6):3
00-3
06.
(US
A)
Mill
ard
MW
, Joh
nson
PT,
McE
wen
M, e
t al.
A ra
ndom
ized
co
ntro
lled t
rial u
sing
the
scho
ol fo
r ant
i-inf
lam
mat
ory
ther
apy
in a
sthm
a. J
Ast
hma.
200
3;40
(7):7
69-7
76.
(US
A)
Oru
war
iye
T, W
ebbe
r MP
, Ozu
ah P
.Do
scho
ol b
ased
hea
lth
cent
ers p
rovi
de a
dequ
ate
asth
ma
care
? J S
ch H
ealth
. 20
03;7
3(5)
:186
-190
. (U
SA
)
A s
choo
l-wid
e scr
eeni
ng p
roce
ss a
t a s
choo
l with
a s
choo
l- ba
sed
heal
th ce
nter
iden
tifie
d 34
stu
dent
s with
sev
ere,
24
with
mod
erat
e, a
nd 9
8 w
ith m
ild a
sthm
a. 3
2 se
vere
and
21
mod
erat
e as
thm
atic
s res
pond
ed to
an
invi
tatio
n to
hav
e at
le
ast a
n in
itial
vis
it to
the
heal
th ce
nter
, whe
re th
ey re
ceiv
ed
a hi
stor
y, p
hysi
cal e
xam
inat
ion,
pul
mon
ary
func
tion
test
s,
educ
atio
n ab
out a
sthm
a, in
clud
ing
envi
ronm
enta
l con
trol
and
med
icat
ions
. Stu
dent
s w
ere
give
n a
writ
ten
sym
ptom
co
ntro
l pla
n an
d re
ferr
al to
a re
gula
r com
mun
ity-b
ased
pr
ovid
er w
here
thes
e w
ere
lack
ing.
22
stu
dent
s (a
ges
5-12
) with
con
firm
ed d
iagn
oses
of a
sthm
a w
ere
give
n ap
prop
riate
pres
crip
tions
of m
edic
atio
ns, 2
pe
ak fl
ow m
eter
s (fo
r sch
ool a
nd h
ome)
, and
2 s
pace
r de
vice
s. T
hey
wer
e br
ough
t to
the
scho
ol cl
inic
2 ti
mes
per
da
y fo
r med
icat
ion a
dmin
istra
tion a
nd p
eak
flow
rat
e m
easu
rem
ent.
162
child
ren
aged
7-1
2 ye
ars;
sch
ools
rand
omly
ass
igne
d as
in
terv
entio
n (as
thm
a edu
catio
n) o
r con
trol (
regu
lar m
edic
al
care
); m
isse
d sc
hool
day
s ov
er a
per
iod
of t
he p
revi
ous
1 ye
ar w
as m
easu
red b
y pa
rent
sur
vey.
34 c
ampe
rs w
ith m
oder
ate
or s
ever
e as
thm
a w
ho a
ttend
ed
a da
y ca
mp
with
a 6
-ses
sion
inte
ract
ive a
sthm
a-ed
ucat
ion
curr
icul
um. P
aren
ts co
mpl
eted
a q
uest
ionn
aire
prio
r to
cam
p an
d w
ere
ques
tione
d on
the
tele
phon
e ab
out
mis
sed
scho
ol d
ays;
chi
ldre
n w
ere
vide
otap
ed fo
r pea
k flo
w te
chni
que
and
com
plet
ed p
re- a
nd p
ostc
amp
ques
tionn
aire
s.
8 el
emen
tary
sch
ools
wer
e ra
ndom
ly d
ivid
ed in
to 4
trea
tmen
ts
(2 s
choo
ls e
ach)
. Stu
dent
s (to
tal 5
2) w
ith p
ersi
sten
t ast
hma
rece
ived
eith
er (1
) sch
ool-b
ased
del
iver
y of i
nhal
ed
ster
oids
; (2)
hom
e-ba
sed
deliv
ery o
f inh
aled
ster
oids
; (3
) sam
e as
(2) p
lus
scho
ol-b
ased
ast
hma
educ
atio
n; o
r (4
) con
trol g
roup
-no
chan
ge in
med
icat
ion.
Chi
ldre
n w
ho v
isite
d 1
of 4
sch
ool-b
ased
hea
lth c
ente
rs a
t le
ast o
nce
for a
sthm
a w
ere
incl
uded
in th
is s
tudy
. 41 5
ch
arts
wer
e re
view
ed a
nd s
urve
ys w
ere
sent
hom
e to
pa
rent
s. S
tudy
focu
sed
on h
ealth
pro
vide
r adh
eren
ce to
as
thm
a gu
idel
ines
, but
abs
ente
eism
dat
a w
ere
also
co
llect
ed fro
m e
ach
of th
e 4
scho
ols.
ER
, Em
erge
ncy r
oom
; IP
A, I
ndep
ende
nt p
ract
ice
asso
ciat
ion.
No
chan
ge o
ccur
red
in s
choo
l abs
ente
eism
afte
r ini
tiatin
g th
e in
terv
entio
n. U
se o
f pea
k flo
w m
eter
, use
of m
edic
al
spec
ialis
ts, a
nd u
se o
f inh
aler
s all
did
impr
ove.
Ove
r the
cou
rse
of 1
3 w
eeks
, mea
n pe
ak fl
ow m
easu
rem
ents
in
crea
sed a
nd b
ronc
hodi
lato
r (re
scue
med
icat
ion)
use
de
crea
sed b
y 66
%. N
o ef
fect
on
stud
ent a
bsen
teei
sm fr
om
scho
ol fo
r ast
hma
coul
d be
det
erm
ined
for t
his
stud
y.
88%
of c
hild
ren
('ast
hma
educ
atio
n" g
roup
) and
79%
of c
hild
ren
('reg
ular
med
ical
car
e' g
roup
) rep
orte
d m
issi
ng a
t lea
st 1
sc
hool
day
prio
r to
stud
y. A
fter t
he s
tudy
, the
re w
as a
si
gnifi
cant
redu
ctio
n of
mis
sing
at le
ast 1
scho
ol d
ay to
38%
an
d 46%, re
spec
tivel
y. Im
prov
emen
t in a
ttend
ance
bet
wee
n gr
oups
was
sta
tistic
ally
sim
ilar.
asth
ma
was
4.1
day
s. P
ostc
amp
frequ
ency
of s
choo
l day
s m
isse
d be
caus
e of
ast
hma
was
3.4
day
s.
Pre
cam
p fre
quen
cy o
f sch
ool d
ays
mis
sed
beca
use
of
Afte
r 5 w
eeks
of t
hese
4 tr
eatm
ents
at 8
sch
ools
, sch
ool
atte
ndan
ce ra
tes
bega
n to
diff
er, b
ased
on
type
of
treat
men
t. S
choo
l-bas
ed at
tend
ance
was
91 %
in s
choo
ls
with
sch
ool-d
eliv
ered
inha
led
ster
oids
, 85%
at s
choo
ls
with
hom
e-de
liver
ed in
hale
d st
eroi
ds, a
nd 77Yo i
n co
ntro
l sch
ools
. Ste
roid
s wer
e si
gnifi
cant
ly be
tter t
han
no
ster
oids
, and
sch
ool-b
ased
del
iver
y was
sig
nific
antly
be
tter t
han
hom
e de
liver
y-fo
r im
prov
ing s
choo
l at
tend
ance
. A
bsen
teei
sm d
ata
wer
e av
aila
ble
for 2
67 c
hild
ren
with
as
thm
a. M
ean
num
ber o
f sch
ool d
ays
mis
sed
was
17.
6. N
o as
soci
atio
ns e
xist
ed b
etw
een
atte
ndan
ce a
nd h
ow w
ell
heal
th c
are
prov
ider
s ad
here
d to
ast
hma
guid
elin
es.
Stu
dent
s un
der a
ge 8
had
mor
e sc
hool
abs
ence
s (2
0 da
ys)
com
pare
d to
thos
e ov
er a
ge 8
(16
days
).
Y 0 Ta
ble 3
Pu
blis
hed
Res
earc
h A
rtic
les
Th
at A
ddre
ss In
terv
entio
ns A
mon
g S
cho
ol-A
ged
Ch
ildre
n W
ith
Ast
hma
and
Rat
es o
f Sch
oo
l Abs
ente
eism
(C
ontin
ued
from
pre
vio
us
pag
e)
Cita
tion
(Ori
gin
of P
rimar
y A
utho
r)
Res
earc
h D
esig
n M
ajor
Fin
ding
s R
elat
ed to
Abs
ente
eism
Per
era
BJC
. Effi
cacy
and
cost
effe
ctiv
enes
s of
inha
led
ster
oids
in a
sthm
a in
a d
evel
opin
g co
untry
. A
rch
Dis
Chi
ld. 1
995;
72(4
):312
-315
. (S
ri La
nka)
Per
saud
DI,
Bar
nett
SE, W
elle
r SC
, Bal
dwin
CD
, Nie
buhr
V,
McC
orm
ick
DP.
An
asth
ma
self-
man
agem
ent p
rogr
am fo
r ch
ildre
n, in
clud
ing
inst
ruct
ion
in p
eak
flow
mon
itorin
g by
sc
hool
nur
ses.
JA
sthm
a. 1
996;
33(1
):37-
43.
(US
A)
Sal
isbu
ry C
, Fra
ncis
C, R
oger
s C
, et a
l. A
rand
omiz
ed
cont
rolle
d tri
al o
f clin
ics
in s
econ
dary
sch
ools
for
adol
esce
nts w
ith a
sthm
a. 6
r J G
en P
ract
(UK
) S
hiffm
an R
N, F
reud
igm
an KA
, Bra
ndt C
A, L
iaw
Y, N
aved
o D
D. A
gui
delin
e im
plem
enta
tion s
yste
m u
sing
han
dhel
d co
mpu
ters
for o
ffice
man
agem
ent o
f ast
hma:
effe
cts
on
adhe
renc
e an
d pa
tient
out
com
es. P
edia
tric
s.
2002
;52(
485)
:988
-996
.
2000
; 105
:767
-773
. (U
SA
)
Spe
ncer
GA.
Ata
v S,
John
ston
Y,
Har
rigan
JF. M
anag
ing
child
hood
ast
hma:
the
effe
ctiv
enes
s of t
he O
pen
Airw
ays
for S
choo
ls p
rogr
am. F
am C
omm
unity
Hea
lth.
2000
;23(
2):2
0-30
. (U
SA
)
Ste
rgac
his A
, Gar
dner
JS,
And
erso
n M
T, S
ulliv
an S
D.
Impr
ovin
g pe
diat
ric a
sthm
a ou
tcom
es in
the
com
mun
ity
setti
ng: d
oes
phar
mac
eutic
al ca
re m
ake
a di
ffere
nce?
JA
m P
harm
Ass
oc. 2
002;
42(5
):743
-752
. (U
SA)
86 c
hild
ren
with
mod
erat
e to
sev
ere
asth
ma
wer
e re
crui
ted
thro
ugh
a pr
ivat
e ho
spita
l; th
ey h
ad lo
st a
t lea
st 2
sch
ool
days
per
mon
th d
ue to
ast
hma
and
wer
e fo
llow
ed o
ver 4
ye
ars
with
intro
duct
ion
of in
hale
d st
eroi
ds (a
ges
3-7
year
s at
ons
et).
36 c
hild
ren
with
ast
hma
wer
e id
entif
ied w
ith e
mer
genc
y ro
om
and
hosp
ital r
ecor
ds (m
ean
age
10 ye
ars)
. 18
rece
ived
8
wee
kly,
indi
vidu
al 2
0-m
inut
e te
achi
ng s
essi
ons
on a
sthm
a,
and
18 re
ceiv
ed n
o sp
ecia
lized
teac
hing
on
asth
ma.
A
bsen
teei
sm fr
om s
choo
l was
elic
ited t
hrou
gh a
par
ent
ques
tionn
aire
. S
ix s
choo
ls in
Eng
land
that
wer
e re
pres
enta
tive
of th
e po
pula
tion’
s so
cioe
cono
mic
stat
us a
nd e
duca
tiona
l ac
hiev
emen
t wer
e re
crui
ted.
Stu
dent
s w
ere
rand
omiz
ed to
se
e a
nurs
e at
a s
choo
l clin
ic o
r to
go to
gen
eral
pra
ctic
e.
Nin
e ph
ysic
ians
col
lect
ed d
ata
from
a to
tal o
f 91
patie
nts
with
as
thm
a en
coun
tere
d in
thei
r pra
ctic
es. D
urin
g th
e co
ntro
l ph
ase,
dat
a w
ere
colle
cted
. Dur
ing
the
inte
rven
tion
phas
e,
pedi
atric
ians
use
d a
hand
held
com
pute
r dev
ice
to s
truct
ure
thei
r int
erac
tion
with
thei
r pat
ient
rega
rdin
g as
thm
a.
Pat
ient
s wer
e co
ntac
ted
7-14
day
s af
ter e
ncou
nter
ing
thei
r pe
diat
ricia
n to
ass
ess
outc
omes
. 36
9 st
uden
ts (i
n 40
sch
ools
; age
s 6-
1 3) r
ecei
ved
the
Ope
n A
irway
s fo
r Sch
ools
edu
catio
n pr
ogra
m fo
r ast
hma
man
agem
ent (
6 w
eekl
y 40
-min
ute
sess
ions
). P
art o
f ev
alua
tion
was
a p
aren
t que
stio
nnai
re o
n m
isse
d sc
hool
da
ys in
the
prev
ious
mon
ths
and
a sc
hool
nur
se
ques
tionn
aire
on
mis
sed
scho
ol d
ays.
Que
stio
n-
naire
s w
ere
com
plet
ed a
t tim
e of
reg
istra
tion
and
6 m
onth
s la
ter.
330
child
ren
with
ast
hma
(age
s 6-
17) w
ere
iden
tifie
d fro
m 3
2 ph
arm
acie
s. E
ligib
le c
hild
ren
had
a pr
escr
ibed
asth
ma
med
icat
ion
for a
t lea
st 3
mon
ths
and
had
refil
led
thei
r m
edic
atio
n no
less
than
onc
e ev
ery
6 w
eeks
, and
cou
ld
use
a pe
ak flo
w m
eter
. Pha
rmac
ists
from
14
phar
mac
ies
wer
e tra
ined
to w
ork
with
pat
ient
s on
asth
ma
drug
-rela
ted
prob
lem
s. 1
8 ph
arm
acie
s wer
e co
ntro
l (us
ual c
are)
. P
harm
acis
ts’ in
terv
entio
n oc
curre
d fo
r a p
erio
d of
1
year
.
Bef
ore
treat
men
t with
inha
led
ster
oids
, 81
patie
nts
had
lost
sc
hool
day
s. A
fter t
reat
men
t, 4
patie
nts
had
lost
sch
ool
days
due
to a
sthm
a.
Res
ults
of g
roup
com
paris
ons s
how
ed n
o si
gnifi
cant
di
ffere
nces
in th
e nu
mbe
r of p
ostin
terv
entio
n da
ys a
bsen
t fro
m s
choo
l.
Mor
e st
uden
ts in
the
scho
ol c
linic
gro
up th
an th
ose
in th
e tra
ditio
nal p
ract
ice
grou
p ha
d th
eir a
sthm
a re
view
ed
clin
ical
ly. A
lthou
gh k
now
ledg
e of
ast
hma
was
gre
ater
in th
e sc
hool
clin
ic g
roup
, the
re w
as n
o di
ffere
nce
in s
choo
l ab
sent
eeis
m.
Enc
ount
ers w
ith p
edia
trici
ans t
hat w
ere
stru
ctur
ed w
ith
a ha
ndhe
ld co
mpu
ter d
id n
ot c
hang
e th
e ou
tcom
e of
m
isse
d sc
hool
day
s. D
urin
g th
e co
ntro
l pha
se, 44% o
f st
uden
ts m
isse
d an
ave
rage
of 1
.29
days
and
afte
r in
terv
entio
n, 4
8% o
f stu
dent
s m
isse
d an
ave
rage
of 1
.04
days
(not
sig
nific
antly
diff
eren
t).
53%
of p
aren
ts re
spon
ded t
hat t
heir
child
with
ast
hma
mis
sed
scho
ol b
ecau
se o
f ast
hma,
with
no
chan
ge fr
om b
asel
ine
to
6 m
onth
s af
ter h
ealth
edu
catio
n pr
ogra
m. S
choo
l nur
ses
who
repo
rted
a m
ean
of 5
.5 d
ays
of s
choo
l mis
sed
at
base
line a
lso re
porte
d a
sign
ifica
nt re
duct
ion
afte
r the
in
terv
entio
n (6
mon
ths
late
r) to
3.7
day
s.
Que
stio
nnai
res
(par
ents
for c
hild
ren
youn
ger t
han
12)
incl
uded
sch
ool d
ays
lost
due
to a
sthm
a. T
he m
ean
num
- be
r of l
ost d
ays
was
1.1
for t
he in
terv
entio
n gr
oup
and
1.7
days
for t
he c
ontro
l gro
up. S
tatis
tical
ly, th
is w
as n
ot
sign
ifica
ntly
diff
eren
t.
ER, E
mer
genc
y ro
om; I
PA
, Ind
epen
dent
pra
ctic
e as
soci
atio
n.
Tabl
e 3
Pub
lishe
d R
esea
rch
Art
icle
s Th
at A
ddre
ss In
terv
entio
ns A
mon
g S
choo
l-Age
d C
hild
ren
With
A
sthm
a an
d R
ates
of S
choo
l Abs
ente
eism
(C
ontin
ued
from
pre
vio
us
pag
e)
Cita
tion
(Ori
gin
of P
rimar
y A
utho
r)
Res
earc
h D
esig
n M
ajor
Fin
din
gs
Rel
ated
to A
bsen
teei
sm
Tara
s H,
Wrig
ht S
, Bre
nnan
J, C
ampa
na J,
Lof
gren
R. I
mpa
ct
of s
choo
l nur
se c
ase
man
agem
ent o
n st
uden
ts w
ith
asth
ma.
J S
ch H
ealth
. 200
4;74
(6):
21 5-
221.
(U
SA
)
Web
ber M
P, C
arpi
niel
lo K
E, O
ruw
ariy
e T, L
o Y,
Bur
ton W
B,
App
el D
K. B
urde
n of
ast
hma
in in
ner-
city
elem
enta
ry
scho
olch
ildre
n: d
o sc
hool
-bas
ed h
ealth
cent
ers
mak
e a
dif-
fere
nce?
Arc
h P
edia
tr A
dole
sc M
ed. 2
003;
157(
2):1
25-1
30.
(US
A)
Zorc
JJ,
Sca
rfone
RJ,
Li Y
, et a
l. S
ched
uled
follo
w-u
p af
ter
a pe
diat
ric e
mer
genc
y de
partm
ent v
isit
for a
sthm
a: a
ran-
do
miz
ed tr
ial.
Ped
iatr
ics.
200
33 1
1 (3)
:495
-502
. (U
SA
)
Inas
choo
ldis
tric
twith
143,
000s
tude
nts (
K-1
2) a
ndfo
rper
iodo
f 3
year
s, s
choo
l nur
ses
reco
rded
thei
r ast
hma-
rela
ted
invo
lve-
m
ent w
ith s
tude
nts
who
had
phy
sici
an-d
iagn
osed
asth
ma.
In
volv
emen
t may
hav
e in
clud
ed a
hom
e vi
sit,
cont
act w
ith
pare
nt, e
duca
tion
of s
tude
nt, c
onta
ct w
ith d
octo
r, or
no
invo
lvem
ent.
Nur
ses
also
reco
rded
whe
ther
stu
dent
had
m
edic
atio
n an
d pe
ak flo
w m
eter
s at
sch
ool.
Abs
ente
eism
ra
tes
for s
tude
nts
with
and
with
out a
sthm
a (b
ased
on
days
mis
sed
for a
ny il
lnes
s) w
ere
mea
sure
d an
nual
ly
usin
g sc
hool
reco
rds.
P
aren
ts of
stu
dent
s (g
rade
s K
-5) i
n 6
scho
ols w
ere
inte
r-
view
ed. F
our o
f the
sch
ools
had
sch
ool-b
ased
heal
th
cent
ers.
Ast
hma
was
det
erm
ined
thro
ugh
sym
ptom
que
s-
tionn
aire
s. 4
775
fam
ilies
retu
rned
ques
tionn
aire
s. A
bsen
- te
eism
dat
a fro
m s
choo
l rec
ords
wer
e av
aila
ble
for o
ver
60%
of s
tude
nts.
To d
eter
min
e if
ther
e w
as p
atie
nt co
mpl
ianc
e w
ith e
mer
genc
y de
partm
ent i
nstru
ctio
ns to
follo
w u
p w
ith a
prim
aly
care
pr
ovid
er a
nd if
this
affe
cted
ast
hma
outc
omes
, par
ents
of 27
8 ch
ildre
n (a
ges
2-18
) wer
e in
stru
cted
to fo
llow
up
with
th
eir d
octo
rs. I
n th
e co
ntro
l gro
up th
at is
all t
hat o
ccur
red.
In
the
inte
rven
tion g
roup
, ER
sta
ff as
sist
ed w
ith m
akin
g th
e ap
poin
tmen
ts d
urin
g th
e E
R v
isit.
Tel
epho
ne in
terv
iew
of
pare
nts o
ccur
red
1 m
onth
late
r.
Bet
wee
n 5% a
nd 6
% o
f all
stud
ents
had
phy
sici
an-d
iagn
osed
as
thm
a. S
tude
nts
with
ast
hma
wer
e ab
sent
be
twee
n %
and
1 %
day
s pe
r yea
r mor
e of
ten
than
thos
e w
ithou
t ast
hma.
Sch
ool n
urse
case
man
agem
ent
had
no s
igni
fican
t effe
ct o
n ra
tes
of s
tude
nt a
bsen
teei
sm.
The
re w
as e
vide
nce
that
sch
ool n
urse
inte
rven
tions
im
prov
ed m
edic
al m
anag
emen
t.
20%
of s
tude
nts h
ad as
thm
a, a
ccor
ding
to th
e qu
estio
nnai
re (1
9%
at s
choo
ls w
ith a
hea
lth ce
nter
, 22%
at s
choo
ls w
ithou
t). S
tu-
dent
s in
sch
ools
with
out a
hea
lth ce
nter
mis
sed
16.4
day
s pe
r ye
ar, a
s co
mpa
red t
o 14
.5 d
ays p
er ye
ar fo
r stu
dent
s in
scho
ols
with
a h
ealth
cent
er. A
mon
g st
uden
ts w
ith a
sthm
a, th
ose
atte
ndin
g sc
hool
s with
out h
ealth
cent
ers m
isse
d 21.
3 da
ys
vers
us 1
8.2d
aysf
orth
ose a
ttend
ing s
choo
ls w
ith h
ealth
cent
ers.
A
lthou
gh in
terv
entio
n in
the
emer
genc
y de
partm
ent i
ncre
ased
fo
llow
-up
visi
ts w
ith p
rimar
y car
e pr
ovid
ers,
no
chan
ge in
m
isse
d sc
hool
day
s be
twee
n co
ntro
l and
inte
rven
tion
grou
ps e
nsue
d. T
wo
days
of s
choo
l dur
ing
mon
th a
fter E
R
visi
t wer
e m
isse
d, o
n av
erag
e.
ER, E
mer
genc
y ro
om; I
PA
, Ind
epen
dent
pra
ctic
e as
soci
atio
n.
primary care providers (Oruwariye et a1 2003; Shiffman et al 2000; Table3) have not yet been shown to improve atten- dance at school. One study that randomly assigned students with asthma to a swimming program showed astonishing improvement in school attendance (Huang et al 1989; Table3). Unfortunately, this was a small sample size (20 in each group) and further studies have not ensued. Further investigation is worthwhile, not only because of the marked benefit shown, but because it confirms an earlier finding that physical exercise improves school attendance’ of children with asthma and supports the theory that swimming is less likely to bring on asthma symptoms than other exercises.s
CONCLUSION The review of articles examining the impact of asthma
on school performance found no clear evidence that the presence of asthma affected academic achievement or ability. Two isolated exceptions were studies that found kindergarten students with asthma had poorer school read- iness scores and that asthma-related interruptions in sleep among children with asthma, rather than the severity of the condition, may affect school performance.
Research does show a correlation between asthma and high rates of student absenteeism.
Inconsistencies in definitions of asthma and collection of absenteeism rates and lack of control groups limit the validity of the magnitude of missed school days in this population. Although studies have looked at the impact of race, socioeco-
nomic factors, severity of the disease, access to health care, and adherence to prescribed medical regimens on school attendance rates, further studies on these and other issues are required. The impact of various interventions for school-aged children with asthma on school attendance is often studied with flaws in the experimental designs that throw question into the reliability of the findings.
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the status of teacher preparedness and training. J Sch Nurs. 2001;17(6):
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6. Gregory EK. Empowering students on medication for asthma to be active participants in their care: an exploratory study. J Sch Nurs. 2000;
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312 Journal of School Health October 2005, Vol. 75, No. 8