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Effects of a Comprehensive School-Based Asthma Program on Symptoms, Parent Management, Grades, and Absenteeism^*

^* From the University of Michigan School of Public Health (Dr. Clark, Ms, Anderson, Ms. Liu, and Ms. Valerio), Ann Arbor; University of Michigan Medical School (Dr. Brown), Ann Arbor; and Henry Ford Health System (Dr. Joseph), Detroit, MI.

Correspondence to: Noreen M. Clark, PhD, University of Michigan School of Public Health, 1420 Washington Heights, Ann Arbor, MI 48109-2029; e-mail: nmclark{at}umich.edu

Study objective: This study assessed the impact of a comprehensive school-based asthma program on symptoms, grades, and school absences in children, and parents’ asthma management practices.

Design: Randomized controlled trial.

Setting: Fourteen elementary schools in low-income neighborhoods in Detroit, MI.

Participants: Eight hundred thirty-five children with asthma in grades 2 through 5 and their parents.

Intervention: The intervention entailed six components for children, their parents, classmates, and school personnel to encourage and enable disease management.

Measurements and results: Parents completed telephone interviews and the schools provided data at baseline and 24 months after intervention. At follow-up, treatment children with persistent disease had significant declines in both daytime (14% fewer, p < 0.0001) and nighttime (14% fewer, p < 0.0001) symptoms. Among children with both mild intermittent and persistent disease, those in the treatment group had 17% fewer daytime symptoms (p < 0.0001) but 40% more nighttime symptoms. Treatment children had higher grades for science (p < 0.02) but not reading, mathematics, or physical education. No differences in school absences for all causes between groups were noted in school records. However, parents of treatment group children reported fewer absences attributable to asthma in the previous 3 months (34% fewer, p < 0.0001) and 12 months (8% fewer, p < 0.05). Parents of treatment children had higher scores (2.19 greater, p = 0.02) on an asthma management index. The program may have stimulated attention to symptoms at night by parents of children with mild intermittent disease. Overall, the intervention provided significant benefits, particularly for children with persistent asthma.

Key Words: asthma • childhood asthma • morbidity • randomized controlled trial • school-based education • school performance • urban children

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