Asthma: School-Based Self-Management Interventions for Children and Adolescents with Asthma
Summary of CPSTF Finding
When implemented in schools in low-income or minority communities, interventions are likely to promote health equity.
Intervention
- Recognize and manage asthma symptoms
- Use medications and inhalers properly
- Avoid asthma triggers
Interventions may also provide instruction on the following:
- Monitoring asthma signs and symptoms
- Stress management
- Implementing an asthma action plan
Interventions may be delivered to students with asthma in group or individual sessions. Trained facilitators may include nurses, teachers, health educators, or peers, and sessions may be provided at school during or outside of regular school hours. Self-management interventions may be combined with additional asthma control activities directed at school staff, parents, or healthcare providers.
CPSTF Finding and Rationale Statement
Promotional Materials
About The Systematic Review
Harris KM, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD011651. DOI:10.1002/14651858.CD011651.pub2
The review included 33 studies (search period through August 28, 2017). The team examined each of the studies included in the systematic review and abstracted supplemental information about study, intervention, and population characteristics.
The CPSTF finding is based on results from the published review, additional information from the included studies, and expert input from team members and the CPSTF.
Context
Summary of Results
The published systematic review included 33 randomized controlled trials. Three of these studies did not measure any of the review’s outcomes of interest and were not included in the CPSTF analysis.
- A meta-analysis of 19 studies reported the following effects of school-based self-management interventions:
- Reductions in asthma-related emergency department visits (13 studies)
- Reductions in asthma-related hospitalizations (6 studies)
- Reductions in unplanned visits to a medical provider (5 studies)
- Increases in self-reported asthma-related quality of life (7 studies)
- Mixed results for all causes of school absences (10 studies)
- Studies also measured intervention effects on asthma control outcomes. Compared with controls, students in self-management intervention groups reported the following:
- Less need for the use of asthma reliever medications (6 studies)
- Fewer activity limitations (6 studies)
- Little or no change in self-reported day-time or night-time symptoms (12 studies) or measures of lung function (6 studies)
Summary of Economic Evidence
There was not enough economic evidence to determine cost-effectiveness or cost-benefit for school-based asthma self-management interventions.
The economic review included 8 studies (search period 1995 through May 2020). Seven studies reported intervention cost, three included the averted cost of healthcare, and two reported return on investment or provided sufficient information for the economic review team to compute it. All monetary values are reported in 2019 U.S. dollars.
Intervention Cost
- The median cost per person was $44 (IQI: $40 to $131), based on eight estimates from seven studies.
- The variation in intervention cost is partly explained by differences in the size of intervention groups, with smaller intervention costs associated with larger groups.
Economic Benefit
- The changes in healthcare cost per person were -$208, $0, and $62, based on estimates from three studies.
Return on Investment
- The return on investment was -1 and -2.5, based on two studies that reported both intervention cost and change in healthcare cost. The negative values indicate intervention cost exceeded the healthcare cost averted.
Applicability
Evidence Gaps
- How effective are these interventions with high school students who have asthma?
- How does effectiveness vary between programs set in urban and rural schools? Future studies could inform and provide additional evidence on programs and program components in rural settings.
- Does teaching students how to use inhalers and following up with them to ensure proper use have an effect on asthma-related outcomes?
- Do additional school policies (e.g. child inhaler possession and use policies, requirements for asthma action plans) improve student self-management practices and overall asthma control?
- How does effectiveness vary by asthma severity?
Study Characteristics
- Included studies were conducted in the United States (19 studies), Canada (4 studies), Australia (2 studies), the United Kingdom (2 studies), China (1 study), Jordan (1 study), and Spain (1 study).
- The published systematic review included 33 randomized controlled trials that assigned groups by student (6 studies) or school (26 studies); one study did not report this information.
- Studies included students aged 5 to 10 years (20 studies), 11 to 15 years (14 studies), and 16 years and older (1 study). Most studies were conducted in elementary schools and/or middle schools (21 studies).
- Studies most often recruited students by using surveys or announcements (50%), or health records (27%).
Analytic Framework
Effectiveness Review
Analytic Framework – Effectiveness Review
When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.
Economic Review
Analytic Framework – Economic Review
Summary Evidence Table
Effectiveness Review
A summary evidence table for this Community Guide review is not available because the CPSTF finding is based on the following published systematic review:
Harris KM, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD011651. DOI: 10.1002/14651858.CD011651.pub2
Economic Review
Included Studies
Effectiveness Review
Al-sheyab N, Gallagher R, Crisp J, Shah S. Peer-led education for adolescents with asthma in Jordan: a cluster-randomized controlled trial. Pediatrics 2012;129(1):e106 12.
Atherly A, Nurmagambetov T, Williams S, Griffith M. An economic evaluation of the school-based “power breathing” asthma program. Journal of Asthma 2009;46(6):596 9.
Bartholomew KL, Sockrider M, Abramson SL, Swank PR, Czyzewski DI, Tortolero SR, et al. Partners in school asthma management: evaluation of a self-management program for children with asthma. Journal of School Health 2006;76(6):283 90.
Bruzzese JM, Unikel L, Gallagher R, Evans D, Colland V. Feasibility and impact of a school-based intervention for families of urban adolescents with asthma: results from a randomized pilot trial. Family Process 2008;47(1):95 113.
Bruzzese JM, Stepney C, Gallagher R, Wang J, Petkova E, Evans D. Reducing morbidity and urgent healthcare utilization in urban pre-adolescents with asthma: results of a randomized control trial of asthma: it’s a family affair. American Journal of Respiratory and Critical Care Medicine 2010;181:A2250.
Bruzzese JM, Sheares BJ, Vincent EJ, Du Y, Sadeghi H, Levison MJ, et al. Effects of a school-based intervention for urban adolescents with asthma. A controlled trial. American Journal of Respiratory and Critical Care Medicine 2011;183(8):998 1006.
Cicutto L, Murphy S, Coutts D, O’Rourke J, Lang G, Chapman C, et al. Breaking the access barrier: evaluating an asthma center’s efforts to provide education to children with asthma in schools. Chest 2005;128(4):1928 35.
Cicutto L, To T, Murphy S. A randomized controlled trial of a public health nurse-delivered asthma program to elementary schools. Journal of School Health 2013;83(12):876 84.
Clark NM, Brown R, Joseph CL, Anderson EW, Liu M, Valerio MA. Effects of a comprehensive school-based asthma program on symptoms, parent management, grades, and absenteeism. Chest 2004;125(5):1674 9.
Clark NM, Gong M, Kaciroti N, Yu J, Wu G, Zeng Z, et al. A trial of asthma self-management in Beijing schools. Chronic Illness 2005;1(1):31 8.
Clark NM, Shah S, Dodge JA, Thomas LJ, Andridge RR, Little RJ, et al. An evaluation of asthma interventions for preteen students. Journal of School Health 2010;80(2):80 7.
Gerald LB, Wittich AR, Erwin S, Hains C, Hemstreet MP, Redden D, et al. Outcomes for a comprehensive school based asthma management program. Journal of School Health 2006;76(6):291 6.
Gerald LB, McClure LA, Mangan JM, Harrington KF, Gibson L, Erwin S, et al. Increasing adherence to inhaled steroid therapy among schoolchildren: randomized, controlled trial of school-based supervised asthma therapy. Pediatrics 2009;123(2):466 74.
Henry RL, Gibson PG, Vimpani GV, Francis JL, Hazell J. Randomized controlled trial of a teacher-led asthma education program. Pediatric Pulmonology 2004;38(6):434 42.
Horner SD, Fouladi RT. Improvement of rural children’s asthma self-management by lay health educators. Journal of School Health 2008;78(9):506 13.
Horner SD, Brown A, Brown SA, Rew DL. Enhancing asthma self-management in rural school-aged children: a randomized controlled trial. Journal of Rural Health 2015;32(3):260 8.
Howell KJ. “Quest for the Code”: A Study of a Computer Based Education Program for Children With Asthma [dissertation]. Syracuse University (Thesis). Syracuse: Syracuse University Libraries, 2005.
Kintner EK, Sikorskii A. Randomized clinical trial of a school-based academic and counseling program for older school-age students. Nursing Research 2009;58(5):321 31.
Levy M, Heffner B, Stewart T, Beeman G. The efficacy of asthma case management in an urban school district in reducing school absences and hospitalizations for asthma. Journal of School Health 2006;76(6):320 4.
McCann DC, McWhirter J, Coleman H, Calvert M, Warner JO. A controlled trial of a school-based intervention to improve asthma management. European Respiratory Journal 2006;27(5):921 8.
McGhan SL, Wong E, Jhangri GS, Wells HM, Michaelchuk DR, Boechler VL, et al. Evaluation of an education program for elementary school children with asthma. Journal of Asthma 2003;40(5):523 33.
McGhan SL,Wong E, Sharpe HM,Hessel PA,Mandhane P, Boechler VL, et al. A children’s asthma education program: Roaring Adventures of Puff (RAP) improves quality of life. Canadian Respiratory Journal 2010;17(2):67 73.
Monforte SE, Gleason M, Covar R, Cicutto L, Szelfer SJ. Reducing health disparities for asthma with a school based asthma education program [Abstract]. Journal of Allergy and Clinical Immunology 2012;129:AB41 [156].
Patterson EE, Brennan MP, Linskey KM, Webb DC, Shields MD, Patterson CC, et al. A cluster randomised intervention trial of asthma clubs to improve quality of life in primary school children: the School Care and Asthma Management Project (SCAMP). Archives of Disease in Childhood 2005;90(8):786 91.
Persaud DI, Barnett SE, Weller SC, Baldwin CD, Niebuhr V, McCormick DP. An asthma self-management program for children, including instruction in peak flow monitoring by school nurses. Journal of Asthma 1996;33(1):37 43.
Praena-Crespo M, Fernandez-Truan J, G lvez-Gonz lez J, Murillo-Fuentes A, Castro-G mez L, Cenizo-Benjumea J. Randomised controlled trial of educational intervention directed by physical education teachers in high schools. European Journal of Allergy and Clinical Immunology 2010;65:190 1.
Shah S, Peat JK, Mazurski EJ, Wang H, Sindhusake D, Bruce C, et al. Effect of peer led programme for asthma education in adolescents: cluster randomised controlled trial. BMJ 2001;322(7286):583 5.
Splett PL, Erickson CD, Belseth SB, Jensen C. Evaluation and sustainability of the Healthy Learners Asthma Initiative. Journal of School Health 2006;76(6):276 82.
Srof BJ, Velsor-Friedrich B, Penckofer S. The effects of coping skills training among teens with asthma. Western Journal of Nursing Research 2012;34(8):1043 61.
Velsor-Friedrich B, Pigott T, Srof B. A practitioner-based asthma intervention program with African American inner-city school children. Journal of Pediatric Health Care 2005;19(3):163 71.
*Bruzzese JM, Bonner S, Vincent EJ, Sheares BJ, Mellins RB, Levison MJ, et al. Asthma education: the adolescent experience. Special Issue: Educating and Counseling Children about Physical Health 2004;55(3):396 406.
*Mosnaim GS, Li H, Damitz M, Sharp LK, Li Z, Talati A, et al. Evaluation of the Fight Asthma Now (FAN) program to improve asthma knowledge in urban youth and teenagers. Annals of Allergy, Asthma and Immunology 2011;107(4):310 6.
*Pulcini J, DeSisto MC, McIntyre CL. An intervention to increase the use of Asthma Action Plans in schools: a MASNRN study. Journal of School Nursing 2007;23(3):170 6.
* Three of the studies included in the review conducted by Harris et al. did not measure any of the outcomes of interest to the CPSTF and were excluded from this analysis.
Economic Review
Atherly A, Nurmagambetov T, Williams S, Griffith M. An economic evaluation of the school-based “power breathing” asthma program. Journal of Asthma 2009;46(6):596-9.
Butz A, Pham L, Lewis L, Lewis C, Hill K, et al. Rural children with asthma: impact of a parent and child asthma education program. Journal of Asthma 2005;42(10):813 21.
Horner SD, Brown A, Brown SA, Rew DL. Enhancing asthma self-management in rural school-aged children: a randomized controlled trial. Journal of Rural Health 2016;32(3):260-8.
Joseph CL, Peterson E, Havstad S, Johnson CC, Hoerauf S, et al. A web-based, tailored asthma management program for urban African-American high school students. American Journal of Respiratory & Critical Care Medicine 2007;175(9):888-95.
Liptzin DR, Gleason MC, Cicutto LC, Cleveland CL, Shocks DJ, et al. Developing, implementing, and evaluating a school-centered asthma program: Step-Up Asthma Program. Journal of Allergy and Clinical Immunology in Practice 2016;4(5):972-9.e971.
Mosnaim GS, Li H, Damitz M, Sharp LK, Li Z, et al. Evaluation of the Fight Asthma Now (FAN) program to improve asthma knowledge in urban youth and teenagers. Annals of Allergy, Asthma, & Immunology 2011;107(4):310-6.
Otim ME, Jayasinha R, Forbes H, Shah S. Building evidence for peer-led interventions: assessing the cost of the Adolescent Asthma Action program in Australia. Australian Journal of Primary Health 2015;21(4):438-43.
Salisbury C, Francis C, Rogers C, Parry K, Thomas H, et al. A randomised controlled trial of clinics in secondary schools for adolescents with asthma. British Journal of General Practice 2002;52:988-96.
Search Strategies
Effectiveness Review
Refer to the existing systematic review for information about the search strategy:
Harris KM, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD011651. DOI: 10.1002/14651858.CD011651.pub2
Economic Review
In May and June of 2020, a research librarian used the terms listed below to search the following databases: Medline, CINAHL, EconLit, ERIC, Cochrane, and CRD at York. The search period covered 1995 through December 2020.
The search was limited to high income countries as defined by the World Bank. The review team also screened reference lists of included studies and consulted subject matter experts about additional studies that may have been missed. Search terms and strategies were adjusted for each database, based on controlled and uncontrolled vocabularies and software.
Database: Medline (OVID)
Date Searched : 05/26/2020
Results: 590
Search Strategy
1 exp Asthma/
2 asthma$.mp.
3 (antiasthma$ or anti-asthma$).mp.
4 Respiratory Sounds/
5 wheez$.mp.
6 Bronchial Spasm/
7 bronchospas$.mp.
8 (bronch$ adj3 spasm$).mp.
9 bronchoconstrict$.mp.
10 exp Bronchoconstriction/
11 (bronch$ adj3 constrict$).mp.
12 Bronchial Hyperactivity/
13 Respiratory Hypersensitivity/
14 ((Bronchial$ or respiratory or airway$ or lung$) adj3 (hypersensitiv$ or hyperreactiv$ or alleg$ or insufficiency)).mp.
15 ((dust or mite$) adj3 (allerg$ or hypersensitiv$)).mp.
16 or/1-15
17 exp Schools/
18 School Health Services/
19 School Nursing/
20 school*.ti,ab,kw.
21 academ*.ti,ab,kw.
22 colleg*.ti,ab,kw.
23 lesson*.ti,ab,kw.
24 pupil*.ti,ab,kw.
25 mobile*.ti,ab,kw. added
26 or/17-25
27 exp Self Care/
28 exp Health Education/
29 Case Management/
30 Patient Education as Topic/
31 educat*.ti,ab,kw.
32 manag*.ti,ab,kw.
33 self-manag*.ti,ab,kw.
34 (self adj manag*).ti,ab,kw.
35 exp Self-Management/
36 self-car*.ti,ab,kw.
37 (self adj car*).ti,ab,kw.
38 train*.ti,ab,kw.
39 instruct*.ti,ab,kw.
40 teach*.ti,ab,kw.
41 patient-cent*.ti,ab,kw.
42 (patient adj cent*).ti,ab,kw.
43 Patient-Centered Care/
44 patient-focus*.ti,ab,kw.
45 (patient adj focus*).ti,ab,kw.
46 coach*.ti,ab,kw.
47 skill*.ti,ab,kw.
48 (knowledge adj develop*).ti,ab,kw.
49 tutor*.ti,ab,kw.
50 (intervention or preventive or prevention or program).ti,ab,kw. added
51 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or 45 or 46 or 47 or 48 or 49 or 50
52 16 and 26 and 51 total before adding cost related terms
53 (cost minimi* or cost-utilit* or health utilit* or economic evaluation* or economic review* or cost outcome or cost analys?s or economic analys?s or budget* impact analys?s).mp.
54 (cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or cost* or income).mp.
55 (life year or life years or qaly* or daly* or cost-benefit analys?s or cost-effectiveness analys?s).mp.
56 ((cost or economic*) and (cost* or cost-effectiveness or markov)).mp.
57 *economics/
58 exp *”costs and cost analysis”/
59 53 or 54 or 55 or 56 or 57 or 58
60 52 and 59
61 60 not (animals not humans).sh.
62 limit 61 to yr=”1995 -Current”
Database: CINAHL (Ebsco)
Date Searched : 06/03/2020
Results: 84
Search Strategy
S1 asthma*
S2 (MH “Asthma+”)
S3 (MH “Schools+”) OR (MH “School Health Services+”) OR (MH “School Nursing+”) OR school* OR academ* OR colleg* OR lesson* OR pupil*
S4 (MH “Self Care+”) OR (MH “Health Education+”) OR (MH “Case Management+”) OR (MH “Patient Education+”) OR educat* OR manag* OR self-car* OR self n1 car* OR train* OR instruct* OR teach* OR patient-cent*
S5 patient n1 cent* OR (MH “Patient-Centred Care+”) OR patient-focus* OR patient N1 focus* OR coach* OR skill* OR knowledge n1 develop* OR tutor*
S6 S4 OR S5
S7 S1 OR S2
S8 S3 AND S6 AND S7
S9 TX cost minimi* or cost-utilit* or health utilit* or economic evaluation* or economic review* or cost outcome or cost analys?s or economic analys?s or budget* impact analys?s)
S10 TX (cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or cost* or income)
S11 TX life year or life years or qaly* or daly* or cost-benefit analys?s or cost-effectiveness analys?s)
S12 TX ((cost or economic*) and (cost* or cost-effectiveness or markov))
S13 (MM “Economics
S14 (MM “Costs and Cost Analysis+”)
S15 S9 OR S10 OR S11 OR S12 OR S13 OR S14
S16 S8 AND S15
S17 S8 AND S15 Limiters – Published Date: 19950101-20201231-
Database: EconLit (Ebsco)
Date Searched: 06/03/2020
Results: 8
Search Strategy
S1 asthma*
S2 (MH “Asthma+”)
S3 (MH “Schools+”) OR (MH “School Health Services+”) OR (MH “School Nursing+”) OR school* OR academ* OR colleg* OR lesson* OR pupil*
S4 (MH “Self Care+”) OR (MH “Health Education+”) OR (MH “Case Management+”) OR (MH “Patient Education+”) OR educat* OR manag* OR self-car* OR self n1 car* OR train* OR instruct* OR teach* OR patient-cent*
S5 patient n1 cent* OR (MH “Patient-Centred Care+”) OR patient-focus* OR patient N1 focus* OR coach* OR skill* OR knowledge n1 develop* OR tutor*
S6 S4 OR S5
S7 S1 OR S2
S8 S3 AND S6 AND S7
S9 TX cost minimi* or cost-utilit* or health utilit* or economic evaluation* or economic review* or cost outcome or cost analys?s or economic analys?s or budget* impact analys?s)
S10 TX (cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or cost* or income)
S11 TX life year or life years or qaly* or daly* or cost-benefit analys?s or cost-effectiveness analys?s)
S12 TX ((cost or economic*) and (cost* or cost-effectiveness or markov))
S13 (MM “Economics
S14 (MM “Costs and Cost Analysis+”)
S15 S9 OR S10 OR S11 OR S12 OR S13 OR S14
S16 S8 AND S15
S17 S8 AND S15 Limiters – Published Date: 19950101-20201231
Database: ERIC (ProQuest)
Date Searched : 06/04/2020
Results: 40
Search Strategy
asthma* AND ((ti(school* OR academ* OR colleg* OR lesson* OR pupil*) OR ab(school* OR academ* OR colleg* OR lesson* OR pupil*)) OR (MAINSUBJECT.EXACT(“High Schools”) OR MAINSUBJECT.EXACT(“Middle Schools”) OR MAINSUBJECT.EXACT(“Elementary Schools”) OR MAINSUBJECT.EXACT(“Public Schools”) OR MAINSUBJECT.EXACT(“School Health Services”) OR MAINSUBJECT.EXACT(“Charter Schools”) OR MAINSUBJECT.EXACT(“Community Schools”))) AND ((ab((educat* OR manag* OR self-car* OR self n/1 car* OR train* OR instruct* OR teach* OR patient-cent*)) OR ti((educat* OR manag* OR self-car* OR self n/1 car* OR train* OR instruct* OR teach* OR patient-cent*))) OR (ti(patient NEAR/1 cent* OR patient-focus* OR patient NEAR/1 focus* OR coach* OR skill* OR knowledge NEAR/1 develop* OR tutor*) OR ab(patient NEAR/1 cent* OR patient-focus* OR patient NEAR/1 focus* OR coach* OR skill* OR knowledge NEAR/1 develop* OR tutor*)))
AND
ti((cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or cost* or income)) OR ab((cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or cost* or income)) OR su((cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or cost* or income))
OR
ti((life year or life years or qaly* or daly* or cost-benefit analys?s or cost-effectiveness analys?s)) OR ab((life year or life years or qaly* or daly* or cost-benefit analys?s or cost-effectiveness analys?s)) OR su((life year or life years or qaly* or daly* or cost-benefit analys?s or cost-effectiveness analys?s))
OR
ab(((cost or economic*) and (cost* or cost-effectiveness or markov))) OR ti(((cost or economic*) and (cost* or cost-effectiveness or markov))) OR su(((cost or economic*) and (cost* or cost-effectiveness or markov)))
OR
MJMAINSUBJECT.EXACT.EXPLODE(“Economics”)
OR
ab(costs N/3 “cost analysis”) OR ti(costs N/3 “cost analysis”) OR su(costs N/3 “cost analysis”)
Limit to 1995-2020
Database: Cochrane (Wiley)
Date Searched: 06/04/2020
Results: 283
Search Strategy
#1 MeSH descriptor: [Asthma] explode all trees
#2 asthma*:ti,ab,kw
#3 #1 OR #2
#4 MeSH descriptor: [Schools] explode all trees
#5 MeSH descriptor: [School Health Services] explode all trees
#6 MeSH descriptor: [School Nursing] explode all trees
#7 (school* OR academ* OR colleg* OR lesson* OR pupil*):ti,ab,kw
#8 #4 OR #5 OR #6 OR #7
#9 (educat* OR manag* OR self-car* OR self NEXT car* OR train* OR instruct* OR teach* OR patient-cent*OR patient NEXT cent* OR patient-focus* OR patient NEXT focus* OR coach* OR skill* OR knowledge NEXT develop* OR tutor*):ti,ab,kw
#10 MeSH descriptor: [Self Care] explode all trees
#11 MeSH descriptor: [Health Education] explode all trees
#12 MeSH descriptor: [Case Management] explode all trees
#13 MeSH descriptor: [Patient Education as Topic] explode all trees
#14 MeSH descriptor: [Patient-Centered Care] explode all trees
#15 #9 OR #10 OR #11 OR #12 OR #13 OR #14
#16 #3 AND #8 AND #15
#17 (cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or cost* or income):ti,ab,kw
#18 (life year or life years or qaly* or daly* or cost-benefit analys?s or cost-effectiveness analys?s):ti,ab,kw
#19 ((cost or economic*) AND (cost* or cost-effectiveness or markov)):ti,ab,kw
#20 MeSH descriptor: [Economics] explode all trees
#21 MeSH descriptor: [Costs and Cost Analysis] explode all trees
#22 #17 OR #18 OR #19 OR #20 OR #21
#23 #16 AND #22 with Cochrane Library publication date Between Jan 1995 and Dec 2020
Database: CRD at York
Date Searched : 06/04/2020
Results: 6
Search Strategy
Title: “asthma” AND Title: “school”
DARE, NHS EED, HTA
Limit 1995 to 2020
Considerations for Implementation
Related CPSTF Recommendation
The CPSTF also recommends school-based health centers based on evidence of effectiveness for a range of student education and health outcomes, including reduced asthma-related emergency department visits and hospitalizations. School-based health centers can provide a useful location for asthma self-management instruction and may be used to identify students with asthma.
Implementation Guidance
Guidance is available to inform implementation of school-based asthma self-management interventions and help schools select from a range of strategies.
- The Centers for Disease Control and Prevention (CDC), National Asthma Control Program (NACP) provides resources and tools to foster asthma-friendly schools.
- Strategies for Addressing Asthma in Schools describes actions schools can take to identify barriers and address environmental triggers.
- Success stories feature ways schools have worked to prevent and control asthma
- The EXHALE technical package [PDF – 760 kB] provides an evidence-based group of strategies to help improve asthma control and inform decision-making in communities, organizations, and states.
- CDC Healthy Schools provides information specific to managing asthma at school.
- The American Lung Association provides resources based on real-life activities that have been used in U.S. schools, including step-by-step instructions for a long-term asthma management plan in the Asthma-Friendly Schools Initiative Toolkit.
- Examples of school-based asthma self-management programs include Open Airways for Schools (OAS) and the Roaring Adventures of Puff. These programs provide educational and interactive approaches (e.g., group discussion guides, stories, games) to promote and improve asthma control.
- The American Academy of Allergy Asthma & Immunology offers guidance on components for a comprehensive school-based asthma management program.
- The National Asthma Education and Prevention Program offers Managing Asthma: A Guide For Schools
Asthma Action Plans
Implementing a personalized asthma action plan involves the student, family, and asthma care provider. Encouraging students to work with their healthcare providers to develop an asthma action plan is a common element of self-management instruction. Schools may want to establish policies or practices that encourage or require students with asthma to submit an asthma action plan.
Example actions plans that can be personalized:
- Asthma Action Plan resources available on the CDC website provide tools for asthma control that were created following evidence-based guidelines published by the National Institutes of Health. Forms can be printed and completed for immediate use or tailored.
- Asthma Action Plan for Home & School [PDF – 68 kB] from the American Academy of Allergy, Asthma, and Immunology.
Additional Considerations
School resources and staff time will likely be required to recruit students with asthma to participate. Schools may send notices to parents or students (e.g., email, fliers), recruit students through school-based health centers, or start with students who have asthma action plans.
Parental consent and provider prescription requirements for self-management training, asthma action plans, and rescue medications vary by school district and can be barriers to full participation.
School-based interventions can be an important component of a comprehensive community and health system approach to asthma control.
Crosswalks
Healthy People 2030
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.