Study Shows Inner-City Asthma Care Program Reduces Student Absenteeism by up to 20 Percent

by Marilyn Roca Enriquez in


Data from a school asthma management program, Building Bridges for Asthma Care, presented at the American Thoracic Society 2015 International Conference, show a significant decrease in school absenteeism among children with asthma from inner-city schools who were enrolled in the program. Absences dropped 11.75 percent among children enrolled in Building Bridges compared to an increase of 8.48 percent in children with asthma not in the program.1 

Asthma outlook-12

Building Bridges for Asthma Care is a school-centered asthma management program funded by global healthcare company GlaxoSmithKline or and implemented across 28 public elementary schools in Denver, Colorado and Hartford, Connecticut. 

The primary implementers of the program are school nurses who identify students with asthma based on medical history provided by the parents or information on their school’s portal. Throughout the school year, the student’s absenteeism, physical activity and asthma control levels are monitored by nurses and communicated to the parents and healthcare providers. At the end of the year, schools work to get families and health care providers organized for the next academic year with an asthma checklist and required school forms to be returned during registration.

Training in asthma management, inhaler technique and how Building Bridges works is offered to all nurses prior to the start of the school year. To coordinate care, the program provides a school nurse coordinator and a series of resources and validated tools such as education materials, standard letters, Asthma Control Test forms and others. A web-based platform manages the data generated by the nurses. 

Asthma1 outlook-12

“Our goal is to improve asthma care by building bridges of communication between school nurses, the child’s family and their primary care provider,” Stanley J. Szefler, M.D., lead clinician for the program and Director of the Pediatric Asthma Research Program in the Breathing Institute of the Pediatric Pulmonary Section at Children's Hospital Colorado, said. “These children already face significant challenges when it comes to their education and well being. We’re working together to take absenteeism off the list.”

Building Bridges is a collaboration between GSK, Children’s Hospital Colorado, Connecticut Children’s Medical Center, National Jewish Health, Rho and the public school systems in Denver and Hartford. GSK fully funds the program and, along with a panel of experts, defined its objectives.

Preliminary data from 2,244 children (40 percent African American, 53 percent Hispanic, 7 percent Other) in the three Hartford, Connecticut elementary schools demonstrated an overall increase in the absenteeism rate from the 2012-13 to 2013-14 school year (9.32 percent vs. 9.63 percent, p<0.001). The absenteeism rate for the 67 children (18 percent African American, 78 percent Hispanic) enrolled in the Building Bridges intervention, however, decreased from 13.3 percent to 12.0 percent whereas those not in the intervention increased from 9.2 percent to 9.5 percent. The difference in the change of absenteeism rates between the intervention children and controls over the two school years was highly significant (p=.0008). In a more direct comparison to an asthma severity matched sample, the intervention children demonstrated a 11.75 percent drop in school absences as compared to a 8.48 percent increase for those children not enrolled in Building Bridges (p<.001).

“Asthma affects approximately 7 million children in the U.S.; each school day, 36,000 children miss school because of their asthma,” David Stempel, GSK’s physician medical lead for Building Bridges, said. “As a company with over 40 years of heritage in respiratory health, we’re proud to contribute to a program that can help children better manage their asthma, so that they can attend school, ready to learn and to reach their full academic potential. We believe this data shows that Building Bridges can serve as a model for school based asthma management across the country.” 

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Asthma is the most common chronic disease that causes school absenteeism in the United States particularly among low income and minority children. It has been classified as one of the “educationally relevant health disparities” that must be addressed as part of school reform due to its contribution to widening the achievement gap between urban minority children and their peers.2 

While the causes of asthma are not completely understood, the common factor for the disease is that it reduces airflow to the lung by causing inflammation and twitchiness of the airways.3 Approximately 26 million people in the U.S., including 7.1 million children currently have asthma, a rate of 84.8 per 1,000 population.4 Around 36,000 children with asthma miss school every day in the U.S.5 

The highest prevalence rate was seen in those five-17 years of age (105.5 per 1,000 population).4 Despite medical advances, more than half of patients continue to experience poor control and significant symptoms.6 Key risk factors are inhaled substances that provoke allergic reactions or irritate the airways, common viral infections and physical exertion of daily childhood activities.

References

  1. Hollenbach J. et al. Reducing School Absenteeism among Inner-City Children: Preliminary Results from the 2013-14 Building Bridges: Advancing Education by Improving Asthma Management in Inner-City Children Program, ATS 2015. 
  2. Basch CE. Healthier students are better learners: a missing link in school reforms to close the achievement gap. J Sch Health. 2011 Oct; 81(10):593-8.
  3. Global Initiative for Asthma. Pocket Guide for asthma management and prevention. Updated 2014.
  4. American Lung Association, Epidemiology & Statistics Unit, Research and Program Services Division, Trends in Asthma Morbidity and Mortality, September 2012, www.lungusa.org/finding-cures/our-research/trend-reports/asthma trend-report.pdf
  5. Cicutto L, Gleason M, Szefler SJ. Establishing school-centered asthma programs. Clinical Reviews in Allergy and Immunology, Dec 2014.
  6. Demoly et al. Eur Respir Rev. 2012 Mar 1;21(123):66-74.