Mandatory asthma screening needed in high-risk groups, Jefferson researcher says

October 22, 2000

Schools are underestimating the prevalence of asthma among their young students and the students themselves all too often ignore their symptoms and don't realize they have asthma, a recent survey shows.

Salvatore Mangione, M.D., associate professor of medicine at Jefferson Medical College of Thomas Jefferson University in Philadelphia and his colleagues, at Children's Hospital of Philadelphia and Medical College of Pennsylvania-Hahnemann University School of Public Health, in conjunction with the Philadelphia Asthma Task Force and with support by Schering-Plough, had previously targeted 12 Philadelphia inner-city schools to gauge both the prevalence and awareness of asthma among schoolchildren. The researchers had studied schools serving poor, minority communities in which asthma is more prevalent.

In this survey, almost 3,300 children were screened for asthma. Approximately one-fourth reported having the disease and more than one-third had asthma symptoms. One-half of all these children were not aware of having asthma. In a previous study, the schools only knew about one-tenth of such children. After year one of the survey, researchers provided the students with education about asthma and monitored symptoms.

Since asthma is among the leading causes of school absenteeism and hospitalization in children, Dr. Mangione and his team conducted a second study in two of the 12 Philadelphia middle schools previously surveyed. They tried to find out the asthma prevalence among high absentees compared to students with few absences. The data showed that those absent most often suffered from asthma more frequently.

Dr. Mangione's group screened 176 high-absentee children and compared them to 404 low-absentees from the same grades and schools. They found that as many as one-third (34.9 percent) of high absentees self-reported asthma compared to a quarter (25.2 percent) of students with a low absentee rate. Using the video questionnaire method, nearly half (or 48.3 percent) of high absentees showed symptoms and were diagnosed with asthma. Slightly more than one-third, or 36.7 percent, of low absentees showed such symptoms. All of these differences were statistically significant. Almost half (43 percent) of high absentee children didn't know that they had asthma, compared to 51.9 percent of low absentees. Dr. Mangione reports his findings Oct. 23 at the 66th Annual International Scientific Assembly of the American College of Chest Physicians in San Francisco.

"It's an important study," Dr. Mangione says. "Since it confirms higher asthma prevalence among absentees, and worse symptoms. A large percentage of these kids are also unaware they have asthma, and this demonstrates a need for increased awareness and control.

"Since many schools are developing systems to tackle absenteeism, data from this study suggest that kids may be more absent from asthma, and maybe don't even know they have it. Intuitively, what they probably need is a doctor. This may represent a missed opportunity.

"The irony," he says, "is that today we have asthma therapies that are very effective but it seems that the real problem is to get them to the kids. We need better access to information and better care." Poor housing, allergenic environments, and a lack of access to medical care all may contribute to the higher incidences and more severe cases of asthma in disadvantaged populations, he says.

Asthma is the most common chronic respiratory disease of childhood throughout the world, and its prevalence has been increasing in epidemic proportions worldwide. In the U.S., asthma affects close to 5 million children, approximately 30-40 percent of who are estimated to have mild to moderate asthma (symptoms more than twice a week). While asthma may be effectively treated with inhaled corticosteroids and bronchodilators, it is a leading cause of school absences, resulting in more than 11 million lost school days a year. It currently is estimated to cost the U.S. economy nearly $2 billion each year. One of Dr. Mangione's projects that puts into practice his research on asthma education is the AsthmaBUS Program. The bus, a public service project developed by Jefferson Medical College under the auspices of the Philadelphia Asthma Task Force and with funding by GlaxoWellcome, relies on a red, double-decker, British Bus, remodeled as a moving asthma exhibit for Philadelphia school children. The bus is visiting middle schools, as well as health fairs and other medical centers. In addition, a set of cartoon characters - The AsthmaBUSters - were created, along with a related comic book and set of trading cards, to be the voice of the bus and the liaison for this educational project.

The Centers for Disease Control and Prevention recently awarded the Philadelphia School District a grant, part of which will continue to support the outreach screening and educational programs in middle schools, in addition to the implementation and assessment of the AsthmaBUSters initiative.
-end-
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