Poorer performing Philadelphia schools have more undiagnosed asthma, Jefferson study finds

October 29, 2003

A new study by researchers at Jefferson Medical College shows that poorer performing schools in the Philadelphia School District have higher percentages of students with unrecognized symptoms of asthma, leading researchers to suggest that those students at risk receive screening for the disease.

Sal Mangione, M.D., associate professor of medicine at Jefferson Medical College of Thomas Jefferson University in Philadelphia, and his co-workers there compared the prevalence and severity of asthma between middle school students in schools run by the Philadelphia School District and those administered by Edison, Inc., a management company designated by the school district to run nearly one-half of its lowest academically performing schools.

In earlier research, Dr. Mangione and his co-workers had studied inner-city schools in Philadelphia to gauge the prevalence and awareness of asthma among 5th and 6th grade schoolchildren, finding that schools were greatly underestimating the prevalence of asthma. The researchers decided to try to find out if the incidence and severity of the disease differed between Edison and other Philadelphia schools.

"If these kids were doing poorly in school, maybe asthma - and resulting absenteeism - was the issue," he says. "Asthma is the number one cause of absenteeism in schools. The question was, were these kids sicker than the others, and not just poorer students? These were kids from more disadvantaged economic areas, which are breeding grounds for asthma. The assumption was, there would be more asthma."

Dr. Mangione's group screened 6,727 middle school students from 65 Philadelphia public schools: 6006 managed by the school district and 721 by Edison. They used a self-administered video questionnaire depicting five symptoms of asthma.

The two groups did not differ in their reporting of asthma: 23.7 percent of the school district children and 24.5 percent of the Edison children said they had asthma.

But when the researchers looked at students who said they didn't know they had asthma, they found that students in schools managed by Edison had a higher prevalence of at least one symptom in the previous year. They also found these students had more severe cases of the disease.

Dr. Mangione presents his findings October 29 at CHEST 2003, the 69th annual international scientific assembly of the American College of Chest Physicians in Orlando.

These data, he says, support previous research showing more than twice the prevalence of asthma among those inner-city middle school students surveyed who were considered to have more than the normal number of absences ("high absentees") from school as compared to those who regularly attend.

"One assumption from this might be that these kids' troubles in school could be from being sicker and not just from being poorer students alone," he says. "The prevalence of asthma could be one factor in poorer academic performance."

Asthma, he contends, is an "important problem that we can do something about." Dr. Mangione stops short of recommending mandatory screening, but hopes evaluations made about a student's academic performance and potential take into account possible health concerns such as asthma.

"I'm suggesting that those kids that are at higher risk for asthma, and who are having problems in school should be tested," he says. "We'd like to create some sort of screening mechanism for asthma in Philadelphia schools. If asthma is present, it should then be treated.

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 GlaxoSmithKline, 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.

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.

Thomas Jefferson University

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