School-based asthma self-management interventions for children and adolescents with asthma

Asthma is a common chronic respiratory condition worldwide. In the UK, more than a million children are living with asthma, and a high prevalence of childhood asthma has also been reported in other countries, according to the International Study of Asthma and Allergy in Children Study (ISAAC). Asthma is characterised by airway inflammation and bronchoconstriction, leading to limited airflow. The symptoms of asthma include wheeze, cough, breathlessness, and chest tightness. Asthma is diagnosed clinically, following an assessment of lung function, symptoms and clinical response to medication. A recent school-based survey assessed current levels of asthma control and school attendance in a sample of 766 children with asthma in London secondary schools. Overall, 20.9% of London school children with asthma self-reported at least one school absence, compared to their peers with optimal asthma control (32.7% vs 10.9%). Other studies have also shown that grade failure is more frequently reported among children with asthma. Self-management involves educating and enabling children to achieve good control of their asthma symptoms to reduce the risk of future exacerbations. In asthma, successful self-management skills include good inhaler technique, optimal treatment adherence, self-monitoring of symptoms, and an ability to respond to asthma symptoms appropriately. Although delivery of an asthma self-management intervention in schools has the potential to reduce the burden of asthma, the effectiveness of such interventions across a variety of outcomes (e.g. healthcare use) is unclear. Similarly, even when interventions are delivered in school settings, several factors, such as variations in study populations, can influence the ways in which school-based self-management interventions are delivered, and their subsequent overall success.