Case Management and Child Health of Children Asthmatic in Schools

Case Management and Educational Programs of Asthmatics in Schools The prevalence of asthma symptoms in school children has risen from 1.3% in 1974 to 19.8% in 2002 in Taiwan. It almost increases 15 times in past 30 years. Asthma is a chronic inflammatory disease of airways and early intervention of anti-inflammatory therapy is recommended by the international guideline to prevent irreversible damage of airway due to progressive airway inflammation and remodeling. The slower patients receive the anti-inflammatory therapy, the less effective the drug response is. Moreover, the children asthma may proceed to adult asthma without proper and early treatment. Poor control of asthma is not only a big burden of government and it also affects quality of life in family and wastes much social cost. In 1999, one of our studies revealed asthmatic children had higher absenteeism from the schools due to asthma attacks and felt that they were not suitable for exercising at schools even the asthma was under control. We also found group health education was more efficient and effective than simple consultation in doctor clinics to correct such incorrect behaviors. In 2001, another our study showed only 17.4% of asthmatic children regularly took anti-inflammatory and none of them could correctly perform inhalation devices completely in each step of technique. That means the education of asthma care is still not adequate for most asthmatics in children in Taiwan. Therefore, under the supervision of government health department, the 2600 school public nurses all over Taiwan received a special one-day training program of asthma care to promote the care quality of asthma at schools between 1999 and 2001. It greatly enhanced the knowledge, inhalation technique and self-confidence of asthma care in school nurses. Besides providing the education for school nurses, more and more researchers propose case management program of asthma care in school asthmatics in recent years. They combine the care resources of family, community, school and medical professionals to set up the case management program for the asthmatic children. They found the case management system resulted in much better outcome and improved quality of life in asthmatic children in schools. Our goals in this study are trying to design case management and education programs for school asthmatics basing on combination of the care resources of school, community and medical professionals and to evaluate if those programs can improve long-term medical outcomes, quality of life, and physical capability in them. The population of the study is going to include asthmatic children aged 6 to 10 ages of year in six primary schools. Four schools are located in Taipei City and the other 2 schools are located in Taoyuan County. Two schools in Taipei city and one school in Taoyuan County are randomly chosen into experimental and control groups respectively. We want to apply the programs to the asthmatic children in experimental group and compare the differences of the short-term and long-term medical outcomes, quality of life, and physical capability of asthmatic children between these 2 groups during 3-year follow-up. If the model of case management programs is successful, we expect to extend the system to other primary schools to promote the well-being of asthmatic children in Taiwan. Ked words: Asthmatic children, Case management program, Outcome, Quality of life, Physical capability

Project ID:PG9304-0442
External Project ID:DOH93-HP-1117