Inadequate management of exercise-induced asthma in NYC students

Background: Prior reports suggest that inner-city, minority children with asthma face challenges in managing their disease, especially in school. Purpose: To identify problems with asthma management in students. Methodology: Qualitative interviews with 23 students with asthma (ages 8-10 yrs; 12 girls, 11 boys) from 10 Bronx, NY elementary schools. Interviews were recorded, transcribed and coded for common themes. Parents were surveyed about child's medications and asthma severity/control as per NHLBI guidelines. Results: 14 children had persistent asthma, and 9 intermittent asthma. Of 14 students with physician-prescribed controller asthma medications, 13 were not well-controlled or very poorly controlled. Based on child report, 21 students had exercise-induced asthma (EIA). The majority experienced these symptoms during school hours. Activities triggering asthma symptoms were: participation in physical education class (PE) or recess, walking upstairs and running in the hallway. The most common methods of managing EIA were sitting out during PE, drinking water and visiting the school nurse. Few students mentioned that they were supposed to use an asthma pump before exercise, but they either forgot to do so or did not bring it to school. Most students reported feeling embarrassed, shy or concerned about being teased by classmates if they use a pump in front of others. Conclusions: Our results indicate a high prevalence of undiagnosed and untreated EIA in students; inappropriate school management of EIA; poor asthma control; and potentially stigmatizing effect of using asthma pump in school. Interventions to improve asthma within an urban school setting must consider these critical issues.