Journal of Asthma & Allergy Educators

For children with asthma, their perceived health-related quality of life (HRQL) is viewed as a valid outcome measure with which to evaluate care and guide clinical interventions. Numerous clinical variables have been associated with HRQL, but few studies have addressed the role of family functioning in relationship to this outcome. The current study extends the findings of an earlier meta-analysis that indicated that family functioning and illness severity were significant predictors of health-related quality of life in children with asthma. Sixty children and 60 parents or guardians participated in this study of school-age asthmatic children who, over the preceding year, received regular care at a pediatric respiratory clinic for their asthma symptoms. Demographic information was obtained from the adults, who also completed standard measures assessing family stress, adaptation, and cohesion. The children were interviewed by the investigator and completed scales to assess HRQL. The major outcome of interest was the child’s HRQL. The child’s level of control over symptoms and the accumulation of family demands, particularly those related to loss, transition, and illness/family care, negatively affected the child’s quality of life. Multiple regression analysis further revealed that level of control and transitions within the family accounted for 23% of the variance of scores measuring HRQL. Family cohesion emerged as a potential mediating factor that may buffer the negative effects of family stress and the lack of control that an asthmatic child may experience in symptom management. An appreciation of the relationships between family stress, cohesion, and HRQL for children with asthma will directly inform clinical practice. Additional family-centered clinical research that fully incorporates HRQL into a theoretical model of health outcomes will continue to refine effective clinical interventions for asthmatic children.

Charlotte-Mecklenburg Schools (CMS), with assistance from the Centers for Disease Control and Prevention (CDC), conducted an evaluation of the CMS Asthma Program. Data were collected during the 2007-2008 school year through surveys of students with asthma (n = 286), interviews with school nurses (n = 11), and reviews of administrative records that included service provision and nurse ratings of the need for asthma services (based on a set of clinical indicators and symptom frequencies) for each student with asthma. Ninety percent of high-need students, 75.8% of medium-need students, 45.3% of low-need students, and 21.4% of nonrated students were enrolled in student-level services. Given the large number of students without a nurse rating for need, asthma management difficulties (AMD; a set of questions completed by all students on the student survey) were examined as a proxy indicator of need for student-level services. When looking only at need based on AMD, 46.0% of high-need students, 48.0% of medium-need students, and 35.2% of low-need students were enrolled in any student-level service. A Pearson χ² revealed that nurse ratings of need and need based on AMD were not significantly related (χ² = 4.1888, df = 4, P = .381); of students with nurse ratings for need, more were classified as medium and high need based on AMD than were rated medium and high need by school nurses. This suggests that many students were experiencing AMD but not coming to the attention of school nurses. Among students with asthma, additional resources and systematic procedures are needed to identify those who need student-level services, particularly for students who do not otherwise present with symptoms to the school nurse.

Exercise-induced bronchoconstriction occurs in 10% to 15% of the general population and in up to 40% of youth soccer players. Sports-induced asthma exacerbations are a well-recognized cause of death in children. The aim of this descriptive study was to determine whether coaches and managers of a youth soccer league were aware of which players on their team carried the diagnosis of asthma or used bronchodilators and whether they had an emergency asthma action plan for these players. Secondary outcomes were the coaches’ and managers’ knowledge of asthma. Data collection consisted of a multiple-choice survey that was sent to 58 volunteer parent coaches and managers of a Connecticut town soccer organization. Twenty-nine (50%) coaches and managers responded to the survey; they supervised a total of 376 children. Most coaches and managers were not sure which players on their team had asthma (16, 55%) or used inhalers (17, 59%). Five (17%) coaches and managers identified 6 children who used an inhaler; 5 of the children had their inhalers on the field for both practices and games. Most (22, 85%) never discussed an asthma action plan with parents or players. Most (16, 67%) felt that they did not know how to treat an asthma attack. Approximately half demonstrated knowledge about the use of bronchodilator for asthma exacerbations (10) and preexercise treatment (12). This is the first study describing asthma awareness and knowledge in a youth soccer league. Findings demonstrated a lack of both awareness and knowledge in supervising coaches and managers. Children in this age group have the highest risk of dying from sports-related asthma and symptoms. Therefore, it is critical to understand the reasons for this lack of awareness and to address it. Asthma education can play an integral role in addressing this deficiency.