Screening for asthma: results from a rural cohort.
BACKGROUND
Asthma, the leading cause of chronic illness in children, must be managed in both the home and school environments. Identification of children who have risk factors associated with asthma is the first step toward achieving one of the Healthy People 2010 (2000) objectives, which identifies that 25 states will establish a system of surveillance to track asthma mortality, morbidity, access to care, and asthma management.


OBJECTIVE
The purposes of this research were to: a) identify rural children who are at risk for asthma through written screening; b) assess parameters of respiratory health status of rural school-aged children as indicated by forced expiratory volume at l second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), mean mid-expiratory flow (FEF(25-75)); and c) identify the number of rural school-aged children who sought and obtained follow-up from their primary health care provider and were given a definitive diagnosis of asthma.


METHODS
The Vulnerable Populations Framework (Flaskerud and Winslow, 1998) was used to organize this study.


METHODS
A prospective descriptive design was utilized for this research.


RESULTS
Approximately 12% of the children screened were referred to their primary care provider (PCP) for follow-up care. Of these approximately half of the children were seen by their PCP. Barriers to seeking follow-up care were: a) the child was not symptomatic all the time, b) reluctance to be diagnosed with asthma, and c) others, such as cost and time. Children who were not well controlled identified that they ran out of medicine and their parents did not refill their prescription.


CONCLUSIONS
Results from this descriptive study indicate that screening for asthma in school may be a way to identify those children who are at risk for asthma, and who are not diagnosed as well as those who are diagnosed with asthma but are not optimally managed. While many parents wanted their children to be screened, follow-up care was not critical to them.


CONCLUSIONS
Nurses working in a school setting are in a prime position to help identify those children with signs and symptoms of asthma. In addition, use of written screenings with or without spirometry may be helpful in identifying children at risk for asthma. Further studies need to be undertaken to determine if written screening is as efficacious as spirometry for school and other ambulatory care settings.
Kim Callahan Rodehorst
T
T
University of Nebraska Medical Center College of Nursing, Scottsbluff, Nebraska 69361, USA. tkrodeho@unmc.edu
Wilhelm
Susan L
SL
Stepans
Mary Beth
MB
D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D002648:Child; D002662:Child Health Services / Q000458:organization & administration; D002669:Child Welfare / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D015146:Midwestern United States / Q000453:epidemiology; D010371:Pediatric Nursing / Q000379:methods; D011446:Prospective Studies; D012129:Respiratory Function Tests / Q000451:nursing; D018570:Risk Assessment / Q000379:methods; D012424:Rural Population / Q000706:statistics & numerical data*; D012572:School Health Services / Q000458:organization & administration