A cross-sectional study on school integration in a general population sample of asthmatic children.

Aims. - Asthma is one of the most frequently encountered chronic illnesses in children. The aim of the present study was to investigate the problem of integration of asthmatic subjects at school by assessing the reactions of parents and teachers, and also by considering the medical aspects. Population and methods. - A cross-sectional random study was carried out du ring autumn 1994 including 4,251 primary school children aged between five and 14 years, and including teachers from 188 classes and 26 schools in Gre noble and its inner suburbs. The first screening questionnaire was complete d by the parents, and data on 3,799 children were obtained; from this, 191 currently asthmatic children were identified. One hundred and forty-six par ents of the identified asthmatics subsequently answered a second questionna ire on the severity of the illness and its effects on school attendance and educational activities. The 186 teachers from the schools involved were in terviewed about their knowledge of the disorder, and about what they knew o f the treatment and management of asthmatic children in school. Results. - It was found that the cumulative prevalence of asthma amounted t o 7.6%, and that the prevalence over the previous 12-month period was 4.3%. Sixteen percent of the asthmatic children reported an asthma-associated sc hool absence of more than six days during the six preceding months. In 45.2 % of cases, physical exercise was responsible for an asthmatic attack, but premedication was used in only 21% of cases. Nine percent of the children h ad obtained a medical certificate which exempted them from participating in sports activities and physical exercise. Seventy-three percent of the pare nts had informed the teachers of their child's illness, but the information communicated was incomplete. It was found that the teachers did not have a thorough knowledge of the disorder, but that many of them (92.7%) would ap preciate further information on the subject and on its management. Eighty-t hree percent of the teaching staff were unaware that the ministerial circul ar No. 93-248 of 22 July 1993 had been issued on the proposed management of chronic disorders at school, advocating a combined effort on the part of t he parents, the child's physician, the school doctors and the teachers in s etting up a concerted plan of action. Conclusions. - This study has demonstrated that the school integration of a sthmatic children remains problematical both as regards treatment and the p ursuit of indoor and outdoor school activities, integration could be improv ed by using parent-doctor-teacher liaison forms, thereby maintaining closer communication regarding the child's needs. When this is not sufficient, an individualized asthma management plan could be introduced in collaboration with the parents, doctors and teachers, which might result in improved tre atment and integration of asthmatic children in school. (C) 2000 Editions s cientifiques et medicales Elsevier SAS.