Evidence to Practice: As-Needed Inhaled Corticosteroid Therapy for Asthma Control

Abstract

School nurses support students living with asthma through care coordination activities that reflect current asthma guidelines. Staying abreast of new and beneficial approaches that may improve asthma management and decrease student absences can be challenging due to time constraints and ingrained treatment practices. As a tool for school nurses, this article reviews the results of the Patient-Centered Outcomes Research Institute study on the use of symptom-based corticosteroid therapy for students with mild, persistent asthma and includes the NASN Implementation Guidance for School Nurses. Families who experience barriers to daily use of asthma controller therapy may benefit when this change in care is appropriate for their student.

Keywords

asthma evidence-based practice school nurses care coordination access to care social determinants of health collaborative communication parent/family inhalers

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References

Akinbami

L. J.

Simon

A. E.

Rossen

L. M.

(2016). Changing trends in asthma prevalence among children. Pediatrics, 137(1), 1–7. https://doi.org/10.1542/peds.2015-2354

Allergy and Asthma Network. (n.d.). Health equities in allergies, asthma, and immunology. https://allergyasthmanetwork.org/health-equity/

Aris

I. M.

Perng

Dabelea

Padula

A. M.

Alshawabkeh

Vélez-Vega

C. M.

Aschner

J. L.

Camargo

C. A.

Jr. Sussman

T. J.

Dunlop

A. L.

Elliott

A. J.

Ferrara

Joseph

C. L. M.

Singh

A. M.

Breton

C. V.

Hartert

Cacho

Karagas

M. R.

, . . . Environmental Influences on Child Health Outcomes. (2023). Neighborhood opportunity and vulnerability and incident asthma among children. JAMA Pediatrics, 177(10), 1055–1064. https://doi.org/10.1001/jamapediatrics.2023.3133

Centers for Disease Control and Prevention (CDC). (2023a). National center for health statistics. Percentage of ever having asthma for children under age 18 years, United States, 2019–2023. National Health Interview Survey. NHIS-Child Summary Health Statistics.

Centers for Disease Control and Prevention (CDC). (2023b). National center for health statistics. National health interview survey and health, United States, 2020–2021 health, United States 2020–2021.

Centers for Disease Control and Prevention (CDC). (2024). Social determinants of health.

Children’s Hospital Pittsburgh. (n.d.). Levels of asthma. https://www.chp.edu/our-services/pulmonology/services/asthma/resources/levels

Everhart

R. S.

Corona

Mazzeo

S. E.

Dempster

K. W.

Schechter

M. S.

(2020). School nurses’ perspectives on components of asthma programs to address pediatric disparities. Journal of Pediatric Psychology, 45(8), 900–909. https://doi.org/10.1093/jpepsy/jsaa039

Global Initiative for Asthma (GINA). (2024). Global strategy for asthma management and prevention. https://ginaasthma.org/2024-report/

10.

National Association of School Nurses. (2024a). A contemporary framework update for today’s school nursing landscape: Introducing the School Nursing Practice Framework. NASN School Nurse, 39(3), 140–147. https://www.doi.org/10.1177/1942602X241241092

11.

National Association of School Nurses. (2024b). PCORI symptom-based adjustment of inhaled steroid therapy study (The ASIST Study) for mild asthma: School nurse implementation guidance. https://higherlogicdownload.s3.amazonaws.com/NASN/8575d1b7-94ad-45ab-808e-d45019cc5c08/UploadedImages/PDFs/Advocacy/NASN_PCORI_Evidence_Implementation_Guidance_for_the_School_Nurse_FINAL.pdf

12.

National Association of School Nurses. (2024c). School nursing evidence-based clinical practice guideline: Students with asthma. https://learn.nasn.org/courses/89514

13.

National Association of School Nurses (NASN). (2022). School nursing: Scope and standards of practice (4th ed.). Author.

14.

Patient Centered Outcomes Research Institute. (2021). Evidence updates, choosing the best option for managing mild persistent asthma in children. https://www.pcori.org/evidence-updates/choosing-best-option-managing-mild-persistent-asthma-children

15.

Sullivan

P. W.

Ghushchyan

Navaratnam

Friedman

H. S.

Kavati

Ortiz

Lanier

(2018). The national burden of poorly controlled asthma, school absence and parental work loss among school-aged children in the United States. The Journal of Asthma: Official Journal of the Association for the Care of Asthma, 55(6), 659–667. https://doi.org/10.1080/02770903.2017.1350972

16.

Sumino

Bacharier

L. B.

Taylor

Chadwick-Mansker

Curtis

Nash

Jackson-Triggs

Moen

Schechtman

K. B.

Garbut

Castro

(2019). Comparing two ways to manage asthma in African American children—The ASIST study. Patient-Centered Outcomes Research Institute (PCORI). https://doi.org/10.25302/07.2020.AS.130705588

17.

Sumino

Bacharier

L. B.

Taylor

Chadwick-Mansker

Curtis

Nash

Jackson-Triggs

Moen

Schechtman

K. B.

Garbutt

Castro

(2020). A pragmatic trial of symptom-based inhaled corticosteroid use in African American children with mild asthma. The Journal of Allergy and Clinical Immunology in Practice, 8(1), 176–185. https://doi.org/10.1016/j.jaip.2019.06.030

18.

Sumino

Nichols

(2023, May 11). Evidence—based decision making—“As-needed” inhaled corticosteroid therapy for pediatric asthma [Webinar]. National Association of School Nurses. https://learn.nasn.org/courses/53703

19.

Toyran

Yagmur

I. T.

Guvenir

Haci

I. A.

Bahceci

Batmaz

S. B.

Topal

O. Y.

Celik

I. K.

Karaatmaca

Misirlioglu

E. D.

Civelek

Can

Kocabas

C. N.

(2020). Asthma control affects school absence, achievement and quality of school life: A multicenter study. Allergologia et Immunopathologia, 48(6), 545–552. https://doi.org/10.1016/j.aller.2020.05.005