Intervention | One staff training session on asthma delivered by school nurse to head teacher, teachers and other staff, including practical demonstrations as well as information on the care and management of asthma, triggers of asthma and inhaler use |
| Written and telephone support for asthma policy development based on model policy 23 and recommendations 17 |
| Distribution to schools of metered-dose β2-agonist inhalers and valved spacers for use in emergencies |
| A 45-min interactive class workshop on asthma delivered by school nurse to all Year 3 and 4 pupils in intervention schools |
| Class workshop delivered by a school nurse on respiratory system for all Year 3 and 4 pupils in nonintervention schools |
Outcome measures# | School absences (primary outcome measure) |
| Establishment of asthma policies and procedures |
| Staff knowledge of asthma 24 |
| Pupil knowledge of asthma in Year 3 and 4 children 25 |
| Prescribed medication using BTS treatment steps 26 |
| BTS 1: occasional use of relief bronchodilators |
| BTS 2: regular inhaled anti-inflammatory agents, i.e. up to 800 µg beclamethasone daily or up to 400 µg fluticasone daily |
| BTS 3: high-dose inhaled steroids plus long-acting inhaled β2-agonist bronchodilator |
| BTS 4: high-dose inhaled steroids and regular bronchodilators plus a sequential therapeutic trial of listed agents |
| BTS 5: addition of regular steroid tablets |
| Asthma symptom reporting 22 |
| Quality of life (QoL) 27 |
| Physical activities (active QoL), leisure activities (passive QoL), emotions related to having asthma (distress), frequency of physical symptoms (severity) |
| Perceived self-competence and self-esteem 28, 29 |
| Scholastic ability, social acceptance, athletic competence, appearance, behaviour, global self-worth |
Possible confounding factors¶ | Employment |
| Social deprivation indicators 30 |
| Pets at home |
| Exposure to environmental tobacco smoke 31, 32 |
| Allergic inflammatory activity 33 |
| House dust mite allergen assessment in Year 3 and 4 classrooms 34, 35 |