School Screenings ID Asthma Cases, Higher Among Poor Students

In The Daily Dumpster Blog by S. Heather Duncanleave a COMMENT

Vision screenings have been a staple of public schools for years. But health screenings for one of the other most common—and riskiest—childhood conditions is now coming to schools, too.

East Tennessee Children’s Hospital and a private asthma treatment practice are conducting asthma screenings in many local schools. The hospital’s Breathe Easy program first tested children in 2013, with a formalized process being developed and broadened since. Now the program offers tests for lung function in all the Knox County Title I schools—schools where poverty rates are high—as well as in some surrounding rural counties. Knox testing began for the year a few weeks ago.

“Low-income Americans are three times more likely to die of asthma,” a disease that is not difficult to control, says Kelly Ernest, a pediatric nurse practitioner with the pulmonology group based at East Tennessee Children’s Hospital.

She says the pulmonology group has been working with the hospital emergency room on developing a better program for tracking pediatric asthma emergency visits and prevalence in Knoxville.   

Breathe Easy was modeled on a program created by a pediatric pumonologist in Atlanta, Ernest says. Schools wouldn’t let him in, so he initially conducted his screenings at churches. At first, Breathe Easy screenings were conducted in a variety of settings, not just schools. Between July 2013 and July 2015, the program screened 1,526 people. It identified 112 children with abnormal lung function at eight schools, according to a 2016 Community Health Needs Assessment by Children’s Hospital.

“We had open arms from the schools, and that opened a lot of avenues for us,” says Ernest.

Title I schools were targeted because studies show asthma rates are higher among poor children, who tend to live in places where they are exposed to more allergens, such as mildew, cigarette smoke, cockroaches, and smog. (While Knoxville’s smog levels have improved in recent years, it remains designated by the federal Environmental Protection Agency as having unhealthy levels of fine particle pollution like soot.)

Besides environmental factors, poor families are also less likely to have health insurance or a regular checkups at a family doctor, Ernest says. That’s one of the reasons Breathe Easy was introduced in Cocke County first.

“They had a lot of limited availability of health care,” she says, adding that asthma specialists were still surprised to find so many children there with poor lung function and no primary care doctor.

Breathe Easy screenings include a “blow test” to check lung function and a series of questions about allergy symptoms. Both are given scores, and anyone whose score is above 0 in either category is notified. Ernest says the results are sent home with students but also forwarded directly to their family doctors, if they have one. She says parents whose child had an abnormal score also receive a follow-up phone call about what to do. (This is not the case with school screenings by private providers at non-Title I schools in Knox County.) Nurses with Breathe Easy send home inhaler spacers for children already diagnosed with asthma, because inhalers aren’t as effective without one.

Tennessee actually has a requirement that schools offer asthma education, Ernest says, although some schools don’t comply. The Breathe Easy program provides a lesson to students during the screening, helping children understand what asthma symptoms feel like and encouraging kids to tell adults if they have trouble breathing.

Knoxville was ranked seventh among “asthma capitals” in the nation last year. The annual list of the most challenging places to live with asthma is compiled by the Asthma and Allergy Foundation of America, which identified Knoxville as worse than average for pollen, public cigarette smoking, and use of asthma-rescue and -control medicines. Memphis ranked worst in the country, and Chattanooga was only one step ahead of Knoxville.

According to a 2014 report by the Tennessee Department of Health, 11.5 percent of children in the state had asthma in 2011.

When asthma is not controlled with prevention, it can be life-threatening at worst, and expensive at best. Hospital charges for childhood asthma were $53.7 million in 2012, according to the state health department report. Black children were not only more likely to have asthma but more likely to end up hospitalized or in the emergency room for asthma symptoms.

Knox County had the third highest rate in the state for asthma-related emergency room visits, and the second-highest rate after Shelby County for in-patient hospitalizations for childhood asthma.

“We’ve worked with our ER a lot lately on this,” Ernest says. “We’ve found that a lot of children do not have a primary care physicians. We just instituted that if they come in with allergy issues, we have a call rotation with outside allergy groups so those children get a call and a follow-up appointment scheduled now.”

Ernest says Children’s wants to expend the Breathe Easy program, which is funded by private and non-profit grants as well as a grant from CarMax, to more surrounding rural areas in addition to Lenoir City and Cocke, Blount and Anderson counties.

S. Heather Duncan has won numerous awards for her feature writing and coverage of the environment, government, education, business and local history during her 15-year reporting career. Originally from Western North Carolina, Heather has worked for Radio Free Europe, the Institute for War and Peace Reporting in London, and several daily newspapers. Heather spent almost a dozen years at The Telegraph in Macon, Ga., where she spent most of her time covering the environment or writing project-investigations that provoked changes such as new laws related to day care and the protection of environmentally-sensitive lands. You can reach Heather at

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