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Asthma Management in School Setting

PICOT Question

In asthmatic children between the ages of 9 and 14 (P), how effective are school-based asthma education programs using IAQ action kits (I) in preventing hospitalizations due to asthma attacks (O) compared to no engagement in any form of school-based asthma education programs (C) within six months (T)?

Literature Review

A “literature review” summarizes earlier studies on a topic by examining, classifying, and contrasting the various articles that have already been written on it (Watson & Webster, 2020). It enables the author to analyze and synthesize pertinent research and academic material. It draws attention to patterns and assists in illustrating the various angles that can be taken on a given subject. It creates the foundation for the author’s future research and shows the importance of the new study on its own. An article, report, or policy paper focusing on recent research may contain a brief introduction known as a literature review. A literature review can also be used as a stand-alone essay.

In order to impact policy, identify future research goals, and inform healthcare professionals and patients of the best available evidence when making healthcare decisions, literature reviews have three main objectives. Despite the fact that there are more than fourteen distinct types of reviews, they may all be divided into scoping reviews, quick evidence assessments (rapid reviews), narrative (descriptive) reviews, and systematic reviews.

Literature Review on Asthma Management in School Environment

Asthma is a long-term inflammatory disorder of the airways that causes coughing, wheezing, chest tightness, and difficulty breathing (Ullmann et al., 2018). Depending on the presence of their triggering events, these symptoms may arise intermittently. Asthma affects an estimated 235 million people globally, according to the World Health Organization (WHO). Asthma is one of the top 30 diseases causing the most suffering worldwide. According to data from the International Study of Asthma and Allergies in Childhood (ISAAC), around 14% of children worldwide have experienced asthmatic symptoms at some point.

Numerous studies have found a link between the school environment and the occurrence of asthma problems. Schools have a crucial role in the activation of asthma symptoms due to the numerous allergens present, including dust, fumes, chalk dust, and paper (Nicole & Wanda, 2020). Many educational institutions continue to utilize old-fashioned windows and air conditioners in their classrooms, polluting the environment. Each class contains a large number of students, which, when paired with the other factors, may aggravate asthma symptoms. Children look up to their schools as role models, and the hazards that exist there frequently negatively impact the pupils’ health. According to current research, the severity of children’s asthma and their exposure to school environments are linked. Previous research has found a link between indoor environmental exposures and the development of asthma in children. Researchers are increasingly exploring environmental exposures in the context of educational institutions after leaving the limits of the home.

Even though many classes in schools across the United States have classroom pets, just a few studies have been conducted to investigate the presence of animals in classrooms. It was previously stated that the majority of the creatures kept in classrooms by the 25% of primary school teachers who responded to the study were tiny vertebrates. According to a 2015 online study conducted by the American Humane Association (AHA), teachers were the most likely to keep fish as classroom pets. The poll was performed to gather information for a 2016 report.

Educational institutions in the United States do few studies on the relationship between environmental activities and health outcomes (Baxi et al., 2019). There have not been many published studies from Europe, and the sample sizes are too small to do a complete analysis of asthma morbidity outcomes. According to a Swedish study, limiting the number of pets allowed in schools and requiring students to wear uniforms resulted in four to six times lower levels of airborne cat allergen in intervention groups (classes with pet ownership bans or school clothing) compared to control classes, resulting in a reduction in the amount of pet dander found in schools. Despite its success in Sweden, it is exceedingly unlikely that this school-based environmental intervention would be adopted in the United States.

Literature on the use of IAQ Action Kits to Prevent Childhood Asthma

School representatives speak to every member of the school’s community, including those working in the buildings, office staff, teachers, students, parents, and local government representatives. This puts them in an excellent position to serve as role models and educate anybody who may influence the process of building healthy indoor school environments, including the management of indoor air quality, or IAQ. Indoor air quality (IAQ) preservation necessitates a well-coordinated management approach that includes offering educational opportunities to building occupants as well as creating rules for routine inspection and repair.

The IAQ Tools for Schools Action Kit instructs schools on how to establish a cost-effective strategy to address problems with indoor air quality by relying on simple activities and utilizing on-site staff (Rodriguez-Vidal et al., 2022). The Action Kit includes sample policies, recommended practices, industry recommendations, and examples of IAQ control strategies.

The majority of indoor air quality issues may be avoided, detected, and remedied by utilizing time- and money-saving measures, according to this advice. This application assists educational institutions in understanding the causes of indoor air quality (IAQ) issues, the significance of proper IAQ, and how poor IAQ impacts students, staff, and other facility occupants. One section provides guidance on how to deal with an indoor air quality (IAQ) emergency and how to educate parents, teachers, and students about IAQ. The appendices to this manual contain detailed information on a range of IAQ-related topics.


Baxi, S. N., Sheehan, W. J., Sordillo, J. E., Muilenberg, M. L., Rogers, C. A., Gaffin, J. M., … & Phipatanakul, W. (2019). Association between fungal spore exposure in inner-city schools and asthma morbidity. Annals of Allergy, Asthma & Immunology122(6), 610-615. DOI: 10.1016/j.anai.2019.03.011

Nicole, A. G., & Wanda, P. (2020). The Indoor Environment and Childhood Asthma. Current Allergy and Asthma Reports20(9). DOI: 10.1007/s11882-020-00941-5

Rodriguez-Vidal, I., Oregi, X., Otaegi, J., Vallespir-Etxebarria, G., Millán-García, J. A., & Martín-Garín, A. (2022). Integration of Indoor Air Quality Concerns in Educational Community Through Collaborative Framework of Campus Bizia Laboratory of the University of the Basque Country. In Smart and Sustainable Technology for Resilient Cities and Communities (pp. 73-88). Springer, Singapore. DOI: 10.3390/buildings12071047

Ullmann, N., Mirra, V., Di Marco, A., Pavone, M., Porcaro, F., Negro, V., … & Cutrera, R. (2018). Asthma: Differential diagnosis and comorbidities. Frontiers in Pediatrics6, 276. DOI: 10.3389/fped.2018.00276

Watson, R. T., & Webster, J. (2020). Analyzing the past to prepare for the future: Writing a literature review a roadmap for release 2.0. Journal of Decision Systems29(3), 129-147. DOI: 10.1080/12460125.2020.1798591


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