Jiaci

Practitioner's Corner

J Investig Allergol Clin Immunol 2019; Vol. 29(5): 378-398

of the asthma burden and its social and economic impact

justifies the implementation of asthma training programs

in schools. By improving knowledge of asthma, clarifying

erroneous beliefs, and promoting the organization of basic

medical care for asthma exacerbation in schools, we can

contribute to the full integration of asthmatics and to reduce

the social and economic costs of asthma. Our data reinforce

the importance of sharing knowledge between different

professional groups as a means of improving the care of

patients with asthma.

Acknowledgments

We are grateful to the following institutions and people:

The University of Madeira for the protocol developed

together with Sociedade Portuguesa de Alergologia e

Imunologia Clínica through which formal accreditation for

the attendees was recognized.

AVASAD – Evaluation Centre for Health and Sport for

making their facilities available.

Drs. Magna Correia, Filipa Sousa, and Ana Margarida

Pereira for their contribution in some of the lessons.

The cardiopulmonologists Catherine Pestana,Ana Cristina

Henriques, Inês Marques, Rita Silva, and Antelma Domingos

for their help in the practical parts of the course.

Dr. Mário Morais de Almeida for his collaboration in

organizing the module of the course in Lisbon and for providing

facilities and equipment at Hospital CUF-Descobertas.

Prof. Dr. João Fonseca for his collaboration in organizing

the module of the course in Porto and for providing facilities

and equipment at Instituto CUF-Porto.

Dr. Rodrigo RodriguesAlves for his help in organizing the

module of the course inAçores and for providing facilities and

equipment at Hospital de Ponta Delgada.

Funding

We are grateful to the Sociedade Portuguesa deAlergologia

e Imunologia Clínica for the funding provided to the Interest

Group of Allergy, Asthma and Sports.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References

1. Storr J, Barrell E, Lenney W. Asthma in primary schools. Br Med

J (Clin Res Ed). 1987;295(6592):251-2.

2. Bevis M, Taylor B. What do school teachers know about

asthma? Arch Dis Child. 1990 Jun;65(6):622-5.

3. Leiria Pinto P, Cordeiro M, Pinto R. Adolescents and school

asthma knowledge and attitudes. Allergol Immunopathol

(Madr). 1999;27(5):245-53.

4. Sandsund M, Thomassen M, Reinertsen RE, Steinshamn

S. Exercise-induced asthma in adolescents: challenges for

physical education teachers. Chron Respir Dis. 2011;8(3):171-

5. Kew KM, Carr R, Donovan T, Gordon M. Asthma education for

school staff. Cochrane Database Syst Rev. 2017;4:Cd012255.

A total of 86 PE teachers from the 5 regions returned the

completed matching questionnaires (mean [SD] age 47.9 [8.1]

years; 58 females [67%]) (Supplementary Material). The

score improved after the course for most questions (Figure),

except questions 7 (general knowledge), 10, 12, 20 (beliefs),

and 14 (treatment). At baseline, 74% of answers were positive

(mean score, 15.57 [1.86]), increasing after training to 85%

(17.23 [1.67]). This increase was statistically significant

for questions regarding general knowledge about asthma

(

<.001), triggers (

<.001), and treatment (

<.001), but

not for questions targeting beliefs. Eighty-four PE teachers

(98%) had ≥1 asthmatic student in their class. An analysis

of the possible effect of personal contact with asthma (n=12;

14%) or family contact with asthma (n=20; 23%) revealed no

significant differences.

The teachers in this sample showed a reasonable degree

of knowledge about asthma. Our findings are better than those

reported by other authors [3], who found knowledge of asthma

among general teachers to be deficient (mean score, 17.7 out

of 30). However, in that study only 60% of the teachers had

or had had an asthmatic student [3], compared with 98% in

our sample. Therefore, we would expect even better results.

Also important is the fact that we included only PE

teachers, whose understanding of exercise-induced asthma

was not ideal. A low proportion were aware that exercise may

induce wheezing or that it could be prevented by pretreatment.

About 70% of PE teachers knew that exercising in cold

weather can exacerbate asthma, although only about 50%

knew that exercise was a common trigger. It is important that

PE teachers are able to recognize when an asthmatic child is

becoming symptomatic and to be aware of the stimuli that

might trigger an exacerbation. Still, asthmatic children should

be encouraged to fully participate in school sports and activities

while taking appropriate medication. Therefore, PE teachers

must have proper knowledge in order to feel confident in this

role. Bearing in mind how relevant it is to recognize asthma

attacks and to treat them promptly with a bronchodilator

inhaler, it is important to promote training courses with a

practical part during which teachers are trained in inhaler

technique. Given the close relationship between asthma and

allergy, courses should include other allergy-related conditions

(eg, rhinitis, anaphylaxis, and urticaria), as was the case in our

program. Specific training on anaphylaxis has been shown to

be effective [6].

Our study is subject to limitations. Although based on

existing questionnaires, the current one has not been validated.

Given the anonymization process, we were unable to assess

whether demographic characteristics were associated with

better baseline knowledge or more marked improvement.

Furthermore, we were unable to assess differences between

age groups or sexes. Although we have offered courses in the

most representative areas of Portugal, our results cannot be

generalized, and selection bias is probable, since those who

signed up were particularly interested in this issue [7]. In any

case, these data clearly demonstrate some lack of knowledge

of asthma among PE teachers, and even about the association

between asthma and sports. We showed that a training course

enables a significant improvement.

Asthma management is difficult, and treatment involves

both a personalized and a global approach [8]. The magnitude

393