Health is the state of complete physical, mental and social well-being, not merely the absence of disease or infirmity (from WHO, 1946, in Park, 2005) and Health Promotion has been defined as an enterprise involving the development over time, in individuals and communities, of basic and positive states of and conditions for physical, mental and social health (Raeburn and Rootman, 1998, p.11). This idea of health promotion has been borne out of acceptance of the limitations of curative medicine and therefore, the need to 'refocus upstream' (Kemm and Close, 1995, p.7). And it is these principles we have adopted in the development of our health promotion model on asthma management in school age children, titled 'Breathe Easy'.
The word 'asthma' is derived from the Greek word 'aazein', meaning 'sharp breath' (Wikipedia, 2007). It is a chronic inflammatory disorder which causes hyper responsiveness of airways to certain stimuli ( known as an asthma triggers) resulting in recurrent variable airflow limitation, at least partly reversible, presenting as wheezing, breathlessness, chest tightness and coughing, particularly at night or early morning (Asthma UK, 2007). Asthma is the most common chronic condition in the UK and while much is spent on clinical research and treatment, the cause (or causes) of the disease remains a mystery (Health Development Agency, 2005). It is however known to be familial with environmental factors playing an important role in its expression. Certain allergens act as stimuli and trigger symptoms. These include airborne allergens (e.g. pollen), animal fur and air pollutants (such as tobacco smoke or traffic fumes). Other triggers include stress and anxiety, respiratory infection, exercise and cold weather (Asthma UK, 2007). What triggers asthma differs from one person to another (ibid). Asthma is a growing problem in the UK, where there are currently 5.5 million people with the disease with 1.1 million being children (ibid). One person dies of asthma every 6 hours. Distressingly, most of these deaths are preventable: an estimated 75% of hospital admissions for asthma are avoidable and as many as 90% of the deaths from asthma are preventable (ibid).
Statistics reveal that asthma is among the commonest chronic disease of childhood in the UK with one in seven children being a sufferer (Norfolk County Council, 2005) making it the highest childhood asthma rates in Europe (Hantsweb, 2007). On average, one in four pupils in a classroom is estimated to suffer from asthma (Teachernet, 2003) and a child is admitted to hospital every 19 minutes for the condition (Asthma UK, 2007).
Asthma costs the NHS over £996 million per year with the estimated annual cost of treating a child with asthma (£181) being higher than the cost per adult (£162) (ibid).
Many children’s lives are needlessly spoilt by the condition. The social impact of morbidity in young people includes diminished school performance, restrictions and disruptions to school life, leisure and family life, as well as perceptions of stigma. In addition, young people with asthma experience slower growth rates and delayed puberty. Much morbidity associated with asthma in the young is under-reported and under treated and children have acquired a reputation for poor compliance (ibid).
As a result of the above evidence-base we developed the Breathe Easy asthma model to be implemented in primary school settings. The name of the model is inspired by the initial observations of the Greek (as stated before) and we chose to use the primary school setting for the implementation of our model in line with the settings approach of the Jakarta Declaration (WHO, 1996). This is principally because a school is the place where all children can be found together in one place, where they spent a third of their waking hours (Norfolk County Council,...