Asthma is one of the most common causes of school absenteeism, and many children are affected by, or encounter, it in the school setting. An integrated curriculum that presents asthma as a real world example can raise all children's awareness and understanding of asthma, not just those with the condition. A 15-lesson, asthma-based curriculum was developed to integrate with and enhance the core subjects of math, science, and communication arts. A pilot test was performed in fourth- and fifth-grade classes to assess student asthma knowledge gain, teacher acceptance, and grade appropriateness of the curriculum. During the 2006-2007 school year, 15 teachers were recruited from the St. Louis, MO, USA area to assess the curriculum through teaching and administering pre- and post-unit tests and completing a teacher evaluation for each lesson taught. Four additional classrooms served as comparisons. Paired t tests were used for each lesson taught, to evaluate pre-/post-test and classroom differences, and focus groups were used for qualitative evaluation. There was an increase in asthma knowledge between pre- and post-tests in both grades, individually and combined (p < 0.001). Intervention post-test scores were higher than comparison classroom scores (p < 0.001). Teacher feedback indicated that the lessons enhanced previously learned skills and increased students' overall understanding of asthma. Offering asthma education in the classroom can provide an opportunity for all students to gain asthma knowledge and build health literacy about a leading chronic disease in school-aged children.

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INTRODUCTIONBreathe Your Best for School Success (BYB) was a feasibility program of Asthma 411, an initiative developed to improve asthma management in the school setting as part of a Centers for Disease Control and Prevention cooperative agreement awarded to the St. Louis Regional Asthma Consortium (SLRAC). The objective of BYB was to increase the number of current provider-written asthma action plans (AAPs) submitted to the school nurse at the beginning of the school year. The Saint Louis University Institutional Review Board approved implementation and evaluation of Asthma 411 interventions. BYB was a collaborative project among the school districts and SLRAC. BYB utilized a "passport" which described the three steps to "breathe your best": (1) obtain an AAP from a health care provider (HCP), (2) fill prescriptions at a pharmacy, and (3) give appropriate medications and the AAP to the school nurse at the beginning of the school year. The passports were designed to be attractive to students and were inserted into plastic cases attached to lanyards for easy transport by students and families. The passport included information describing the importance of each step and included space for signatures from the HCP, pharmacist, and school nurse to verify completion of each step. Incentives were offered to promote participation. To assess reasons for participation or nonparticipation in the BYB program, randomized telephone surveys with parents or guardians of children with asthma were conducted in the fall of 2007. IMPLEMENTATIONBYB targeted elementary (K-sixth grade) students in two districts and was promoted during the summers preceding the 2005-2006 (one school district, five schools) and 2006-2007 (two school districts, nine schools) school years. Demographic information for the two districts appears in Table 1. To generate awareness, nurses distributed fliers Richmond, Hobson, Pike, Kleiss, and Wottowa are with the Saint