氣喘在全世界各地都是一個影響兒童及成人健康的問題。民國 90年在台灣地區氣喘與慢性支氣管炎更是名列第十大死因。根據衛生署委託台大作的台北市成人氣喘盛行率研究調查顯示，國人18歲以上的支氣管性氣喘盛行率為7.79%。依此推算，台灣成人的氣喘病人至少超過100萬人。而20年來,台灣學童氣喘盛行率增加了8倍之多。且近年來每年增加百分之一。

根據長庚兒童醫院最新的研究報告顯示，現在台灣國中學生將近百分之十四、七罹患氣喘病。氣喘病的增加其結果加重了家庭、社會、國家的負擔。在台灣約有2成的重症氣喘病人不知自己罹病而未曾使用藥物，而在台灣有一半以上的氣喘病童未接受適當的治療。

顯然台灣的氣喘病人很多均未達到良好的控制。外國的研究報告均指出醫師對氣喘治療指引的遵從性不高。同時醫師們對於開立抗發炎藥物的適應症，彼此間仍有差異。不可諱言，近幾年氣喘病學的研究進展很快 ,治療氣喘的方式屢有重大突破,稍不學習就會落伍。

鑑於台灣地區醫師氣喘治療之概況，並未有一流行病學的調查，且國內有關氣喘衛生教育及行為醫學的研究才剛起步 。因此擬借本研究來了解現行台灣各醫療層級的醫師對氣喘病的認知與治療概況。從氣喘治療指引的了解與實行度、各類氣喘藥物的了解與使用、尖峰呼氣流速計的監測及吸入性藥物輔助艙的使用、醫師治療氣喘之自我效能調查及非氣喘專科轉介氣喘病人給氣喘專科醫師的原因，來分析台灣地區治療氣喘之概況。同時比較不同醫療層級的醫師其對氣喘治療之認知與處置差異，以作為擬定未來改善氣喘治療之參考，發展出改善氣喘病人照護最佳醫療模式，縮短城鄉差距，以期全面推廣正確的氣喘診療，進而使氣喘病患均能受到最好的醫療照護，達到提供全民健康福祉之目標。

92年學校氣喘學童個案
氣喘是兒童最常見的慢性疾病，近十年來由於空氣品質惡化與諸多因素，氣喘的盛行率逐年增加，發展結合學校、家庭與醫院的整體性氣喘個案管理模式，以全方位的提供氣喘學童之照顧方式，提昇氣喘兒童與父母的的自我管理的行為，加強身體活動，進而提升其生活品質。過去氣喘防治工作，主要在於醫院的衛生教育推動，但是學齡兒童主要的生活與時間仍是在學校及家庭，雖然在某些國外研究以學校為基礎教育工作頗具成效，但是結合三方之整體性的照顧模式都仍付闕如，為推展國內氣喘防治工作，本研究群設計完整的「氣喘學童學校個案管理模式」作為衛生行政機構在未來推動氣喘防治工作之重要參考依據。

本研究計畫之目的為：
•  以 ISAAC 篩選氣喘兒童在六所學校之盛行率，完成確診以及呼吸功能檢測。
•  探討台北市和桃園縣國小，學校教職員之氣喘照護能力，及相關知識與技能。
•  探討台北市和桃園市國小，氣喘學童與父母氣喘知識、自我處理、與生活品質之情形。
•  建立學校氣喘病照護政策及工作指引。
•  執行學校氣喘病照護政策及工作指引，並評估其成效。
•  長期評價校園氣喘個案管理模式下，氣喘病童每年氣喘的嚴重度、醫治療、生活品質與運動狀況的成效情形。

本研究報告為第一年期的成果報告，依研究進度，第一年具體成果為：
完成校園氣喘管理工作手冊 ：
內容包括校護照護藍圖、指導內容參考、急性發作處理流程、以及家長聯繫單、轉介通知單等。本手冊最終目的乃建立一套適合全國，而且以學校為基礎的氣喘學童個案管理模式。
完成 ISAAC 篩檢及肺功能檢測 ：
本年度之初步結果為六所小學之氣喘兒童盛行率為為 7.7% ，嚴重度大多為輕度。
教職員的照護能力評估 ：
氣喘知識偏低，氣喘態度仍需改正，照顧能力欠佳，尤其對氣喘藥物以及呼氣流速計之觀念有待加強。
  氣喘兒童父母的自我處理能力 ：
氣喘知識中等程度，對氣喘照護有正向態度，自我處理行為約為中等程度；有參加過衛教的父母顯著在氣喘知識、自我效能以及自我處理行為較佳。 71.93% 未參加過任何氣喘衛教活動。實驗組與對照組織父母在氣喘知識、態度、自我效能、效能預期以及自我處理行為上並無顯著不同。
氣喘兒童的自我處理能力 ：
則在氣喘知識上呈現中下度程度，對藥物以及尖峰呼氣流速計之使用與了解不足，氣喘兒童之生活品質則是中上程度。
推動校園氣喘管理策略 ：
製作 VCD 教學光碟、教師氣喘教育手冊、氣喘兒童父母教育手冊、氣喘兒童自學注音版手冊、氣喘日誌本 ( 單雙月版 ) ，實驗組學校各舉辦三場教育活動分別給教職員、氣喘兒童父母與氣喘兒童。建立個人檔案資料夾。登錄每月氣喘症狀、用藥情形以及峰速值等。

未來二年預計工作計畫為，繼續推動校園氣喘管理模式，並依實際操作情形修訂之，並每六個月評價管理成效。

Abstract
Keyword: School-age children with asthma, School asthma case management model, Quality of life, Self-management, Physical activity

Over the past decade, the prevalence of asthma was increasing by various factors and air pollution. Asthma became the most common disease of childhood.Developing a holistic project of case management model by integrate the school, family and hospital together will provide the comprehensive care of school-age children with asthma. Increasing the ability of self-management of teacher, children with asthma and their parents will promote their quality of life. Hospital-based health education for children with asthma was the traditional policy in the health care system. But most daily activity and time of school-age children were expending in school and family. Some research indicated that school-based asthma education was an effective method. Integrating the family, school and hospital together, setup the cooperative care model of case management will be the most important model to control asthma in the future.

The purposes of this longitudinal study were to ：
(1) Screening the asthma case by ISAAC in six elementary schools.
(2) Exploring the asthma knowledge, attitude, self-efficacy of faculty in school.
(3) Exploring the asthma knowledge, attitude, self-efficacy, self-management, and quality of life in children with asthma and their parents.
(4) Establishing the School Asthma Care Policy and School Children Asthma Case Management Model
(5) Implementaing the School Children Asthma Case Management Model and evaluate the effectiveness.
(6) Longitudinal effects of School Children Asthma Case Management Model, on asthma severity, medical care utilization, qualityof life and physical activity.

The results of first year were:
1. Developing a School Children Asthma Case Management Model ：
including the care map, instructin guideline, acute attack management flow chart, transfer and inform parents letters.
2. Completing the screening asthma cases by ISAAC ：
the total prevalence of asthma was 7.7%. Mostly the severity of children with asthma were classified as mild.
3. Assessing the ability of faculty:
asthma knowledge was not enough, the attitude needed more correction, as well as efficacy of care need enhanced, especially the peak flow meter and asthma medication.
4. Assessing the ability of parents ：
Their asthma knowledge were middle level, having positive attitude, middle level self-management behaviors. The parents with experience of asthma education had better knowledge, self-efficacy, and self-management behaviors. But 71.93% parents never participated in any asthma education activity. There were no significantly difference between the experimental group and comparison groups in asthma knowledge, attitude, self-efficacy, efficacy expectation, and self-management behaviors.
5. Assessing the ability of children with asthma:
Their asthma knowledge were middle to lower level. Children with asthma have misunderstanding about the asthma medication and less use of peak flow meter. Self-efficacy was the middle level. Mostly their quality of life was within satisfaction.
6. Promoting the strategies of School Children Asthma Case Management Model ：
Developing a teaching VCD for parents, and teaching manual for faculty, parents and children with asthma. An asthma diary book was developed. Three asthma education programs were designed for faculty, parents and children with asthma.