气喘在全世界各地都是一个影响儿童及成人健康的问题。民国 90年在台湾地区气喘与慢性支气管炎更是名列第十大死因。根据卫生署委托台大作的台北市成人气喘盛行率研究调查显示，国人18岁以上的支气管性气喘盛行率为7.79%。依此推算，台湾成人的气喘病人至少超过100万人。而20年来,台湾学童气喘盛行率增加了8倍之多。且近年来每年增加百分之一。

根据长庚儿童医院最新的研究报告显示，现在台湾国中学生将近百分之十四、七罹患气喘病。气喘病的增加其结果加重了家庭、社会、国家的负担。在台湾约有2成的重症气喘病人不知自己罹病而未曾使用药物，而在台湾有一半以上的气喘病童未接受适当的治疗。

显然台湾的气喘病人很多均未达到良好的控制。外国的研究报告均指出医师对气喘治疗指引的遵从性不高。同时医师们对于开立抗发炎药物的适应症，彼此间仍有差异。不可讳言，近几年气喘病学的研究进展很快 ,治疗气喘的方式屡有重大突破,稍不学习就会落伍。

鉴于台湾地区医师气喘治疗之概况，并未有一流行病学的调查，且国内有关气喘卫生教育及行为医学的研究才刚起步 。因此拟借本研究来了解现行台湾各医疗层级的医师对气喘病的认知与治疗概况。从气喘治疗指引的了解与实行度、各类气喘药物的了解与使用、尖峰呼气流速计的监测及吸入性药物辅助舱的使用、医师治疗气喘之自我效能调查及非气喘专科转介气喘病人给气喘专科医师的原因，来分析台湾地区治疗气喘之概况。同时比较不同医疗层级的医师其对气喘治疗之认知与处置差异，以作为拟定未来改善气喘治疗之参考，发展出改善气喘病人照护最佳医疗模式，缩短城乡差距，以期全面推广正确的气喘诊疗，进而使气喘病患均能受到最好的医疗照护，达到提供全民健康福祉之目标。

92年学校气喘学童个案
气喘是儿童最常见的慢性疾病，近十年来由于空气质量恶化与诸多因素，气喘的盛行率逐年增加，发展结合学校、家庭与医院的整体性气喘个案管理模式，以全方位的提供气喘学童之照顾方式，提升气喘儿童与父母的的自我管理的行为，加强身体活动，进而提升其生活质量。过去气喘防治工作，主要在于医院的卫生教育推动，但是学龄儿童主要的生活与时间仍是在学校及家庭，虽然在某些国外研究以学校为基础教育工作颇具成效，但是结合三方之整体性的照顾模式都仍付阙如，为推展国内气喘防治工作，本研究群设计完整的「气喘学童学校个案管理模式」作为卫生行政机构在未来推动气喘防治工作之重要参考依据。

本研究计画之目的为：
•  以 ISAAC 筛选气喘儿童在六所学校之盛行率，完成确诊以及呼吸功能检测。
•  探讨台北市和桃园县国小，学校教职员之气喘照护能力，及相关知识与技能。
•  探讨台北市和桃园市国小，气喘学童与父母气喘知识、自我处理、与生活质量之情形。
•  建立学校气喘病照护政策及工作指引。
•  执行学校气喘病照护政策及工作指引，并评估其成效。
•  长期评价校园气喘个案管理模式下，气喘病童每年气喘的严重度、医治疗、生活质量与运动状况的成效情形。

本研究报告为第一年期的成果报告，依研究进度，第一年具体成果为：
完成校园气喘管理工作手册 ：
内容包括校护照护蓝图、指导内容参考、急性发作处理流程、以及家长联系单、转介通知单等。本手册最终目的乃建立一套适合全国，而且以学校为基础的气喘学童个案管理模式。
完成 ISAAC 筛检及肺功能检测 ：
本年度之初步结果为六所小学之气喘儿童盛行率为为 7.7% ，严重度大多为轻度。
教职员的照护能力评估 ：
气喘知识偏低，气喘态度仍需改正，照顾能力欠佳，尤其对气喘药物以及呼气流速计之观念有待加强。
  气喘儿童父母的自我处理能力 ：
气喘知识中等程度，对气喘照护有正向态度，自我处理行为约为中等程度；有参加过卫教的父母显著在气喘知识、自我效能以及自我处理行为较佳。 71.93% 未参加过任何气喘卫教活动。实验组与对照组织父母在气喘知识、态度、自我效能、效能预期以及自我处理行为上并无显著不同。
气喘儿童的自我处理能力 ：
则在气喘知识上呈现中下度程度，对药物以及尖峰呼气流速计之使用与了解不足，气喘儿童之生活质量则是中上程度。
推动校园气喘管理策略 ：
制作 VCD 教学光碟、教师气喘教育手册、气喘儿童父母教育手册、气喘儿童自学注音版手册、气喘日志本 ( 单双月版 ) ，实验组学校各举办三场教育活动分别给教职员、气喘儿童父母与气喘儿童。建立个人档案资料夹。登录每月气喘症状、用药情形以及峰速值等。

未来二年预计工作计画为，继续推动校园气喘管理模式，并依实际操作情形修订之，并每六个月评价管理成效。

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.