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Resume L'asthme est l'une des maladies chroniques les plus frequentes chez les enfants. La presente etude vise a mieux connaitre les problemes poses par l'integration scolaire des enfants asthmatiques. Population et methodes Une etude transversale a ete realisee au cours de l'annee 1994 aupres de 4251 enfants de cinq a 14 ans scolarises en primaire et de leurs enseignants dans 188 classes de 26 ecoles tirees au sort a Grenoble et dans sa proche banlieue. Un premier questionnaire a ete rempli pour 3799 enfants par l'intermediaire de leurs parents. Il a permis l'identification de 191 enfants asthmatiques actifs (crise d'asthme ou traitement pour l'asthme dans la derniere annee). Les parents de 146 d'entre eux ont repondu a un deuxieme questionnaire evaluant la gravite de la maladie et ses retentissements et consequences a l'ecole. Les 186 enseignants des memes ecoles ont ete interroges sur leur connaissance de la maladie et la prise en charge des enfants asthmatiques dans le cadre scolaire. Resultats La prevalence cumulee de l'asthme est de 7,6 % et la prevalence instantanee des 12 derniers mois de 4,3 %. Seize pour cent des enfants asthmatiques rapportent un absenteisme scolaire lie a l'asthme de plus de six jours sur les six derniers mois. L'exercice physique est un facteur declenchant des crises pour 45,2 % d'entre eux et 21 % seulement prennent un traitement preventif de l'asthme induit par l'exercice. Neuf pour cent des enfants ont une dispense medicale d'education physique et sportive. Soixante-treize pour cent des parents ont informe l'enseignant de la maladie de leur enfant, mais les informations echangees ne sont que parcellaires. Parmi les enfants ayant un traitement antiasthmatique, seule la moitie a son traitement a disposition a l'ecole. Les connaissances qu'ont les enseignants sur l'asthme sont parcellaires, et 92,7 % souhaiteraient plus d'informations sur ce sujet. Quatre-vingt-trois pour cent d'entre eux ne connaissent pas l'existence de la circulaire ministerielle n∘ 93–248 du 22 juillet 1993 envisageant les conditions de la prise en charge des enfants atteints de maladies chroniques a l'ecole. Conclusion Lintegration scolaire des enfants asthmatiques reste difficile pour la prise des traitements et l'adaptation des activites scolaires et extrascolaires. La mise a disposition de fiches de liaison parents-medecins-enseignants pourrait ameliorer leur integration. Quand des difficultes persistent, la mise en place d'un projet d'accueil individualise, a l'initiative des parents et en collaboration avec le medecin traitant, le medecin scolaire et l'enseignant, peut permettre d'ameliorer la prise en charge et l'integration des enfants asthmatiques a l'ecole.

Asthma is one of the most frequently encountered chronic illnesses in children. The aim of the present study was to investigate the problem of integration of asthmatic subjects at school by assessing the reactions of parents and teachers, and also by considering the medical aspects.A cross-sectional random study was carried out during autumn 1994 including 4,251 primary school children aged between five and 14 years, and including teachers from 188 classes and 26 schools in Grenoble and its inner suburbs. The first screening questionnaire was completed by the parents, and data on 3,799 children were obtained; from this, 191 currently asthmatic children were identified. One hundred and forty-six parents of the identified asthmatics subsequently answered a second questionnaire on the severity of the illness and its effects on school attendance and educational activities. The 186 teachers from the schools involved were interviewed about their knowledge of the disorder, and about what they knew of the treatment and management of asthmatic children in school.It was found that the cumulative prevalence of asthma amounted to 7.6%, and that the prevalence over the previous 12-month period was 4.3%. Sixteen percent of the asthmatic children reported an asthma-associated school absence of more than six days during the six preceding months. In 45.2% of cases, physical exercise was responsible for an asthmatic attack, but premedication was used in only 21% of cases. Nine percent of the children had obtained a medical certificate which exempted them from participating in sports activities and physical exercise. Seventy-three percent of the parents had informed the teachers of their child's illness, but the information communicated was incomplete. It was found that the teachers did not have a thorough knowledge of the disorder, but that many of them (92.7%) would appreciate further information on the subject and on its management. Eighty-three percent of the teaching staff were unaware that the ministerial circular No. 93-248 of 22 July 1993 had been issued on the proposed management of chronic disorders at school, advocating a combined effort on the part of the parents, the child's physician, the school doctors and the teachers in setting up a concerted plan of action.This study has demonstrated that the school integration of asthmatic children remains problematical both as regards treatment and the pursuit of indoor and outdoor school activities. Integration could be improved by using parent-doctor-teacher liaison forms, thereby maintaining closer communication regarding the child's needs. When this is not sufficient, an individualized asthma management plan could be introduced in collaboration with the parents, doctors and teachers, which might result in improved treatment and integration of asthmatic children in school.