Helping children manage their asthma at school may do more than improve their health. A new study led by a Michigan State University College of Nursing researcher found that students participating in a school-based asthma treatment program experienced substantial reductions in missed instructional time and behavioral incidents, highlighting the potential for school-based healthcare to improve children’s educational experiences.
Published in the Journal of School Health, the study is the first, to the researchers’ knowledge, to examine behavioral incidents and academic grades alongside excused and unexcused absences among children receiving school-based asthma therapy (SBAT).
“We’ve known for years that school-based asthma programs improve children’s health, but this study allowed us to look beyond traditional health outcomes,” said Kimberly Arcoleo, professor at Michigan State University’s College of Nursing and lead author of the study.
“For the first time, we were able to examine not only how much instructional time students missed, but whether those absences were excused or unexcused, as well as changes in their behavioral incidents.”
Significant improvements in attendance and behavior
Researchers examined academic records from 552 elementary, middle, and high school students enrolled in the SBAT program in Columbus City Schools in Ohio, comparing outcomes during the year before and the year after enrollment.
The findings revealed:
- 17% fewer unexcused missed instructional hours among elementary and 53% fewer among middle and high school students.
- 27% fewer excused missed instructional hours among middle and high school students
- 32% fewer Level 2 behavioral incidents among elementary students and 34% fewer among middle and high school students. These incidents include repeated disruptive behavior and more serious misconduct such as bullying and fighting.
- Consistent reductions in missed instructional time across sex and racial/ethnic groups, suggesting the program’s potential to promote more equitable educational opportunities.
- Although academic grades did not significantly improve, the reductions in missed instructional time and behavioral incidents represent meaningful educational outcomes.
Why these findings matter
One of the study’s most important contributions is distinguishing between excused and unexcused absences. Previous research suggests that unexcused absences may be particularly detrimental to academic achievement, especially among children from economically disadvantaged backgrounds.
“Not all school absences have the same implications for children’s education,” Arcoleo explained. “The substantial reductions in unexcused absences, particularly among middle and high school students, are especially encouraging because missed instructional time can have lasting consequences for academic success.”
The study also provides new evidence linking participation in SBAT with improvements in student behavior. Poorly controlled asthma can interfere with sleep, concentration, and daily activities, potentially affecting students’ ability to engage in the classroom.
“When children are struggling with asthma symptoms, it can affect much more than their breathing,” Arcoleo said. “Our findings suggest that helping children better manage their asthma may also support their behavior and engagement at school.”
A model for improving health and educational opportunities
The SBAT program, implemented in partnership with Nationwide Children’s Hospital, provides children with persistent, poorly controlled asthma two controller inhalers – one for home and one for school. On school days, preventive medication is administered under the supervision of school nurses, helping children receive their medication consistently.
By integrating evidence-based asthma treatment into routine school health services, SBAT reduces barriers to medication adherence and healthcare access, particularly for children from underserved communities.
“Schools are uniquely positioned to help children manage chronic health conditions because that is where they spend much of their day,” Arcoleo said. “Our findings demonstrate that investing in school-based healthcare has the potential to improve not only children’s health, but also their ability to attend school and participate successfully in the classroom.”
The researchers believe this approach could provide a model for managing other pediatric chronic conditions, with potential benefits for children’s health, school attendance, and educational experiences.
About the study
“Health Supports Learning: Academic Outcomes Improved by the School-Based Asthma Therapy Program” was published in the Journal of School Health in 2026. The research was conducted by investigators from Michigan State University, the University of Rochester, the University of Buffalo, Virginia Tech University, and Nationwide Children’s Hospital, with funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. Read the study.