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Objective . Childhood asthma is a frequent cause of absenteeism that affects school performance. We aimed to investigate the impact of asthma on absenteeism and school performance level of elementary and high school students.  Methods . Data about sociodemographics, absenteeism, and academic achievement were obtained from 1539 students attending 98 schools in Greece. School performance was assessed for the last two years of school attendance using parents' and teachers' reports and grade point average promotion.  Results . The mean of the days of absence of students with asthma was higher compared to the healthy students (6.2 ± 11.7 versus 0.3 ± 3.1, resp.,  P  < 0.001). Students with reduced healthcare use presented less absenteeism than those with increased healthcare use for asthma (4.3 ± 8.6 versus 12.4 ± 17.0 days, resp.,  P  < 0.001). Asthma and healthcare use for asthma accounted for an overall estimated variability in absence days of 13.8% and 9%, respectively. Absenteeism was associated with poor school performance for the last two years of school ( P  = 0.002) and with lower grade point promotion in elementary school students ( P  = 0.001) but not in high school students ( P  = 0.316). Higher level of parental education was associated with better school performance ( P  < 0.001). Asthma was associated with a decreased possibility for excellent performance (OR = 0.64,  P  = 0.049, 95%CI = 0.41–1.00) in elementary students. Students with asthma using inhalers were four times more likely to perform excellently in elementary school (OR = 4.3,  P  = 0.028, 95%CI = 1.17–15.95) than their asthmatic peers with alternative asthma treatments.  Conclusions . Asthma and increased healthcare use enhance school absenteeism. Inhaled steroid use and the higher parental education level were the most important predicting factors for good school performance in elementary school asthmatic children.

The Presence of Asthma, the Use of Inhaled Steroids, and Parental Education Level Affect School Performance in Children