Case Study 8.2: Middle School, Science
Ms. Huizenga teaches a seventh-grade general science course at a small private school located in a
large metropolitan area. She has developed a unit on the body systems with a particular focus on
how these systems can be affected by environmental conditions. Her primary goal is to have
students understand each system. In addition, she wants them to see how these systems can be
influenced by diverse factors, such as access to recreational opportunities for exercise or diseases
induced by air pollution. In part, her aim is to help students develop healthy practices that will
protect and strengthen the body systems they are learning about. This unit has allowed her to
address several science content standards and benchmarks, as well as those that focus on improving
content area reading—a particular goal in her school.
Ms. Huizenga’s students are studying the segment of her unit dealing with the respiratory
system. A small group is considering how asthma, a disease impacting children in disproportionate
numbers in their city, might be influenced by environmental conditions. These students are also
interested in learning how this disease can be managed. For today’s small-group lesson, Ms.
Huizenga has used a variety of sources to construct an information sheet on asthma, its impact on
individuals, and its management (see Figure 8.4).
Figure 8.4: Ms. Huizenga’s Asthma Information Sheet
What is asthma?
According to the American Lung Association, “Asthma is a chronic inflammation of
the airways with reversible episodes of obstruction, caused by an increased reaction
of the airways to various stimuli. Asthma breathing problems usually happen in
‘episodes’ but the inflammation underlying asthma is continuous” (American Lung
What is an asthma episode?
“An asthma episode is a series of events that result in narrowed airways. These
include: swelling of the lining, tightening of the muscle, and increased secretion of
mucus in the airway. The narrowed airway is responsible for the difficulty in
breathing with the familiar ‘wheeze’” (American Lung Association, 2005).
What can cause an asthma episode?
Many things can initiate an asthma episode. Some people have episodes that are
induced by exertion—such as exercise or participating in a sport. For others,
episodes can be triggered by a virus. Environmental conditions can also promote
asthma reactions. These conditions can range from pollens released into the air to
pollution from automobiles or smoke.
What are the treatments for asthma?
Currently there is no cure for asthma. Individuals who live with asthma need to learn
to manage this disease—both long-term and during episodes.
A variety of options exist.
Doctors: It is important for individuals with asthma to see their doctors regularly. At
these meetings, doctors can monitor asthma symptoms, medications, and treatment
Medications: Many individuals with asthma manage the disorder with medications.
These can range from daily pills and inhalers (medication delivered in vaporized
form and inhaled directly into the lungs) to injections of steroids.
Peak flow meter—a tool that measures the lung capacity of asthmatics. These meters
vary in size and shape. In all types, the individual blows into one end of the
instrument. The air flow is then measured by the meter. A doctor helps the
individual interpret the results. Typically, scores fall within three color-coded
ranges: green (healthy), yellow (caution), and red (danger). Depending on the
results, individuals follow the plan developed by their doctor.
Nebulizer—a machine that delivers vaporized medication into the lungs of
asthmatics as they inhale through a mouthpiece.
Rescue inhaler—a small instrument used to introduce medication into the lungs of
an asthmatic either during an asthma episode or prior to its onset, as directed by the
Environmental issues affect asthma.
Since many asthma episodes are triggered by environmental conditions, individuals
are urged to avoid or minimize certain types of exposure. In particular, exposure to
smoke, pollen, dust, mold, and animal dander can be problematic and should be
avoided by those who live with asthma.
Earlier in the year, Ms. Huizenga noted that a number of her students were struggling with
the structure of the informational text that dominates her content area readings. She believed that
student reading levels were adequate and that they could understand science concepts that were
presented orally. However, she suspected that her students had not had adequate work with
informational text in the past. In particular, they seemed to have difficulty responding to questions
beyond the Right There level. Therefore, Ms. Huizenga has worked with her students using the
QAR model with their textbook and primary source readings. As a result, her students have become
far better consumers of informational text. Specifically, they are able to use the QAR model and
related terminology to find information in a passage and connect it with other parts of a reading. In
addition, they are better at connecting information between texts and using their prior knowledge of
a topic. Pleased with these results, Ms. Huizenga has continued to emphasize QAR whenever
reading is done in her class.
In this Case Study, Ms. Huizenga is working with students who have decided to use the
relationship between asthma and the environment as the focus of a project on the respiratory
system. Although she has many content-related learning objectives for this unit, we will list only
the objective related to her use of the QAR model:
The learner will use QAR to demonstrate comprehension while reading and
discussing text about asthma.
Ms. Huizenga and the five students meet at a small table in the back of the room. Behind
them is a chart (similar to Figure 8.2) they developed when learning about QAR earlier in the year.
It shows each of the relationships and continues to be used as a reference tool for students as they
read and discuss text.
Ms. Huizenga: Today we are going to spend a little bit of time reading about
asthma to help you get started on your project. I have an
information sheet we are going to read today, but before we do
that, I thought it would be helpful to explore what you already
know about this disease.
Drew: Well, part of the reason that I wanted to do this project on asthma
is because my sister has asthma, and I already know some things
about it, but I also thought it might be good to learn more about it
Betsy: I know a lot of kids at this school who have asthma. One of the
girls on my softball team had an asthma episode during one of our
games, and I thought it would be good to know how to help her if
it ever happened again.
Michael: I read once in the newspaper that kids in this city have a lot more
problems with asthma than kids in other places, and they said it
had a lot to do with the air pollution from all the cars and buses. I
want to know if that’s true, and if it is, we should do something to
Ms. Huizenga: So we know that asthma affects a lot of people, and, according to
what Michael is telling us, that may be because we have more air
pollution in this city than in other places. If that is true, how do
you see this as related to the respiratory system?
Nicky: Well, air pollution is obviously not good for our lungs, which are
important parts of the respiratory system. I don’t know for sure,
but maybe it’s the dirty air that causes asthma, or it could just
make it worse. I know my friend Meg can’t be around people who
are smoking or even around campfires because they cause her to
have asthma problems.
Ms. Huizenga: That seems to be a good connection between what we are learning
about the respiratory system and asthma. I just want to point out
here too that it is clear that you already know a lot about asthma.
Using our QAR language for this, we could say that your answers
to my questions were developed on your own, right? As we read
this information sheet, I just want to remind you to use the
question-answer relationships we have explored to help you
understand this sheet and increase your understanding of asthma.
Let’s go ahead and start reading. (She distributes the information
sheet to the students.) I think it might be useful if we start by
reading parts of it together out loud. Any volunteers?
Ian: Sure. I’ll start. (He reads.) What is asthma? According to the
American Lung Association, “Asthma is a chronic inflammation
of the airways with reversible episodes of obstruction, caused by
an increased reaction of the airways to various stimuli. Asthma
breathing problems usually happen in ‘episodes’ but the
inflammation underlying asthma is continuous.”
Ms. Huizenga: Okay, let’s stop there for a minute. That definition is quite a
mouthful. Let’s see if we all understand it before we go on. Tell
me what you think this definition of asthma is saying.
Drew: One thing it says right there in the first sentence is that it is an
inflammation of the airways. I know that sometimes when things
get inflamed, they swell up, because that happened to my toe one
time when I had an infection.
Betsy: It also says that it is chronic. I have chronic bronchitis, which
means that I keep getting it. So that must mean that the
inflammation keeps happening—which seems to make sense.
Ms. Huizenga: Nice work there. You’ve said that the author told you that it is a
chronic inflammation. And then you used your own experiences
with a toe and repeated bronchitis to figure out what that phrase
Ian: It also says that there are reversible episodes of obstruction. I was
watching this show on television last night, and this lady was
choking. The doctor said that she had an obstruction in her throat,
instead of just saying that she was choking. So, an obstruction
must mean that there is something in the way so that the air can’t
get through, and with asthma it can be reversed so that you can
Nicky: It also says that inflammation is caused by a reaction to various
stimuli. We learned about stimuli last month when we where
talking about things like food and salivation. That makes me think
that things in the environment could be the stimuli; things like
smoke or other pollution.
Ms. Huizenga: Makes sense to me. You’ve done a nice job again of using the
words on the sheet and also using your own experiences to figure
this one out. Let’s try reading the next two sections silently, and
then we can talk about them. (The students read the sections
entitled “What is an asthma episode?” and “What can cause an
Drew: Well one thing I noticed is that the author says here that an asthma
episode is a series of events that result in narrowed airways. So, if
you put that together with what they said before about the
inflammation, it would mean that the airways swell up and that’s
what makes it hard to breathe during an asthma episode.
Michael: Yes, and it also says here that one thing that can trigger an asthma
episode is air pollution. That fits with what Nicky was saying
earlier about how smoke and other kinds of pollution can be the
stimuli for an asthma episode.
Betsy: Right. Of course it also mentions that other things that aren’t part
of the environment can cause asthma episodes too, but now we
know that air pollution is one of the things that cause people to
have an asthma episode.
Ms. Huizenga: Again, you are doing a really fine job of reading carefully and
putting information from different sections together to find what
you are looking for. Now I’m curious. Does what you have read so
far tell you what causes asthma or how to cure it?
Ian: Well, it doesn’t really say that. So far, this sheet just says what
causes someone to have an asthma episode, but it doesn’t really
say what causes the disease itself or how you would cure it.
Ms. Huizenga: Try reading this next section with those questions in mind. Again,
let’s just each read silently. (They all read the section entitled
“What are the treatments for asthma?” on their own.)
Nicky: Well, in the first line of this section it answers part of that question
you asked us to think about. The author tells you that there is no
cure for asthma. It doesn’t really say what causes someone to have
it, though, and I am guessing that they probably don’t know, and
that is why they don’t have a cure for it.
Michael: Yeah, the rest of it talks about how to manage asthma, not how to
cure it. And when you manage something, you are controlling it.
Like my dad is the manager of his department at work, and he just
tries to keep things moving along and avoid problems. So, the
author gives ways to prevent problems with asthma and what to do
if you have an episode.
Betsy: Right, and the author does say that avoiding certain things in the
environment that can trigger an asthma episode is one way to
manage asthma. That could be the focus of our project. We could
talk about how air pollution causes asthma episodes and what
people could do to help eliminate some of those things in our
Ian: We could talk about how air pollution impacts the lungs and other
parts of the respiratory system for all of us, but especially how and
why it can be a problem for someone with asthma. Then we could
talk about what we can do about it.
Ms. Huizenga: Sounds to me like your reading of this information sheet has
given you some good links between our study of the respiratory
system and your project on asthma. I think you are ready to
continue. One last thing I’d urge you to do is to go to the Web site
for the American Lung Association that is listed on the
information sheet to get even more information on asthma and its
impact on the respiratory system.
Case Study 8.2: Post-Lesson Reflection
In this lesson, Ms. Huizenga demonstrated her beliefs that students need to master seventh-grade
science content and that she has a responsibility to teach reading in her content area. Her use of the
QAR model was designed to do both. Although Ms. Huizenga had often heard the saying that
students learn to read in the first few grades of school and then read to learn in middle and high
school, she did not embrace this way of thinking, nor did her school district. Students at all levels
need opportunities to enhance their reading skills. While many students are excellent consumers of
narrative stories (a particular focus in many elementary classrooms), they struggle with
informational text. Narrative and informational texts do not have the same structure, and each needs
to be learned for competent reading fluency and comprehension. Given that many content areas at
the secondary level rely heavily on such informational texts, it is imperative that secondary teachers
use various reading models and strategies to ensure their students’ comprehension of these texts.
Ms. Huizenga’s use of this model sounded quite different from the use of QAR in Case
Study 8.1. In her classroom, students talked about question-answer relationships with some
references to the terminology used in the QAR model she was employing, but they did so very
informally. The students in Case Study 8.1 were learning to use the model. To ensure clarity and
accurate use of the model, repeated use of the terminology of QAR was important. Ms. Huizenga’s
students had been using the model for quite some time and had integrated it into the way they read
and discussed text. As a result, they were able to talk casually about question-answer relationships.
Second, secondary students can sometimes respond to repeated uses of terminology, such as On My
Own and In My Head, with something less than enthusiasm. Developmentally, they can benefit
from an initial use of such terms and phrases, but once they have integrated the underlying
concepts, they may prefer to express them in words they find more appropriate.
This case study also demonstrated clearly the use of On My Own questions and answers to
set the stage for reading the text (Raphael, 1986). At the beginning of the lesson, Ms. Huizenga told
the students to explore with each other what they already knew about asthma from their own
experiences before they read the information sheet. This allowed the ensuing discussion to both
frame the reading and activate students’ prior knowledge of the topic. Both are important ways to
strengthen comprehension of text to be read. We encourage the use of On My Own questions and
answers in this way when appropriate.
Finally, Ms. Huizenga encouraged students’ responses by avoiding yes-no questions. For
example, after the students had read the first section of the information sheet, Ms. Huizenga said,
“Tell me what you think this definition of asthma is saying.” This prompted the students to actively
explore what the author said and to use their own experiences to enrich the text. In contrast, a
question such as “Does the author provide a definition for asthma?” could result in a simple yes
response that functions at the lowest level of most taxonomies of thinking about and responding to
text. If you want your students to respond at higher levels, practice reframing your questions.