Berryville School District
Berryville, AR
Health Management for Schools Series

Web page 1: Asthma

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     What is Asthma?

In people with asthma, triggers cause the air passages to spasm, swell, and secrete extra mucous.  These changes force an individual to exert more effort to breathe.  In more severe cases, these changes can lead to complete airway obstruction. 

Asthma is a complex disorder involving many factors. Heredity and allergic tendencies are thought to be the strongest predisposing factors in the development of asthma.  This condition is more common in African-American and Hispanic individuals and typically appears between the ages of 2 - 8.  It is NOT contagious, but it is a chronic health problem – one an individual usually does NOT outgrow.

Implications: Asthma management must become a commitment. In the U.S., asthma is the number one chronic illness in children.  It also is the leading cause of hospital admissions and school absences in children.  Clearly, asthma can affect a child’s learning, self-confidence, and psycho-social development. 

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Symptoms of Asthma

The frequency and severity of asthma symptoms vary among individuals.  Some people are symptom-free most of the time. Others suffer from severe, recurrent attacks.  Symptoms commonly experienced during an episode of asthma include:

• Shortness of breath
• Cough
• Anxiety
• Chest tightness
• Wheezing – especially when the individual exhales

In more severe cases of asthma, muscles of the chest and neck may be needed to move air in and out of the lungs.  Individuals may lean forward in their chairs to help them breathe, signaling that they are working hard to breathe.  They may speak only a few words before stopping for breath, and they may exhibit signs that they are not getting enough oxygen:

• Confusion
• Sluggishness
• Exhaustion
• Difficulty walking
• Pallor (pale skin) or cyanosis (bluish-colored skin)
• These symptoms indicate that an emergency exists!
• The individual’s emergency plan should be initiated immediately!

For additional reading, a copy of Allergic Asthma for Dummies is available in nurse’s office, compliments of the Allergy and Asthma Network/Mothers of Asthmatics. Visit them at: http://www.aanma.org

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 Drug therapy may include oral, inhaled, and/or injected medicines.  These medicines may be taken every day, just before exercising, and/or during an asthma attack.  Sometimes, individuals use a combination of medicines for asthma control.
 
Implications: Every student with asthma should have an individualized asthma plan on file in the school.  The plan should include information on the student’s asthma medicines and directions for their use.  The plan also should clearly address what to do in an emergency situation. 

If a student uses an inhaler, the plan should address whether the student can carry the inhaler with them or where (and with whom) it should be kept. Inhalers must be used correctly, otherwise they are extremely dangerous.   

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For more information on asthma action plans, visit the website of the American Lung Association: http://www.lungusa.org Visit your school nurse for additional information on asthma action plans.

The Impact of Asthma on the Individual

1. Students may feel self-conscious about leaving class or visiting the nurse for asthma treatment.
2. Student’s academic progress may suffer due to frequent absenteeism.
3. Asthma medications may interfere with students’ thinking and concentration skills.
4. Medications may cause a delay in puberty and physiologic growth, negatively affecting self-esteem and self-image.
5. Students may feel isolated from their peer group, especially if the treatment plan includes certain restrictions.
6. Students may use asthma to avoid activities (physical activity generally is NOT limited).
7. Asthma may place a strain on the financial resources and functioning of the student’s family.
8. The school environment may be a source of triggers that aggravate asthma symptoms.
   
   Implications: Be aware of students’ restrictions and the impact of the environment (indoor/outdoor) on their health. Be cognizant that asthma can have an effect on a student’s psycho-social development and on family dynamics.

To determine if your classroom is asthma-friendly, visit the National Asthma Education and Prevention Program website at http://www.nhlbi.nih.gov/about/naepp.

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Management Strategies

For Parents of Children with Asthma 

1. Complete ALL school forms in a timely manner, including the health and emergency cards.
2. Update school forms whenever changes occur.
3. Provide the school with emergency instructions and current telephone numbers where you, your child’s doctor, and other emergency contacts can be reached.
4. Provide the school with your child’s prescribed medication and directions for use. All medications should be clearly labeled with your child’s name and physician directions.
5. If your child has a life-threatening allergy, provide the school with an emergency adrenalin kit (EpiPen or Ana-Kit).  Make sure school staff has been correctly trained in its use.  Also make sure your child is trained in the use of these devices, if possible.
6. Educate your child on the importance of keeping an inhaler or adrenalin kit safe and out of the hands of other children.
7. Include the cafeteria and lunchroom staff in the asthma action plan, especially if your child has food allergies.  Provide workers with a picture of your child and a list of food triggers.
8. If necessary, request ingredient lists of school meals from cafeteria staff.
9. For class parties and special occasions, provide special treats your child can have.  You may wish to send enough treats to share with the entire class.
10. Although asthma can be frightening, empower your child to learn about asthma, asthma triggers, early warning signs of asthma attacks, proper use of medications, and healthy lifestyle choices.
11. Consider having your child wear a medical alert bracelet or necklace at all times.

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For Faculty and Staff of Students with Asthma

1. Learn about asthma and the needs of your individual students with asthma.
2. Request individualized, asthma action plans for ALL students with asthma. Obtain a copy of your students’ action plans for your files.  All teachers working with the students should receive copies as well.
3. Request that student photos be attached to asthma action plans.
4. Ensure that all staff – including substitute teachers, PE teachers, coaches, cafeteria workers, teaching assistants, clerical staff, administrators, school volunteers, and bus drivers – have access to and understand their role in students’ asthma action plans.
5. Request development of a school-wide asthma management protocol. 
6. Attend all in-services on asthma management.
7. Regularly review management strategies for which you may be responsible (i.e., identifying signs of an attack, administering medication, supervising medication administration, obtaining peak flow measurements, and initiating the emergency action plan).
8. Monitor the school environment for the presence of asthma triggers. 
9. Avoid bringing cleansers, air fresheners, or other chemical substances from your home to the school.  
10. Avoid using pens, paints, and/or glues that create irritating fumes. 
11. Refrain from wearing heavy perfume or cologne to school.
12. Avoid in-door plants in the classroom.  These encourage the growth of mold.
13. Avoid carpets or upholstered furniture in the classroom.  These harbor dust mites.
14. Avoid feathered and furry pets in your classroom.  These are common triggers.
15. Refrain from smoking on school grounds – even when students are not present.
16. Report water leaks, cockroaches, mice, mold, and other environmental problems immediately to the maintenance crew. 
17. Use non-latex, protective gloves if students in your school have latex allergies.
18. Keep classroom windows closed when pollen, spores, and pollution levels are high.
19. Review students’ asthma action plans prior to field trips.  Review management and emergency protocols prior to leaving school.  Make sure all necessary medications and asthma action plans are brought along.
20. Develop a supportive and CONFIDENTIAL environment for students with asthma.  Don’t embarrass students about the need to care for their asthma at school.
21. If a student is having an asthma attack, DON’T panic!  Help students stay remain calm by talking to them and staying with them.  Quickly consult their asthma action plan and obtain necessary assistance.  When directed, administer asthma medications or supervise administration of medications as ordered.  Contact emergency services (or delegate staff to call 9-1-1) when necessary.  Follow school policy regarding documentation.

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For Health Care Professionals

1. The health care provider (HCP) is responsible for the diagnosis, treatment, and on-going evaluation of a child’s asthma. 
2. The HCP develops individualized asthma action plans for children with asthma and shares these plans with school personnel.  Generally, the school nurse is the liaison between the school and HCP.
3. The asthma action plan should clearly communicate how and when to administer medication or other treatments during the school day. The plan also should provide the school staff with the steps to take in an emergency.
4. The HCP communicates changes in a student’s treatment regimen to the appropriate school personnel – frequently the school nurse.  The nurse, in turn, documents and shares these changes with faculty and staff with the need to know.
5. The school nurse provides education and training to school staff on asthma, signs and symptoms of an impending attack, proper use of medications, and protocols for an attack or emergency.
6. When the school nurse is on campus full-time, the nurse generally is responsible for administering medications. However, back-up personnel must be identified and trained in this skill for times when the nurse is not present.
7. As a liaison between the school and medical community, the school nurse also is responsible for monitoring students’ health throughout the school day.  This may involve assessment of breath sounds, breathing patterns, vital signs, and peak flow measurements. The school nurse also monitors the efficacy of the asthma treatment plan and communicates concerns with parents and the student’s HCP.
8. As a student advocate, the nurse serves as an important resource person on asthma services and programs available at the local, state, and national levels.
9. The school nurse remains current on federal and state mandates as well as on nursing and school policies and guidelines and incorporates this knowledge into a student’s plan of care.

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Asthma Resources

For more school management strategies, visit “Breatherville, USA,” available on the National Allergy and Asthma Network/Mothers of Asthmatics web site: http://www.aanma.org.

PDF articles and Power Point slides on asthma are available on the National Asthma Education and Prevention Program web site: http://www.nhlbi.nih.gov/about/naepp. 

An interactive resource bank is available on the Allies Against Asthma website: http://www.asthma.umich.edu.

A guide for managing asthma in the schools is available as a PDF document on the Center for Disease Control website: http://www.cdc.gov/asthma.default.htm

A downloadable book and coloring pages are available for classroom use on the web site of the American Academy of Allergies, Asthma, and Immunology: http://www.aaaai.org.

                                                                              References

DeStefano-Lewis, K., & Bear, B.J. (2002). Manual of school health (2^nd Ed.). St. Louis:  Saunders.

Mesec, A.L. & Fraser, C.H. (1997). Serious illness in the classroom: An educator's guide. Englewood, CO: Libraries Unlimited. Retrieved September 22, 2004, from    http://www.netlibrary.org.

Velasco-Whetsell, M., Coffin, D.A., Lizardo, L.M., MacDougall, B.J., Madayag, T.M., & Marcus, M.S. (2000). Pediatric nursing. New York: McGraw-Hill.

Wong, D.L., Hockenberry-Eaton, M., Wilson, D., Winkelstein, M.L., & Schwartz, P. (2001).   Wong’s essentials of pediatric nursing (6^th Ed.). St. Louis: Mosby.

Written: October 5, 2004
Last Updated: February 8, 2005
S. Verwey, R.N.
Graduate Student
Southwest Missouri State University
Springfield, MO

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Disclaimer: This page was created for the faculty and staff of the Berryville School District for informational purposes only.  The information provided on this page should never be substituted for evaluation and treatment by a qualified health care provider.