Download Asthma Action Plan

Asthma Action Plan
Trigger avoidance
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Viral illnesses: hygiene and flu shots!
Allergens
Irritants: especially secondhand smoke!
Internal triggers: GERD/rhinitis/sinusitis
Medications: b blockers, ASA/NSAID,
sulfites
• Advocate for environmentally friendly
schools (including infection control!)
Ways schools can help
• Asthma education for
all students
• Monitor adherence
• Implement action
plans
• Facilitate
communication
• Reduce triggers
• Counseling
• Prevent EIB
• Encourage physical
activity
• Dietary instruction
• Teach respect of
differences among
children
• Monitor asthma in
staff members
Communication with schools
• Acknowledge operational definition of “health”
that may differ from yours
• Adapt language, avoid acronyms
• Make no assumptions about a program or
staffing for healthcare in schools
• Be aware that staff morale may be low
• Realize that funding is decreasing while demand
for healthcare programs is increasing
• Consider unified chronic disease approach to
policymaking
Inner-city asthma interventions
• Home interventions to reduce allergen exposure
result in fewer days with asthma symptoms;
effect similar in magnitude to that reported from
trials of ICS (Morgan et al, NEJM
2004;351:1068-80)
• School-based health center improves access to
optimal asthma care, improves self management
practices, decreases hospitalizations (Lurie et al,
J Sch Health 2001;71:9-16)
– Similar findings with BreathmobilesTM (Jones et al, Dis
Management 2005;8:205-22)
Inner-city asthma interventions
• Computer-assisted instruction improves
asthma self-management, reduces
symptoms and hosps, improves functional
status (Bartholomew et al, Patient Educ
Couns 2000;39:269-80)
• MSW intervention reduces asthma
symptoms, hospitalizations (Evans et al, J
Pediatr 1999;135:332-8)
Inner-city asthma interventions
• Harlem Children’s Zone Asthma Initiative
(interdisciplinary team providing medical,
educational, environmental, social, legal
services): decreased school absences and ED
visits (MMWR 2005;54:11-14)
• Inhaled steroids at school: improved QOL,
reduced absence, fewer symptoms in those not
smoke-exposed (Halterman, et al, Arch Pediatr
Adolesc Med 2004;158:460-7)
Schools
• Schools are children’s workplaces
• Children may spend up to 40 hours a
week in a school building
• School buildings are generally more
densely occupied than commercial offices
• Our school buildings in the US are growing
older
– Mean age = 40-50 yrs
• Employees have occupational health and
safety laws designed to protect an
environmentally safe and healthy
workplace
– These standards are set for healthy adults
• No ‘occupational’ health and safety
standards have been set to protect
children in schools
Air-borne pollutants in schools:
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Dirt
Dust
Lead
Asbestos fibers
Chemical fumes
Tar fumes
Diesel fumes
People
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Carbon monoxide
Other gases
Pesticides
Bacteria
Mold
Contaminants from
photocopiers &
computers
• Pest droppings
Health Issues for You &
Children in Schools
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Irritation of eyes, nose, throat
Dry mucous membranes and skin
Fatigue, headache, sleepiness
Airway infections, cough
Hoarseness, wheezing
Sinus problems
Nausea, dizziness
Asthma attacks
• Children are among the most
vulnerable groups to environmental
threats
• They may be exposed to higher
levels of contaminants
• Organs are still developing &
growing
– Brain growth
– Lung growth
• Immune defenses not fully developed
• Relative to the size of adults:
– Eat more food, drink more water
– Breathe more air
Sources of Environmental Health
Hazards for Children
• Sensitizers and/or Triggers for
Asthma
• Secondhand smoke exposure
• Lead
• Asbestos
• Pesticides and other Chemicals
• Radon
Sensitizers and/or Triggers for
Asthma
• Ambient Ozone
• Indoor Allergens
• Indoor Combustion Products
Combustion Products
• Sources
– Unvented Space Heaters
– Smoking—Secondhand smoke
– Fire Places
– Internal Combustion Engines
• Combustion Products
– Particulate Material, including PM 2.5
– Sulfur and Nitrogen Oxides
– Carbon Monoxide
– Formaldehyde
Pesticides and Other
Chemicals
• Home use of chemicals
• School use of chemicals (exposure & use)
• Chemicals from the ambient environment
– Industrial Wastes
– Accidental Releases
School Use of Chemicals
• Adhesives
• Cleaning
Products
• Disinfectants
• Pesticides
• Waxes
• Air Fresheners
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Cosmetics
Strippers
Caulking
Degreasers
Paints
Varnishes
Imagine, What If:
• Several classrooms are closed at your school after a mold
aggravates allergies, sparks illnesses, and a leaky roof spreads the
problem
• You notice strong odors in a classroom after a science experiment
• You notice poor air exchange in one room, but good air exchange in
most of the rooms in one hall, children in the classroom with poor air
exchange have more complaints of allergy and asthma symptoms
• A student becomes ill after being exposed to chemical fumes after a
floor is cleaned in a classroom
• Teachers and students in your school start to complain of fatigue,
asthma attacks, problems with allergies, sinus problems and
headaches
Why School Environments?
• Indoor air pollution can be found in all
types of buildings, even schools
• Approximately 55 million people spend
their days inside of schools
• Indoor Air Quality has been reported as
unsatisfactory in about 1/4 of public
schools