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Asthma Intervention In and For
Schools, Preschools, and Afterschool Programs
APHA 132nd Annual Meeting
Elisa Nicholas, MD, MSPH
Maura Dwyer, MPH
Asthma can significantly disrupt
the education process
• 2-3 children in every classroom are likely to
have asthma
• 14 million school days are lost annually to
asthma (leading cause of missed school days
due to chronic disease)
• National survey of nurses found asthma is
more disruptive of school routines than any
other chronic condition
• Many staff lack awareness of asthma
Federal laws (IDEA 1997 and Section 504 of the
Rehabilitation Act of 1973) require schools to
promote the health, development and
achievement of students where the disease
interferes with their learning and to remove
“disability barriers,” like poor indoor air quality,
which impede health, participation, and
academic and/or extracurricular success.
Improvement of care for children with
asthma must take place where children
live,
learn,
and play.
“Asthma is a multi-faceted medical problem but
also a community problem and public health
problem. No single intervention is going to
decrease rates of asthma . . .It needs this type
of community coalition to have a real impact.”
Long Beach Coalition Member
Participatory planning process
involved stakeholders from:
• Schools - school nurses, asthma nurses,
principals, superintendent, deputy
superintendent, parent resource centers, PTA
• Preschools - Head Start, YMCA
• After School Programs - YMCA, Parks and
Recreation, Boys and Girls Club, Campfire
Girls, Scouts
• Childcare Programs/Networks
Engagement
 Tiered approach (top down and bottom up):
Utilized existing relationships and networks
Coalition leaders engaged Superintendents,
Principals and Program Directors
Parent leaders engaged School Parent
Resource Centers
Principals/Directors ensured access to lead
staff (nurses, health aids)
Presented at multi-site meetings
“On-board” programs/schools influenced others
Identified needs
Adequate understanding of asthma
Ability to recognize signs of distress
Plan for responding to an asthma emergency
Plan for children to access medications
Understanding of how to reduce environmental
asthma triggers on site
Asthma Action Plans
Coordination and communication between
family, provider and community efforts to
manage asthma
Policies and procedures for modifying activity
on poor air quality days
Interventions: Policies,
Procedures and Guidelines
Policies/guidelines for responding to an asthma
emergency
Policies for accessing medications (on-site, field
trips)
Policies for coordinating with family, provider and
community efforts
Environmental assessment checklist
Interventions: Policies,
Procedures and Guidelines
Policies regarding environmental triggers (pets)
Policies for annual staff asthma training
Policies and procedures for modifying activity on
poor air quality days
Asthma surveillance in schools
WHAT TO DO IN AN ASTHMA EMERGENCY IN CHILDREN
SIGNS OF AN ASTHMA
EMERGENCY
PERSISTENT OR WORSENING ASTHMA SIGNS OR SYMPTOMS
 EXTREME DIFFICULTY
BREATHING AND TALKING DUE TO
SHORTNESS OF BREATH
 UNCONTROLLED COUGH
1
2
3
 SEVERE CHEST
TIGHTNESS
 CAN’T TALK, WALK, OR
MOVE WELL
 LIPS OR FINGERNAILS
TURN BLUE
 DO NOT LEAVE THE CHILD ALONE
 CALM THE CHILD
 SEAT CHILD UPRIGHT
 ADMINISTER QUICK-RELIEF
MEDICINE (ALBUTEROL)
IMMEDIATELY
 FOLLOW THE CHILD’S ASTHMA
ACTION PLAN
 IF ASTHMA SIGNS DO NOT
IMPROVE IMMEDIATELY
CALL 911 OR GO TO THE NEAREST
EMERGENCY ROOM
Created by the Long Beach Alliance for Children with Asthma and The Children’s Clinic
For more information (562) 427-4249
Interventions:
Curricula
Open Airways for Schools (ALA)
Alvi’s Awesome Lung Adventure - one-week
science based respiratory health curriculum
(FAM)
A is for Asthma (ALA)
EZ Breathers (ALA)
Smokeless Homes (PAAA)
Interventions:
Education
Classes/Training
Asthma 101/Asthma Basics for staff
Asthma Management Training for nurses,
clinic staff and health educators (FAM)
Asthma Survival Skills classes for families
(FAM)
Exercise and Asthma Training for coaches, PE
teachers, and recreation staff (FAM)
Interventions:
Special Programs/Activities
Tools for Schools (EPA)
Awesome Asthma School Day field trips (FAM)
Air Quality Flag Program (LBACA)
Interventions:
Materials
Asthma Jeopardy Game
Asthma Action Plans
“All About Asthma” pamphlet
“Asthma Triggers” pamphlet
“What to do in an Asthma Emergency” posters
“Asthma Control Test”
“Tips for Watching Students at Play”
“What is Exercised Induced Asthma?”
Messages to Parents
Notify the classroom teacher, school nurse, PE
teacher, babysitter and coach about your child’s
asthma
Talk to them about:
your child’s triggers
when to use medicine and how
encouraging participation in physical activities
what to do in an asthma emergency
Only keep your child home if the wheezing is bad
or he/she has a fever or sore throat
Take the Asthma Action Plan to your child’s
teacher, school nurse, PE teacher, babysitter and
coach
We C.A.N. Control Asthma Now
“Training of Trainer”
Health Education Materials
Sponsored by:
The Long Beach Alliance for Children With
Asthma
And
The Children’s Clinic
Serving Children and Families
Is your asthma “controlled”?
Take the 30 Second Asthma Control Test
1. In the past 4 weeks, how much of the time did your asthma keep you from getting as much
done at work or at home?
 None of the time
 Some of the time
 A little of the time
 most of the time
 all of the time
2. During the past 4 weeks, how often have you had shortness of breath?
 Not at all
 3 to 6 times a week
 Once or twice a week
 once a day
 more than once a day
3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness
of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?
 Not at all
 Once a week
 Once or twice
 2 to 3 nights a week
 4 or more nights a week
4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication
(such as albuterol)?
 Not at all
 A few times a week
 Once a week or less
 1 or 2 times per day
 3 or more times per day
5.
How would you rate your asthma control during the past 4 weeks?
 Completely controlled
 Somewhat controlled
 Well controlled
 Poorly controlled
 Not controlled at all
If you checked any blue answers, your asthma may not be well
controlled. Be sure to talk to your healthcare professional about
your asthma treatment plan.
Developed by: ASTHMA ACTION AMERICA (www.AsthmaActionAmerica.org)
For More information call:
Long Beach Alliance for Children with Asthma
562-427-4249
Developed by: ASTHMA ACTION AMERICA
Asthma Jeopardy could be played in team of two or more. The questions are separated
into asthma categories and range from $100-$400. Write the asthma categories and price
ranges on
the board and keep the questions and answers.
Asthma Facts
$100
A condition in the lungs that
makes breathing difficult
$200
Two common asthma triggers.
$300
Two types of asthma medicine
$400
Three things that occur to the
airways during an asthma
attack?
$500
The number of children in the
United States affected by
asthma
$600
You should take this type of
medicine everyday
Triggers
$100
Cigarette smokes, Perfumes,
nail polish are examples of
what kind of trigger.
$200
Things that may bother the
airways, making it hard to
breathe or cause Asthma
signs.
$300
Small microscopic animals
that live in mattresses, teddy
bears, on our skin, anywhere
there’s dust
$400
These pests have been in
existence since before the
dinosaurs and their bodies and
spray are what cause an
allergic reaction
$500
This allergen grows best in
humid and dark locations.
$600
These cuddly animals produce
allergens because of the
dander that is found on there
furry coats
Solutions to Triggers
$100
Storing food in these could
keep cockroaches from
coming around
$200
Washing stuffed animals in
water hotter than 130 F kills
these triggers.
$300
Mixing water and what
solution is effective in killing
mold spores
$400
If you have exercise induced
asthma how long before you
exercise should you take your
medicine
$500
One of most recommended
and preferred methods of
getting rid of roaches
$600
If a child with asthma lives
with a smoker, where is the
best place to smoke
M Y ASTHM A ACTION PL AN:
C hild ’s N a me: ____ ______ ______ ______
D. O. B. : __________ ______ _______ ____ MD/ NP’s
S ig nat ure:________ ______ ______ _
Dat e Co mp let ed :_____ ______ ____
I give permission for the school nurse or designated school personnel to assist my child with
the Asthma Action Plan. I also give permission for school personnel to exchange information
with the physician regarding my child’s asthma.
Guardian’s Signature:_____________________
Pe rsona l B e st Pea k F low: _____ ___
You can use the co lo rs o f the t ra ffi c light to help you lea rn to cont ro l
you r Asth ma!
GREE N = GO!
 Breat hing is go o d
 No co ugh o r whe eze (w hist le
no ise)
 Ca n wo rk o r p la y a s no r ma l
OR
Peak Flo w Nu mber is:
_______ to _______
80%
100%
YELLOW = SLOW DOWN
Tight Chest
Cough
Wheezing
OR
Peak Flow Number is:
_ _ _ _ _ _ _ to _ _ _ _ _ _ _
60%
79%
RED = STOP





Med ic ine is no t he lp ing
Ca n’t t alk, wa lk o r mo ve w e ll
Ha ve e xt re me d iffic u lt y bre at hing
Severe c hest t ig ht ne ss
Unco nt ro lle d co ugh
OR
Peak Flo w N u mber is:
______ to ______
0%
59%
Use L ong-Te rm- Cont ro l M edicine
EVE RYDA Y to ke ep Asth ma in chec k!
Med ic ine
Ho w Muc h
Whe n
____________________________________
____________________________________
____________________________________
E xercise Indu ced Asthma 20 mi nutes befo re spo rts:
__________________________
__________
__________________________________________
__________________________________________
__
Take
Quick-Relief medicine to stop
your Asthma from getting worse!
1) Cont inue medicine in GREEN ZONE
2) St art Albutero l (inha ler with
spa cer/ spa cer w ith ma sk)
right a wa y – 2 sprays, then every 4-6
hours as needed.
3) If yo u a re in the Yello w Zo ne
a nd ha ve no impro vement in
6- 12 ho urs even a fter using
Albutero l – ca ll yo ur do cto r.
_____________________________________
_____________________________________
_________________________________
1)
2)
3)
4)
Take Quick-Relief Medicine and get
help from a doctor now!
St art Albute ro l right awa y – 2 spra ys
Go to The Clinic-Nur s ing St at io n
OR if closed, go to the Emergency
Room/Call 911
Make a fo llo w up appo int me nt at t he
Clinic for the following day if you went to the ER
Co nt inue t ak ing med ic ine in GRE E N ZO NE
Challenges
 Confidentiality issues
 Time
 Lack of shared vision
 Differing priorities
 Specialization
 Inadequate resources
 Turf issues
 Liability
 Conflicting mandates
 Divergent professional perspectives
Summary
1) Determine common goal
2) Assess your community - where are the kids?
3) What policies, procedures, training and
knowledge exist?
4) Tailor the interventions to your community
5) Utilize existing relationships and networks
6) Respect for and recognition of each individual’s
expertise, experience and skills
Summary
7) Utilize existing resources (i.e. Tools for Schools)
8) Nurture key relationships
9) Engage leadership
10) Constantly re-assess
11) Be observant, patient, persistent and offer quality
products and support!
12) Celebrate your successes!
The Faces of Asthma
For more information: