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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: