Asthma Intervention In and For Schools, Preschools, and After-

school Programs

APHA 132nd Annual Meeting

Elisa Nicholas, MD, MSPHMaura 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 networksCoalition leaders engaged Superintendents, Principals

and Program DirectorsParent leaders engaged School Parent Resource

CentersPrincipals/Directors ensured access to lead staff (nurses,

health aids)Presented at multi-site meetings“On-board” programs/schools influenced others

Identified needsAdequate understanding of asthmaAbility to recognize signs of distressPlan for responding to an asthma emergencyPlan for children to access medicationsUnderstanding of how to reduce environmental

asthma triggers on siteAsthma Action PlansCoordination and communication between family,

provider and community efforts to manage asthmaPolicies 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 trainingPolicies and procedures for modifying activity on

poor air quality daysAsthma surveillance in schools

W H A T T O D O I N A N A S T H M A E M E R G E N C Y I N C H I L D R E N

P E R S I S T E N T O R W O R S E N I N G A S T H M A S I G N S O R S Y M P T O M S

12

3

S I G N S O F A N A S T H M AE M E R G E N C Y

D O N O T L E A V E T H E C H I L D A L O N E C A L M T H E C H I L D S E A T C H I L D U P R I G H T

A D M I N I S T E R Q U I C K - R E L I E FM E D I C I N E ( A L B U T E R O L )I M M E D I A T E L Y

F O L L O W T H E C H I L D ’ S A S T H M AA C T I O N P L A N

I F A S T H M A S I G N S D O N O TI M P R O V E I M M E D I A T E L YC A L L 9 1 1 O R G O T O T H E N E A R E S TE M E R G E N C Y R O O M

C r e a t e d b y t h e L o n g B e a c h A l l i a n c e f o r C h i l d r e n w i t h A s t h m aF o r m o r e i n f o r m a t i o n ( 5 6 2 ) 4 2 7 - 4 2 4 9

E X T R E M E D I F F I C U L T YB R E A T H I N G A N D T A L K I N G D U E T OS H O R T N E S S O F B R E A T H

U N C O N T R O L L E D C O U G H

S E V E R E C H E S TT I G H T N E S S

C A N ’ T T A L K , W A L K , O RM O V E W E L L

L I P S O R F I N G E R N A I L ST U R N B L U E

C r e a t e d b y t h e L o n g B e a c h A l l i a n c e f o r C h i ld r e n w i t h A s t h m a a n d T h e C h i l d r e n ’ s C l i n i cF o r m o r e i n f o r m a t io n ( 5 6 2 ) 4 2 7 - 4 2 4 9

Interventions:

CurriculaOpen 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/TrainingAsthma 101/Asthma Basics for staffAsthma 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 GameAsthma 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 ParentsNotify the classroom teacher, school nurse, PE teacher,

babysitter and coach about your child’s asthmaTalk to them about:

your child’s triggerswhen to use medicine and howencouraging participation in physical activitieswhat 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 A lliance for Children WithA sthma

A nd

The Children’s ClinicServing Children and Families

D evelo ped by: A STH M A A CT IO N A M ER IC A ( www.A sthm aA ctio n A m erica.o rg) F o r M o re in fo rm atio n call:L o n g B e a c h A llia n c e f o r C h i ld r e n w it h A st h m a562-427-4249

I s yo u r asthm a “co n tro lled”?Take the 30 Seco nd A sthm a Control Test

1. In the past 4 weeks, ho w m uch o f the t im e did yo u r asthm a keep yo u fro m gett in g as m uchdo ne at wo rk o r at ho m e?

N o n e o f the tim e A litt le o f the t im e

So m e o f the t im e m o st o f the t im e all o f the t im e

2 . D urin g the past 4 weeks, ho w o ften have yo u had sho rtness o f breath? N o t at all O nce o r twice a week

3 to 6 tim es a week o n ce a day m o re than o nce a day

3. D urin g the past 4 weeks, ho w o ften did yo u r asthm a sym pto m s ( wheezing, co ughin g, sho rtnesso f breath, chest t ightn ess o r pain ) wake yo u up at n ight o r earlier than usu al in the m o rn ing?

N o t at all O nce o r twice

O nce a week 2 to 3 n ights a week 4 o r m o re n ights a week

4 . D urin g the past 4 weeks, ho w o ften have yo u u sed yo u r rescu e inhaler o r n ebu lizer m edicat io n( such as albutero l) ?

N o t at all O nce a week o r less

A few t im es a week 1 o r 2 t im es per day 3 o r m o re t im es per day

5. H o w wo u ld yo u rate yo u r asthm a co n tro l du ring the past 4 weeks? C o m pletely co n tro lled W ell co n tro lled

So m ewhat co n tro lled P o o rly co n tro lled N o t co n tro lled at all

I f yo u checked an y blu e an swers, yo ur asthm a m ay n o t be wellco n tro lled. Be su re to talk to yo u r healthcare pro fessio n al abo u tyo u r asthm a treatm en t plan .

Developed by: ASTHMA ACTION AMERICA

Asthma Jeopardy could be played in team of two or more. The questions are separatedinto 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 Triggers Solutions to Triggers

$100A condition in the lungs that

makes breathing difficult

$100Cigarette smokes, Perfumes,nail polish are examples of

what kind of trigger.

$100Storing food in these could

keep cockroaches fromcoming around

$200Two common asthma triggers.

$200Things that may bother theairways, making it hard tobreathe or cause Asthma

signs.

$200Washing stuffed animals inwater hotter than 130 F kills

these triggers.

$300Two types of asthma medicine

$300Small microscopic animals

that live in mattresses, teddybears, on our skin, anywhere

there’s dust

$300Mixing water and what

solution is effective in killingmold spores

$400Three things that occur to the

airways during an asthmaattack?

$400These pests have been inexistence since before the

dinosaurs and their bodies andspray are what cause an

allergic reaction

$400If you have exercise inducedasthma how long before you

exercise should you take yourmedicine

$500The number of children in the

United States affected byasthma

$500This allergen grows best inhumid and dark locations.

$500One of most recommendedand preferred methods of

getting rid of roaches$600

You should take this type ofmedicine everyday

$600These cuddly animals produce

allergens because of thedander that is found on there

furry coats

$600If a child with asthma liveswith a smoker, where is the

best place to smoke

U s e L o n g - T e r m - C o n t r o l M e d i c i n eE V E R Y D A Y t o k e e p A s t h m a i n c h e c k !M e d i c i n e H o w M u c h W h e n_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _E x e r c i s e I n d u c e d A s t h m a -2 0 m i n u t e s b e f o r e s p o r t s :_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _

G R E E N = G O ! B r e a t h i n g i s g o o d N o c o u g h o r w h e e z e ( w h i s t l e

n o i s e ) C a n w o r k o r p l a y a s n o r m a l

O R P e a k F l o w N u m b e r i s : _ _ _ _ _ _ _ t o _ _ _ _ _ _ _ 8 0 % 1 0 0 %

Y E L L O W = SL O W D O W N

T ight Chest Cough W heezing O R Peak Flow Number is: _ _ _ _ _ _ _ to _ _ _ _ _ _ _ 60% 79%

M Y A S T H M A A C T I O N P L A N :C h i l d ’ s N a m e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _D . O . B . : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ M D / N P ’ sS i g n a t u r e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _D a t e C o m p l e t e d : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _I g iv e p e rm is s io n fo r th e s c h o o l n u r se o r d e s ig n a te d s c h o o l p e r so n n e l to a s s is t m y c h ild w ithth e A s th m a A c tio n P la n . I a lso g iv e p e rm is s io n fo r s c h o o l p e r so n n e l to e x c h a n g e in fo rm a tio nw ith th e p h y s ic ia n r e g a rd in g m y c h ild ’s a s th m a .G u a rd ia n ’s S ig n a tu re :_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _P e r s o n a l B e s t P e a k F l o w : _ _ _ _ _ _ _ _Y o u c a n u s e t h e c o l o r s o f t h e t r a f f i c l i g h t t o h e l p y o u l e a r n t o c o n t r o ly o u r A s t h m a !

T a k e Q u i c k -R e l i e f m e d i c i n e to s to py o u r A s th m a f r o m g e tt i n g w o r s e !1) Cont inue medicine in GREEN ZO N E2) Start A l b u t e r o l (i n h a l e r w i t h

s p a c e r / s p a c e r w i t h m a s k )r i g h t a w a y – 2 sprays, then every 4- 6hours as needed.

3) I f y o u a r e i n t h e Y e l l o w Z o n ea n d h a v e n o i m p r o v e m e n t i n6 - 1 2 h o u r s e v e n a f t e r u s i n gA l b u t e r o l – c a l l y o u r d o c t o r .

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

T a k e Q u i c k -R e l i e f M e d i c i n e a n d g e th e l p f r o m a d o c to r n o w !

1 ) S t a r t A l b u t e r o l r i g h t a w a y – 2 s p r a y s2 ) G o t o T h e C l i n i c - N u r s i n g S t a t i o n O R i f c l o s e d , g o to th e E m e r g e n c y R o o m /C a l l 9 1 13 ) M a k e a f o l l o w u p a p p o i n t m e n t a t t h e C lin ic fo r t h e fo llo w in g d a y if yo u w e n t to th e E R4 ) C o n t i n u e t a k i n g m e d i c i n e i n G R E E N Z O N E

R E D = ST O P M e d i c i n e i s n o t h e l p i n g C a n ’ t t a l k , w a l k o r m o v e w e l l H a v e e x t r e m e d i f f i c u l t y b r e a t h i n g S e v e r e c h e s t t i g h t n e s s U n c o n t r o l l e d c o u g h

O R P e a k F l o w N u m b e r i s : _ _ _ _ _ _ t o _ _ _ _ _ _ 0% 59%

Challenges

Confidentiality issuesTimeLack of shared visionDiffering prioritiesSpecialization Inadequate resourcesTurf issuesLiability Conflicting mandatesDivergent 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 community5) Utilize existing relationships and networks6) 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 leadership10) Constantly re-assess11) Be observant, patient, persistent and offer quality

products and support!12) Celebrate your successes!

The Faces of Asthma

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