Asthma in School

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Asthma in School

• its more serious than you think!
• Karen P. Kain, MS, RRT-NPS, AE-C
• Pulmonary Education Specialist
• Asthma Initiative of Michigan
• 9/26/2007

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WHY TALK ABOUT ASTHMA?

• Asthma can be deadly.
• Most asthma episodes can be prevented.
• There are legal requirements that affect how
  schools deal with students who have asthma.
• Children with asthma account for almost 15
  million missed school days a year, and miss more
  days on average than their friends who dont have
  asthma.1
• CDC. Asthma prevalence, health care use and
  mortality, 2002. Hyattsville, MD U.S. Department
  of Health and Human Services 2004.

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Could this happen in your district?  

• Jury Awards 9 Million in Asthma Death at School
• A California jury that unanimously awarded a
  mother 9 million in damages for her 11-year old
  sons fatal asthma attack at school found the
  school district guilty of negligence for failing
  to inform parents of an unwritten school policy
  that would have allowed the child to carry an
  inhaler.
• Gonzalez vs. Hanford Elementary School District,
  Nos. F033659, F034555, (Super. Ct. Nos. 0031
  1109). June 2002.

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What is Asthma?

• Chronic inflammatory disease of the
• airways characterized by
• Recurrent episodes of wheezing
• Shortness of breath
• Chest tightness/pain
• Coughing
• Airways are supersensitive and react to a
  variety of stimuli or triggers

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Lung Changes During an Asthma Attack

• In response to a trigger (something that makes
  asthma worse)
• Airways swell and become narrowed
• Bronchial muscles tighten
• Mucus further obstructs airways
• Breathing becomes difficult

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Normal Airway
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Asthma Airway Changes
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Asthma Attack Airway Changes
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Triggers

• A variety of stimuli or triggers can cause
  airway inflammation (swelling) and bring on an
  asthma flare
• Eliminating or reducing exposure to these
  triggers will decrease the need for asthma
  medications and reduce symptoms

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Asthma triggers in a classroom may include

• Stuffed animals
• Carpeting
• General dusty clutter
• Plants
• Pets
• Mold
• Perfume, candles, air fresheners

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What is asthma control in children?

• No coughing
• No difficulty breathing, wheezing, or chest
  tightness
• No waking up at night because of asthma symptoms
• Normal activities, including play, sports,
  exercise, or other school activities

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What is asthma control in children, contd

• No acute episodes of asthma that require a doctor
  visit, emergency room visit, or urgent care
• No absences from school or activities
• No missed days from work or other activities for
  the parent or caregiver
• Normal (or near normal) lung function

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What about those inhalers?

• Does your school allow students to possess and
  self-administer prescribed medications at school?
  

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MDI Inhaler Law
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Do school facilities compromise student health
and achievement?

• Environmental triggers exacerbate asthma and
  other respiratory ailments.1
• 50 of schools serving over 20 million children
  have unsatisfactory environmental conditions such
  as poor ventilation, heating and lighting.2
• Studies support the link between poor indoor air
  quality and low student achievement.1,3
• 1Indoor Air Quality and Student Performance.
  Environmental Protection Agency, March 2001,
  Revised 2003.
• 2U.S. General Accounting Office. School
  Facilities The Condition of Americas Schools.
  2000.
• 3Schneider, M. Do School Facilities Affect
  Academic Outcomes? National Clearinghouse for
  Educational Facilities, November 2002.

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School Facilities and Achievement

• Students whose school facilities are in poor
  condition have test scores about 5.5 percentage
  points below students whose school facilities are
  in fair condition, and about 11 percentage points
  below students in excellent facilities.1
• 90 of U.S. schools were built before 1980, and
  50 before 1960.2
• 1Indoor Air Quality and Student Performance.
  Environmental Protection Agency, March 2001,
  Revised 2003.
• 2U.S. General Accounting Office. School
  Facilities The Condition of Americas Schools.
  2000.

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To think about

• Do you know your districts policy about the
  self-possession and use of inhalers (and other
  quick-relief medication) for students with
  asthma?
• How well does your district monitor indoor air
  quality related to carpeting in classrooms?
• What is your districts policy on keeping pets or
  plants in the classroom?

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What can schools do?
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Be Proactive

• Create local policies that support
  asthma-friendly schools.
• Provide school health services for students with
  asthma.
• Offer asthma-management education to students,
  staff, and families.
• Provide a safe and healthy environment by
  reducing asthma triggers in the school
  environment.
• Coordinate school, family, and community
  resources to better manage asthma symptoms and
  reduce school absences.

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Asthma Management Plan (AMP)
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State Board of Education Model Asthma Policy
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Resources for School Leaders from AASA

• AASAs Indoor Air Quality Asthma initiatives.
• School Governance and Leadership (Spring 2003).
• Schoolhouse in the Red (2004 Edition).
• Frequently Asked Asthma Questions document.
• Powerful Practices A Checklist for School
  Districts Addressing the Needs of Students with
  Asthma.

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Schoolhouse in the Red
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School Governance Leadership

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Completing HSAT

• Process Driven by Coordinated School Health Teams
• Identify Strengths
• Identify Challenges
• Develop an Action Plan
• Make Policy and Environmental Changes

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The HSAT Homepage
www.mihealthtools.org/hsat
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What is the Healthy School Action Tool (HSAT) ?

• Assessment
• Action Plan
• Implementation
• Expected Results
• Partnerships
• Policy Change
• Environmental Improvement(s)
• www.mihealthtools.org/hsat
•  

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The HSAT Process
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Asthma Strategic Plan for MI

• Goal 5
• Reduce Barriers to Self-Management In People With
  Asthma
• Objective 1
• Promote development and implementation of
  asthma-friendly policies in schools.
• Strategy A Develop a statewide partnership to
  address asthma in schools.
• Strategy B Facilitate implementation of asthma
  inhaler law and State Board of Education Asthma
  management Policy and other asthma-friendly
  policies in all Michigan schools.

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Additional Resources

• Strategies for Addressing Asthma Within a
  Coordinated School Health Program Centers for
  Disease Control and Prevention -
  http//www.cdc.gov/healthyyouth/asthma/strategies.
  htm
• Managing Asthma A Guide for Schools National
  Asthma Education and Prevention Program (NAEPP)
  http//www.nhlbi.nih.gov/health/prof/lung/asthma/a
  sth_sch.htm
• Fit, Healthy, and Read to Learn National
  Association of State Boards of Education -
  http//www.nasbe.org/HealthySchools/fithealthy.htm
  l
• Quest for the Code Asthma CD Rom Game Starlight
  Starbright Childrens Foundation
  -http//www.starlight.org/site/c.fuLQK6MMIpG/b.135
  2333/k.2867/Asthma_CD_ROM_Quest_for_the_Code.htm
• Schooled in Asthma American Academy of
  Pediatrics - http//www.aap.org/schooledinasthma/
• Tools for Schools Environmental Protection
  Agency - http//www.epa.gov/iaq/schools/toolkit.ht
  ml
• Open Airways for Schools Asthma 101 (for
  Elementary School children) - http//www.lungusa.o
  rg/
• Power Breathing (for Teens) - http//www.aafa.org
  /display.cfm?id4sub79cont436

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For More Information

• For more information on AASAs efforts to address
  asthma in schools please visit www.aasa.org/focus.
  
• For more information on AIM school initiatives
  visit www.GetAsthmaHelp.org

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Asthma Contacts

• Karen P. Kain, MS, RRT-NPS, AE-C
• President, Asthma Coalition of NW MI
• [phone]
• Asthma School Coordinator
  
• Shawn Cannarile, MAEd
  
• Michigan Public Health Institute
  
• 517-324-7385 or scannari_at_mphi.org
• Asthma Initiative of Michigan
• www.GetAsthmahelp.org

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References

• CDC. Asthma prevalence, health care use and
  mortality, 2002. Hyattsville, Maryland US
  Department of Health and Human Services, CDC,
  National Center for Health Statistics, 2004.
• Gonzalez vs. Hanford Elementary School District,
  Nos. F033659, F034555,
• (Super.Ct. Nos. 0031 1109). June 2002
• Indoor Air Quality and Student Performance. EPA,
  March 2001, Revised 2003.
• School Facilities The Condition of Americas
  Schools. US General Accounting Office 2000.
• Schneider, M. Do School Facilities Affect
  Academic Outcomes? National Clearinghouse for
  Educational Facilities, November 2002.

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HSAT Expansion

• New Topic Areas
• Asthma Management
• Violence and Injury Prevention
• New Format a la carte design allows schools to
  choose topics to assess
• More resources!
• Better tools!