Asthma in the Classroom: What do teachers need to know?

1
Asthma in the Classroom What do teachers need
to know?
2
Asthma Impact

• Asthma
• affects over twenty five million people
  nationwide
• causes 10.5 million lost school days annually
• third-ranking cause of hospitalization among
  those younger than 15 years of age
• Estimated cost of asthma in the U.S. is 56
  billion per year (direct and indirect costs)

Source EPA Asthma Facts 2013, http//www.epa.gov/
asthma/pdfs/asthma_fact_sheet_en.pdf
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Asthma is Common

• Nationally, 9.5 of children have asthma
• Rates are twice as high for schoolchildren in
  some cities in MA
• Holyoke- 18.7
• Springfield- 17.2
• High rates of uncontrolled asthma
• asthma hospitalizations are more than double the
  state rate in both Holyoke and Springfield

Sources National Health Interview Survey Data,
2011, http//www.cdc.gov/asthma/nhis/2011/table4-
1.htm, Baystate Health Community Health Needs
Assessment 2013 CDC. Asthmas Impact on the
Nation, http//www.cdc.gov/asthma/impacts_nation/i
nfographic.htm
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Asthma Impact School

• Asthma can affect
• School attendance
• Ability to concentrate
• Overall academic performance
• Overall quality of life

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What is asthma?

• Overview

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What is Asthma?

• Chronic lung disease that can affect a persons
  breathing
• Asthma can range from mild to severe

Image from www.mitchellzhomes.com/AZAPAA/azapaa_as
thma.htm
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What is Asthma?
In asthma, two main things happen
1. Muscles tighten around the airways
(bronchoconstriction)
2. The insides of the airways swell
(inflammation) and make mucus
Modified from GSK Programs to Go What do you
really know about asthma?
8
Common Asthma Symptoms

• Cough
• Wheezing/whistling with breathing
• Hard to breathe
• Chest tightness
• Tired or fatigued

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Asthma Triggers

• What is an asthma trigger?
• Things in the environment that can cause a person
  with asthma to have asthma symptoms (commonly
  called attacks, flare-ups or exacerbations)
• Types of asthma triggers
• Allergens things that trigger allergies
• Irritants substances that irritate respiratory
  passages
• Other infections, exercise, cold air
• Asthma triggers are different for everyone

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Environmental Asthma TriggersHow does the
environment impact asthma?

• Environment can affect
• who can get asthma
• when someone gets asthma
• how bad the asthma is

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Asthma Medications

• Two main types of asthma medication
• Rescue/quick-relief medications
• Controller medications

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Quick Relief Medications

• Provide quick treatment to reduce airway blockage
  when having asthma symptoms
• Stops tightening of muscles around airway
  (bronchospasm)
• Example Albuterol

modified from Arizona Asthma Coalitions Asthma
in the School Setting http//www.azasthma.org/Com
mon/Files/AAC20Asthma20School20Presentation202
007.pdf
13
Controller Medications

• Taken DAILY to control persistent asthma
• Used to stop chronic inflammation
• Examples Flovent, Advair, Pulmicort, Symbicort

modified from Arizona Asthma Coalitions Asthma
in the School Setting http//www.azasthma.org/Com
mon/Files/AAC20Asthma20School20Presentation202
007.pdf
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Asthma in the Classroom

• Asthma Triggers

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Triggers in the Classroom Allergens Pets and
Pests

• Examples
• Dust mites
• Example - found in classroom carpets and clutter
• Animal dander Pets and Pests
• Example - from class pets or pet hair on student
  clothes
• Cockroach droppings

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Triggers in the Classroom Allergens

• Examples
• Pollen
• Example - from plants in classroom or outdoors
• Molds
• Examples from wet drywall, rug or saturated
  plants

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Create an Asthma Friendly Classroom Keep
classroom allergen free!
No dust mites here!

• Make sure classroom is clean
• Dust with damp rag (microfiber if possible)
• Wash blankets, furry costumes and stuffed animals
  weekly in hot water
• Use throw rugs, whenever possible, that can be
  machine washed periodically or replaced
• Furry pets may be a trigger and should be avoided
  in classroom per protocol

modified from Arizona Asthma Coalitions Asthma
in the School Setting http//www.azasthma.org/Com
mon/Files/AAC20Asthma20School20Presentation202
007.pdf
18
Create an Asthma Friendly Classroom Keep
classroom allergen free!
No dust mites here!

• Make sure classroom is cleanable
• Remove clutter to prevent accumulation of dust
• Clear areas for custodians to dust, mop and
  vacuum

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Create an Asthma Friendly Classroom Keep
classroom allergen free!

• Prevent allergens from entering or multiplying
• Stay inside/close windows on high pollen days
• Keep pet and people food tightly covered to
  prevent attracting pests and having food spoil
• Avoid hissing cockroaches as pets if they are a
  trigger for students or staff

modified from Arizona Asthma Coalitions Asthma
in the School Setting http//www.azasthma.org/Com
mon/Files/AAC20Asthma20School20Presentation202
007.pdf
20
Create an Asthma Friendly Classroom Keep
classroom allergen free!

• Identify possible sources of mold

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Create an Asthma Friendly Classroom Keep
classroom allergen free!

• Prevent allergens from multiplying

• Keep plants well drained
• Locate items that leak away from carpet
• Locate plants away from air vents to prevent
  circulation of allergens (mold pollen)
• Identify sources of water leaks and report to
  maintenance

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Create an Asthma Friendly Classroom Keep
classroom allergen free!

• Prevent exposure to allergens
• Make sure ventilation system is working and
  report to custodian if it is not
• Locate childrens clothes with smoke and pet
  allergens away from occupied areas and
  ventilation system

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Triggers in the Classroom Irritants - Chemical

• Products with fragrance or odor
• Personal Care Products - perfume, scented lotions
• Curriculum Products permanent markers, scented
  markers
• Cleaning and maintenance products
• air fresheners
• solvent-based cleaning products
• disinfectants and sanitizers i.e. bleach

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Triggers in the Classroom Irritants - Particulate

• Airborne particles in the building - chalk dust,
  from buffing waxed floors
• High air pollution days
• Note Though it should not be found in the
  classroom, it is important to be aware that
  second-hand smoke is a strong asthma trigger as
  many children have family members that smoke

modified from Arizona Asthma Coalitions Asthma
in the School Setting http//www.azasthma.org/Com
mon/Files/AAC20Asthma20School20Presentation202
007.pdf
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Triggers in the Classroom Irritants - Particulate

• Exhaust (indoor/outdoor)
• Vehicle - school bus, delivery and car idling
• Landscaping equipment - snow blower, lawn mower,
  leaf blower

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Triggers in the Classroom Irritants - Particulate

• Exhaust - Office Equipment
• Copier
• Laminating machine
• Laser printer

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Create an Asthma Friendly ClassroomKeep
classroom free of chemical irritants!

• Create a fragrance free classroom
• Avoid use of perfumes, powders, lotions, air
  fresheners, scented markers, etc.
• Use safe products
• Check with your school district about using green
  cleaning products
• Springfield Public School District has a list of
  approved cleaning products for use and teachers
  should not bring in products from home.
• Use microfiber whenever possible
• Do not dust or clean while children are present
• Only use cleaning products when children are
  absent
• Only trained custodians using approved products
  should disinfect after hours

No fragrances here!
modified from Arizona Asthma Coalitions Asthma
in the School Setting http//www.azasthma.org/Com
mon/Files/AAC20Asthma20School20Presentation202
007.pdf
28
Create an Asthma Friendly ClassroomKeep
classroom irritant free!

• Stay inside/close windows on poor air
  quality/high ozone days
• Make sure ventilation system is working properly
• Promote anti-idling policies at your school

modified from Arizona Asthma Coalitions Asthma
in the School Setting http//www.azasthma.org/Com
mon/Files/AAC20Asthma20School20Presentation202
007.pdf
29
Indoor Air Quality (IAQ) Reporting

• If you find a ventilation or odor problem OR
• If you suspect that staff or students have a
  reaction or symptoms due to conditions in the
  building
• Report it to your principal who has the authority
  to have it investigated.
• Ask your principal to report back on any action
  based on the investigation.
• Check with your district to see if there is a
  specific protocol for investigating IAQ problems.

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Asthma Triggers at SchoolExercise

• Exercise and asthma
• Exercise can trigger asthma
• Some children with asthma take quick-relief
  medication before they exercise
• Children with asthma should warm-up before
  exercise
• If a child with asthma is wheezing during
  exercise, it is a sign of uncontrolled asthma
• They should talk to their doctor to see if they
  need to adjust their medications
• Children with asthma should not be excluded from
  exercise or recess unless they have written
  physicians instructions to do so

Asthma can be controlled and children with asthma
can lead active, healthy lives!
modified from Arizona Asthma Coalitions Asthma
in the School Setting http//www.azasthma.org/Com
mon/Files/AAC20Asthma20School20Presentation202
007.pdf
31
Asthma Triggers at SchoolWeather Outdoor Air

• Check the weather and outdoor air forecast
• Cold air can make asthma worse
• High air pollution/ozone days can trigger asthma
• Pollen can trigger asthma
• On cold days, wearing a scarf over nose and mouth
  warms and humidifies air
• Close windows and limit exposure to outdoor air
  on high pollution, ozone and pollen days

modified from Arizona Asthma Coalitions Asthma
in the School Setting http//www.azasthma.org/Com
mon/Files/AAC20Asthma20School20Presentation202
007.pdf
32
Asthma Triggers at SchoolOther

• Some other asthma triggers
• Respiratory infections
• Food Additives
• Some food additives such as sulfites can trigger
  asthma flare-ups
• Emotional Stress
• Stress during an asthma flare-up can produce
  rapid breathing or hyperventilation which can
  make the episode worse

modified from Arizona Asthma Coalitions Asthma
in the School Setting http//www.azasthma.org/Com
mon/Files/AAC20Asthma20School20Presentation202
007.pdf
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Asthma in the Classroom

• What to be aware of

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Asthma in the ClassroomKnow Early Warning Signs
of Asthma Episode

• cough
• wheeze
• chest tightness
• shortness of breath
• runny or stuffy nose
• sneeze
• headache
• funny feeling in chest

• stomach ache
• poor appetite
• itchy throat or chin
• glassy eyes
• feeling tired
• coughing or waking at night

modified from ALA Asthma Education Certification
Course and Developing an Effective Asthma Action
Plan by Dr. Matthew Sadof
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Asthma in the Classroom Asthma Episodes

• What to do during an asthma episode
• Stay calm
• Keep child calm
• Have the child try to stay relaxed and focus on
  breathing
• Contact the school nurse
• Always make sure the nurse is available before
  sending a child to the nurses office
• Never send a child experiencing asthma symptoms
  alone to the nurses office

modified from Arizona Asthma Coalitions Asthma
in the School Setting http//www.azasthma.org/Com
mon/Files/AAC20Asthma20School20Presentation202
007.pdf
36
Asthma in the ClassroomDanger Signs of Asthma
Episode

• Know danger signs of an asthma episode
• Difficulty speaking
• Lips or fingernails turn gray or blue
• Heart rate is very fast
• Noisy breathing (may not be present if severe
  airway
• constriction)
• Visible drawing in or sinking of chest
  (retractions) when student inhales
• Quick-relief medicine does not improve the signs
  listed above

Contact school nurse immediately!
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Asthma in the ClassroomPotential Medication Side
Effects

• Be Aware of Potential Medication Side Effects
• Anxiety
• Restlessness
• Hyperactivity
• Rapid heartbeat
• Thrush
• Sore throat

modified from Arizona Asthma Coalitions Asthma
in the School Setting http//www.azasthma.org/Com
mon/Files/AAC20Asthma20School20Presentation202
007.pdf
38
AsthmaMedication Devices

• Be Aware of Types of Medication
• Devices
• Metered dose inhalers
• Nebulizer
• Dry powder inhalers
• Spacers

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Asthma at SchoolAsthma Action Plans

• All children with asthma should have a written
  Asthma Action Plan at school, home and
  physicians office
• Asthma action plans provide information on
• How to assess and monitor asthma symptoms and
  lung function (green, yellow and red zones)
• Medications to take and when to take them
• What to do during an asthma flare-up when things
  get worse
• Triggers to avoid

modified from ALA Asthma Education Certification
Course and Developing an Effective Asthma Action
Plan by Dr. Matthew Sadof
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Asthma Action Plan- Example
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Classroom Asthma ManagementSummary

• Create a healthy classroom by reducing exposure
  to triggers!
• Encourage policies in your school to reduce
  triggers
• Be aware of asthma symptoms
• Know warning signs of an asthma episode and what
  to do
• Encourage all children with asthma to have an
  Asthma Action Plan on file with the school nurse

Together we can help children in our schools
control asthma so that they can lead active,
healthy lives!
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Questions?
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Thank you!

• If you have any questions about asthma or would
  like more information, visit
• Pioneer Valley Asthma Coalition,
  www.pvasthmacoalition.org
• American Lung Association, www.lung.org/lung-disea
  se/asthma

Brought to you by
Presentation developed by Michele Hart, RN, BSN,
AE-C, Baystate Pulmonary Rehab Ann Ottalagana,
American Lung Association Kathleen Szegda, and
Sarita Hudson, Pioneer Valley Asthma Coalition