Creating Asthma Friendly Schools
06
November

By Adem Lewis / in , , /


Welcome, and thank you for
listening to this presentation. This training was developed by
the Montana Asthma Control
Program, a program within the Montana Department of Public
Health and Human Services.
Today, I am going to talk with you about an important health
issue that has a significant
impact on our school system- Asthma. My goal today is to help
you to learn more about asthma,
especially as it relates to children and young people, and
to make you more aware of some
of the steps that the schools can take to combat this disease.
I will be referring to the
booklet entitled “Creating Asthma Friendly Schools in
Montana” as we go through this
presentation. If you do not yet have a copy of this booklet,
please download a pdf version of
the booklet from the Montana Asthma Control Program website,
which is located at
dphhs.mt.gov/asthma. Now, let’s begin. First of all,
let’s define what asthma
actually is. Asthma is a chronic lung disease causes many troubling symptoms.
It is characterized by a
reversible narrowing of the airways. Symptoms commonly
experienced during an asthma
attack include: wheezing, tightness in the chest,
coughing, and shortness of
breath. Next, let’s review the basic anatomy of the lungs and
the airways. When we breathe in,
air in comes through our nose and mouth and passes through a
system of branching tubes. These
tubes start with the trachea (indicated by number 1 on the
slide), branch into the left and
right bronchi (branch point is at number 10 on the slide), and
continue to divide again and
again. When the bronchi become very small, they become known as
bronchioles (represented by 7 on
the slide). Eventually, the air reaches the alveoli (indicated
by number 5 on the slide), where
oxygen in the air is taken into the blood stream and carbon
dioxide is expelled into the
airways and finally, out of the body. An asthma attack is
characterized by a reversible
narrowing of the airways, which causes the symptoms I outlined
earlier. There are two ways in
which the airways can become narrowed in asthma: One way
is by swelling of the walls of
the airways- caused by inflammation with excess mucus
production; Another way is by
constriction of the muscles surrounding the airways. The two
mechanisms of airway blockage
can occur separately or at the same time. No matter which
mechanism predominates at any
given time, the outcome is the same- the airway becomes
obstructed. The obstructed
airway blocks the normal flow of air and makes breathing
difficult. Asthma is a common
disease, both nationally and in Montana. As of 2014, 7.1% or an
estimated 15,400 Montana
children ages 0-17 have asthma. The percent of Montana children
with asthma increases to 10.1%
among children ages 12-17. This means that in a classroom of 30
students, about 2-3 will
currently have asthma. Asthma is especially important to address
in the school setting because of
the large impact that asthma has on both school attendance and
student performance. However,
with proper planning and informed policy decisions,
asthma can be successfully
managed in the school setting. So how well are Montana schools
actually addressing asthma in
the school setting? As of 2014, Only 16.2% of Montana schools
provide information on asthma to
parents and families. While over 50% of lead health education
teachers want more
professional development on managing asthma, only 17.9% of
Montana schools provided
professional development related to asthma. The Creating Asthma
Friendly Schools Resource Guide
outlines seven steps that schools can take to work towards
creating asthma friendly
schools. The first step is to identify students with asthma.
The second step is to allow
students easy access to their inhalers, the third step is to
create a school wide protocol
for handling an asthma episode. Step four is to identify and
reduce common asthma triggers.
Step five is to enable students with asthma to participate in
activities. Step six is to
educate staff parents and students about asthma. Step
seven is to collaborate with
families, students, staff and health providers. We are now
going to go through the steps,
one by one. As we go through the steps, I will cover why each
step is important and what
actions can be taken to complete each step. The first step that a
school should take is to
identify those students who have asthma. It is important that
schools identify which students
have asthma every year, as students may develop asthma
throughout their academic
careers. Schools should then ensure that the proper
paperwork, such as medication
authorization forms, is collected to help facilitate
their care at school. Finally,
there needs to be a system in place to communicate to the
school staff which students in
their classes have asthma and what steps need to be taken to
care for them. This is an
example of a recommended form that allows students to
self-carry and self-administer
emergency medications; a copy of this form can be found in the
resource guide. This form
complies with the Montana law requiring that students with
asthma, after proper
authorization, be allowed to possess or self-administer
asthma medication. The form
requires signatures by both a parent/guardian and a healthcare
provider. Here are a couple
examples of what an asthma action plan can look like. An
asthma action plan contains
information about the steps to take when a student is having
different asthma-related
symptoms. Step two in creating an asthma friendly school is to
ensure that students with asthma
have easy access to their inhalers. Access should be
ensured for the wide variety of
activities in which students are involved. Quick access to
medications will prevent asthma
symptoms from turning from bad to worse. If school staff become
aware of asthma medication
basics, they will recognize the importance of ensuring students
easy access to their inhalers;
before we cover this step in more detail, I will give you a
brief overview of the types of
asthma medications. Asthma medications can be divided into
two categories:One is
controller medications. And two is rescue or quick-relief
medications. Controller
medications are taken every day to prevent asthma attacks; they
are usually taken at home.
Common names of controller medications include but are not
limited to: Advair, Symbicort,
Singulair, Serevent, Pulmicort, QVAR, and Flovent. Rescue or
quick relief medications are
taken only as needed, and are used during an attack to obtain
relief of symptoms; they need to
be readily available for students with asthma. The common
name of rescue, or quick-relief,
medicine is Albuterol. To help students with their disease, it
is helpful to know the
difference between the rescue and controller medications, and
when each type of medication is
used. In Montana, there is a law– MCA 2-5-420 –that allows
students with a medication
authorization form on file to carry and self-administer their
own asthma rescue medication;
however, those students who do not carry their own medication
also need easy access to their
medication. Allowing easy access to medications allows students
to prevent more severe symptoms
from developing and also helps to protect the school from
unnecessary legal liability. In
order to ensure easy access, school staff should encourage
students with asthma to
self-carry or to store their medication in a safe, accessible
location at school. It is
important for all school staff to respect the right of students
to self-carry their medication.
Step three involves creating a school wide protocol for
responding to a student’s asthma
attack. This is critically important, as it is possible
that a student could have an
asthma attack at any location throughout the school. Thus,
having a protocol in place may
potentially save a child’s life. This is a sample school wide
protocol; it is taken from the
resource guide. This or a similar protocol should be
posted widely around the school.
Posting this widely around the school will enable a quick
response to an emergency
situation. When a student has an asthma attack, you may have to
assist them as they use their
inhalers. These are the required steps to use a metered-dose
inhaler. We will demonstrate
these steps, so that you may better be able to assist your
students with using their
inhalers. Remove the cap and shake the
inhaler.
Tilt your head back and breathe out. Put the inhaler
mouthpiecebetween the teeth
wit tongue underneath. Compress the canister.
Breathe in slowly for 3 to 5
seconds. Hold breath for 5 to 10 seconds.
Exhale. Wait at least one minute, and
repeat puffs as recommended by a
healthcare provider. Additionally, some students will
use a spacer with their inhaler, which has the
potential to increase the amount
of drug that reaches the lungs.
The use of spacers is
recommended for everyone who uses a meter-dose aerosol
inhaler. To help a student use their
inhaler with a spacer, follow
these steps: Remove the cap from the inhaler.
Shake the inhaler.
Put the inhaler in the spacer. Put your lips around the spacer
mouthpiece and exhale through
your nose, Press the inhaler and take a
deep, slow breath for 5 seconds.
Hold breath for 10 seconds. Exhale.
Wait 1 to 3 minutes before
administering a second puff. Repeat as necessary, Some students will use
a peak flow meter to monitor their asthma over time and to
help them decide what steps to
take when they have an asthma exacerbation. To assist a child
with using a peak flow meter,
have the child stand up and position the indicator at the
bottom of the numbers. Some
people with asthma do not have allergies; however, at least 80%
of children with asthma do have
allergies. Non-allergic asthma and allergic asthma are the same
disease, except for the absence
of allergies to specific triggers. Anaphylaxis is an
allergic reaction that affects
the whole body; it occurs if the body has an especially intense
reaction to an allergy-causing
substance. Common allergy-causing substances that
may cause anaphylaxis include
bee stings and food such as peanuts or shell fish.
Anaphylaxis is a
life-threatening condition, as blood pressure can drop
dramatically and the child can
go into cardiac arrest. There are several symptoms of
anaphylaxis to watch out for.
These include: sweating or paleness of the skin;
light-headedness or fainting;
hives and itching; swelling of the skin, lips, mouth, or
throat; stomach cramps or
vomiting; and difficulty breathing. These symptoms
usually occur within a few
minutes after contact with the allergy-causing substance, but
can also present hours after
contact with the allergen. If a child is experiencing symptoms
of anaphylaxis, it is necessary
to immediately call 911. If you believe a child is experiencing
anaphylaxis, you should also
give an injection of epinephrine; one of the most
commonly used devices for
injecting epinephrine is called the EpiPen. In Montana, there is
a law, MCA 20-5-420, that allows
schools to stock Epinephrine and administer to students in
emergency situations. We will
demonstrate how to use the EpiPen in a short video. Before
use the EpiPen should be stored
in a dark area and kept at room temperature. You should keep
track of the EpiPen’s expiration
date and be sure to replace it before it expires. To use an
EpiPen form a fist around the
EpiPen, with the black tip pointing downward. With your
other hand, remove the gray
safety cap. DO NOT touch the black tip after removing the
cap. Push the black tip firmly
against the outer thigh of the child who is having the severe
allergic reaction for 5-10
seconds. You can the remove the EpiPen and massage the injection
area for a few seconds. Check
the black tip to ensure that the needle is exposed so that you
know that the child has received
the dose. If they have not received the dose and the needle
is not sticking out, repeat the
previous steps. Ensure that you have called 911 so that the
child can go to the closest
emergency room. The effects of the EpiPen will only last 15-20
minutes and anaphylaxis is a
life-threatening condition. If you are interested in learning
more about anaphylaxis, the
Montana Asthma Control Program has also developed an Allergies
and Anaphylaxis Training for
schools that can be found at dphhs.mt.gov/onlineasthmatrainin
gs. Teachers and other school
staff can learn about anaphylaxis and earn OPI renewal
units for completing the course.
Step 4 in creating asthma friendly schools is to identify
and reduce common asthma
triggers. Asthma “triggers” are those things that can start an
asthmatic reaction in your
airways. Many of these triggers are things that people inhale.
Common asthma triggers in the
school setting include school bus exhaust, tobacco smoke,
allergens like pollen and animal
dander, strong cleaning products, and cold air. Asthma
triggers are different for each
person with asthma, so it is important to find out which
asthma triggers affect the
students at your school. The resource guide lists simple
steps that can be taken to
reduce asthma triggers in the school environment. For example,
keeping windows closed when
pollen levels are high, and using low volatility organic
compound cleaners can both help
to reduce triggers. School policies such as the elimination
of school bus idling, creating a
comprehensive tobacco free school, and practicing
integrated pest management can
also be effective at reducing asthma attacks at school. Step
five is to enable students with
asthma to participate in school activities. This involves
dealing with exercise-induced
asthma. Exercise-induced asthma involves airway narrowing in
people with asthma that is
brought on by vigorous exercise; it is quite common, affecting up
to 90% of people with asthma.
The symptoms that people experience during
exercise-induced asthma are the
same symptoms that normally occur in an asthma attack. Those
symptoms are the ones I
mentioned earlier in this presentation: chest tightness,
difficulty breathing, wheezing,
and coughing. Although symptoms can occur during exercise, the
symptoms are often experienced
shortly after exercising. In fact, the symptoms often peak
five to ten minutes after
exercise is completed. The airway narrowing can
spontaneously resolve 20-60
minutes after starting, although it may last longer. Although
exercise induced asthma can be
serious, it can be effectively controlled. When asthma is
well-controlled, students with
the disease should be able to fully participate in school
activities. Step six involves
educating your fellow school staff, parents, and students.
Since asthma is so common, it is
necessary that everyone involved with students receive education
on asthma. In particular,
teachers have often not received recent training on asthma, and
it is clear that many want
additional education. In addition to the information in
the resource guide, there is a
useful guide produced by the National Heart, Lung, and Blood
Institute called “Managing
Asthma: A Guide for Schools.” The guide is located at the
website indicated on the slide.
There are also links in the Creating Asthma Friendly Schools
guide to further resources on
specific topics that may be helpful in learning about and
teaching others about asthma. In
order to create an asthma friendly school, the efforts of
many people are required; thus,
step 7 involves collaboration between all of the different
groups of people that have a
stake in creating asthma friendly schools. Since many
different tasks and skills are
involved, collaboration and cooperation between all affected
parties is critical. One of the
key ways that your school has the potential to greatly improve
student health, including issues
related to asthma, is to increase communication between
staff and the school nurse. If
your school does not have a school nurse, this could be a
key resource that you could add
in the future. Before we conclude today, I would just
like to briefly reiterate a few
key points. First of all, remember that asthma is a
disease that is characterized by
a narrowing of the airways. This narrowing can be caused by both
inflammation and muscle
constriction. For treating asthma, two types of medications
are utilized: controller
medications, used for long-term maintenance of asthma; and
rescue medications, used to
treat symptoms as they appear. Next, remember that students are
allowed to self-carry their own
asthma medication in Montana. This requires completed
paperwork with signatures by the
student’s parent or guardian and healthcare provider. Finally,
remember that asthma triggers
cause asthmatic reactions in the airways of people with asthma.
Removing and/or reducing these
triggers can lessen the chance that students will have asthma
attacks at school. That
concludes our overview of asthma and the steps to take in
creating an asthma friendly
school. Thank you for taking thetime to
learn a little about creating
asthma friendly schools. If you have any comments or questions about this
presentation, please do not
hesitate to contact us. The contact information for the
Montana Asthma Control Program
is on the slide.


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