Asthma Management for Students in Saint Paul Public Schools

Vision:  Students with Asthma are under Good Control

1.  Asthma can be controlled.  When asthma is controlled - students can fully participate in class and  school activities.

2.  Contact your school nurse if you have a student that has difficulty breathing or managing their asthma. 

3.  SPPS has a medication policy and procedure to ensure the safety of students.

• Medication in School
  Most students need a rescue medication (albuterol) at school in case they have problems with asthma. SPPS has a board approved medication policy.
• All medication requires a written doctor or nurse practitioner order and parent/guardian authorization every year.
• Upon written recommendation of the prescribing doctor/nurse practitioner, parent/guardian and after consultation with the school nurse, a student may be allowed to self-administer medication, provided that the school nurse has developed a written health care plan.
  

4.  All students with asthma should have a rescue medication (albuterol) at school.

Role of the School Nurse in Asthma

• School nurses serve an important function to help students remain in school and ready to learn.
• The school nurse partners with students, families, health care providers, school administrators, and school staff so that kids with asthma remain in good control. 
• Students with asthma in good control miss less days of school and can avoid unnecessary emergency room visits and hospitalizations.

The school nurse provides:

1)  Direct health care to students who experience an asthma episode (exacerbation) in school.

2) Asthma Education

• School nurses check that students know how to use their inhalers correctly for their age and developmental stage.
• School nurses can help students understand how to check their peak flows.
• School nurses help students follow their asthma action plan.
• School nurses teach students and families about asthma, such as avoiding asthma triggers and asthma early warning signs.

3)  Coordinate care between families, providers and school.

• School nurses may be the first health care person that sees a child with asthma that is poorly controlled or undiagnosed.
• School nurses help kids connect with providers to review their asthma care or get an appropriate diagnosis.
• Some students may not know they have asthma. Students may see the school nurse because they are coughing, coughing at night, can't participate in school activities, or have other symptoms.  School nurses can explain why the student should be seen and connect them with health care providers.  The right diagnosis can help kids get on track to asthma management. 
• Some students may know they have asthma but are having a hard time managing their asthma for some reason.  For example, teenagers face many changes that can make managing asthma more challenging.  School nurses can identify students that may need to see their health care provider to reevaluate their medication.

4)  Teach parents and school staff how to identify asthma.

• School nurses provide individual and classrooom education asthma so that children and families have the tools they need to manage asthma.

The Rule of 2:  Applies to Children and Adults

Do you use a quick relief inhaler (albuterol) more than 2 times a week?

• Do you wake up at night due to asthma or cough more than 2 times a month?
• Do you refill your quick relief inhaler (albuterol) more than 2 times a year?

If you answer “yes” to any of these questions, it is a sign that your asthma may be poorly controlled.

What should you do?
If you are a parent and think your child is having trouble, talk to your child’s school nurse and help your child get to their health care provider for an asthma check-up.  If you are an adult, talk to your health care provider for an asthma check-up.  If you are a school staff member and notice a child needs better asthma management - contact your school nurse.  If you have any questions, please contact the nurse in your school.

All Staff Can Help Prevent Asthma Attacks

There are some simple things you can do to help prevent asthma attacks in students and your fellow staff members.  It is important to:

• Wash your hands.  Handwashing prevents the spread of illnesses, such as the cold and flu, that can make asthma attacks worse. 
• Avoid wearing perfumes, cologne, or other strong scents.  These can make asthma worse in adults and children. 
• Check your work area.  Eliminate potential moisture problems. If you have plants, make sure the plant is getting the water, not the furniture or carpeting. Make sure drip trays are under each plant. If you have a large number of plants, think about reducing the number of plants.  Remove dead or dying leaves from plants. Refrigerators should have a drip tray underneath to catch any moisture.Bacteria and mold like moisture.  Bacteria and mold can make asthma worse in adults and children. 
• Eliminate clutter. Clutter makes it harder to keep rooms free of dust.  Dust can make asthma worse. 
• Check your classroom for stuffed animals.  Smaller stuffed animals can be washed.  It is better to have small stuffed animals that can be washed, rather than large stuffed animals.  Stuffed animals can collect dust and other allergens that can make asthma worse.

Indoor Air Quality

Each day in the United States about 56 million people spend their day in an elementary or secondary school building.  This includes students and staff.  This is approximately 20 percent of the population.  Because of the number of people that spend time inside school buildings, it is important for you to understand how you can contribute to indoor air quality. 

The Environmental Protection Agency has a Tools for Schools program that addresses indoor air quality.  What does indoor air quality mean for students and staff?  According to Shelly Harding, Director of Student Achievement in Spokane, Washington, "Indoor air quality impacts the physical health of many students, as well as teachers and staff who assist them in learning.  It also affects the ability of students to learn and adults to teach them, so the journey to attain and maintain healthy indoor air quality is important."

One way you can help improve indoor air quality is to reduce the number of asthma triggers in the building. 

What is an Asthma Trigger?

People with asthma have airways that react to triggers. The airway lining swells, mucous forms, and the airway muscles tighten. As a result, less air moves in the chest. The person with asthma feels short of breath and chest tightness. This is why people with asthma have difficulty breathing.

Asthma triggers are irritants that make the airways react. There are many kinds of triggers in the environment. The environment can include the indoor air quality of the school building or outdoor air quality - such as pollen, ozone, and weather. It is important that you are aware of asthma triggers to:

1) Avoid introducing asthma triggers into the school building. For example, strong scents or pets can make asthma worse. Staff can avoid wearing products with strong scents or bringing pets into the classroom.

2) Understand when students or staff may have more difficulty due to the presence of triggers. For example, sudden changes in temperature or exercise can make asthma worse.

3) Make decisions about scheduling activities. If you have questions about scheduling activities, contact your school  nurse.

Click on the link below for Minnesota air information.

http://aqi.pca.state.mn.us/hourly/

Common Asthma Triggers

Changes in Temperature and Humidity

Cold, dry air can be irritating. Sudden changes in temperature or humidity can make asthma worse.

Cigarette Smoke

Cigarette smoke is an asthma trigger. Even second hand or passive smoke makes asthma worse. Cigarette smoke also stays on hair and clothing – which can make asthma worse.

Cleaning Supplies

Check with your building mainentence staff. Use approved cleaning supplies.  Some cleaning supplies can be an asthma trigger.  It is important to keep your work area clean.  Make sure you use approved cleaning supplies and avoid brining supplies from home.

Coughing, Yelling, or Laughing

Coughing, yelling, or laughing can be an asthma trigger.

Exercise

Anyone with asthma has the potential to develop asthma symptoms during exercise. It doesn’t mean that people with asthma cannot exercise. It does mean that people with asthma should have a rescue inhaler (albuterol) and use it as prescribed. Some people with asthma use their inhaler before starting exercise to prevent problems. If they use their inhaler before exercise, it is important to use the inhaler 15 minutes before starting exercise to prevent symptoms.  Others may need to use their inhaler if they have symptoms.

Asthma symptoms usually start about 15 minutes after beginning an activity. A person with an asthma exacerbation may have difficulty talking, keeping up with others, shortness of breath, coughing, wheezing, or chest tightness. If this happens, the student needs your help.

If you are a teacher, coach, or staff person – you should know the student’s health plan and emergency plan. Talk to the school nurse, parent, and student so you know what to do for students with asthma.

Take the Coaches Clipboard program. See the link at the bottom of the page.

Perfume

Scents in candles, perfume, and sprays should be avoided.

Pets

Pets can also be a source of allergens – such as dander, feather, fur, and saliva. When students handle pets, the allergens can get on their hands and clothing. Allergens can be released into classroom air. Allergens can travel from one student to another on their clothing or travel through the air vents. Students with asthma can have an asthma attack when exposed to animal allergens. In addition, some students can become allergic if they are repeatedly exposed to animal allergens.

                   Some tips:

Students should always wash their hands before and after handling pets. Students should avoid rubbing their faces on pets. Pets should remain in cages (no roaming).Don’t place cages near vents or on carpeting.  Cages should be cleaned regularly. Non-latex gloves may help reduce contact with allergens.

The school nurses are good resources on appropriate classroom pet management.  They can also help you pick the most appropriate type of classroom pet. 

Some pet alternatives that do not introduce fur, feathers, or dander into the classroom:

How about a fish?

How about a bird feeder outside the classroom window?

New or sudden stress can make asthma worse. Ongoing stress can make asthma worse also.

Conclusion:  Managing Triggers in the School Building

As a staff member, you can help minimize the number of asthma triggers in the school building.  It is important that you understand what asthma triggers are and how to avoid them.