|
Health Topics
Asthma
Strategies for Addressing Asthma within a
Coordinated School Health Program
(With updated resources, Revised Fall 2006)
A healthy student is a student ready to learn. Asthma-friendly schools
are those that make the effort to create safe and supportive learning
environments for students with asthma. They have policies and procedures
that allow students to successfully manage their asthma. Chances for success
are better when the whole school community takes part–school administrators,
teachers, and staff, as well as students and parents.
The Centers for Disease Control and Prevention (CDC) has identified six
strategies for schools and districts to consider when addressing asthma
within a coordinated school health program. These strategies can be
effective whether your program is for the entire school district or just one
school. Establish management and support systems for asthma-friendly
schools.
- Establish management and support systems for asthma-friendly
schools.
- Provide appropriate school health and mental health services
for students with asthma.
- Provide asthma education and awareness programs for students
and school staff.
- Provide a safe and healthy school environment to reduce
asthma triggers.
- Provide safe, enjoyable physical education and activity
opportunities for students with asthma.
- Coordinate school, family, and community efforts to better
manage asthma symptoms and reduce school absences among students with
asthma.
Strategy Development
These strategies are based on six key elements of school-based education
and
intervention developed by expert panelists at the November 2000 national
conference, “Asthma Prevention, Management, and Treatment: Community-Based
Approaches for the New Millennium,” sponsored by Kaiser Permanente and the
American Lung Association.1 Two National Asthma Education and
Prevention Program (NAEPP) documents, Resolution on Asthma Management at
School2 and How Asthma-Friendly is Your School?3 were
used to develop these school-focused elements. CDC’s school asthma
strategies also incorporate the eight interactive components of the
coordinated school health program, a model used by the CDC and many state
education agencies and school districts.4 These six strategies for addressing asthma fit
within the eight components of a coordinated school health program,
and are illustrated below.
Addressing Asthma within a Coordinated School Health
Program
Back to Top
Strategy Implementation
Implementation of the strategies will require a team effort that involves all
school administrators, faculty, and staff, as well as students and parents.
These strategies can be used to develop a plan for addressing asthma within a
coordinated school health program. They complement NAEPP’s Managing Asthma: A
Guide for Schools,5 which provides specific action steps for school
staff members.
Every strategy is not appropriate or feasible for every school to implement.
Schools and districts should determine which strategies have the highest
priority on the basis of the needs of the school and available resources.
Schools and districts should, whenever possible, initially focus their asthma
programs on students with poorly managed, moderate-to-severe persistent asthma
as demonstrated by frequent school absences, school health office visits,
emergency department visits, or hospitalizations. Low-income, minority
populations and inner-city residents experience more emergency department
visits, hospitalizations, and deaths due to asthma than the general population.6,7
Back to Top
|
|
|
The Six Strategies
1. Establish management and support systems for asthma-friendly schools.
- Identify your school’s or district’s existing asthma needs,
resources for meeting those needs, and potential barriers.
- Designate a person to coordinate asthma activities at the district
and school levels. If your school or district has a health coordinator,
determine if asthma coordination can be integrated into his or her
activities.
- Share these strategies with the district health council and school
health team if they exist. If you do not have a council or team, help
create them. Ensure that school-based asthma management is addressed as
a high priority.8
- Develop and implement written policies and procedures regarding
asthma education and management. Promote asthma programs that are
culturally and linguistically appropriate.9,10
- Use or adapt existing school health records to identify all students
with diagnosed asthma.
- Use health room and attendance records to track students with
asthma. Focus particularly on students with poorly managed asthma as
demonstrated by frequent school absences, school health office visits,
emergency room visits, or hospitalizations. Avoid mass screening* and
mass case detection† as methods for routine identification. These
methods have not been shown to meet the World Health Organization’s or
American Academy of Pediatrics’s criteria for population or school
screening programs.11-16
- Use 504 Plans or Individualized Education Plans (IEPs), as
appropriate, especially for health services and physical activity
modifications.
- Obtain administrative support and seek support from others in the
school and community for addressing asthma within a coordinated school
health program.
- Develop systems to promote ongoing communication among students,
parents, teachers, school nurses, and health care providers to ensure
that students’ asthma is well-managed at school.
- Seek available federal, state, and private funding for school asthma
programs.
- Evaluate asthma program strategies and policies annually. Use this
information to improve programs.
* Screening for asthma (spirometry) can identify students who, in a
test situation, exhibit signs and symptoms of asthma. These students may
or may not truly have asthma. † Case detection (symptom
questionnaires) can identify students with asthma symptoms who may or
may not have the disease. Only testing and evaluation by a health
professional can confirm which students truly have asthma. 2. Provide appropriate school health and mental health services for
students with asthma.
- Obtain a written asthma action plan for all students with asthma.
The plan should be developed by a primary care provider and be
provided by parents. It should include
individualized emergency protocol, medications, peak flow monitoring,
environmental triggers, and emergency contact information.17–19 Share
the plan with appropriate faculty and staff in accordance with the
Family Educational Rights and Privacy Act (FERPA) guidelines or with
parental permission.20
- Ensure that at all times students have immediate access to
medications, as prescribed by a physician and approved by parents.
Specific options, such as allowing students to self-carry and
self-administer medications, should be determined on a case-by-case
basis with input from the physician, parent, and school.21
- Use standard emergency protocols for students in respiratory
distress if they do not have their own asthma action plan.1
- Ensure that case management‡ is provided for students
with frequent school absences, school health office visits,
emergency department visits, or hospitalizations due to asthma.22
- Provide a full-time registered nurse all day, every day for each
school.1
- Ensure access to a consulting physician for each school.1
- Refer students without a primary care provider to child health
insurance programs and providers.23,24
- Provide and coordinate school-based counseling, psychological, and
social services for students with asthma, as appropriate. Coordinate
with community services.18,22,25
‡ Case management by a trained professional
includes assessing needs and planning a continuum of care for students and
families.
3. Provide asthma education and awareness programs for students and school
staff.
- Ensure that students with asthma receive education on asthma
basics, asthma management, and emergency response. Encourage parents
to participate in these
programs.19,26–30
- Provide school staff with education on asthma basics, asthma
management, and emergency response as part of their professional
development activities. Include classroom teachers, physical
education teachers, coaches, secretaries, administrative assistants,
principals, facility and maintenance staff, food service staff, and
bus drivers.31–35
- Integrate asthma awareness and lung health education lessons
into health education curricula.36
- Provide and/or support smoking prevention and cessation programs
for students and staff.37
4. Provide a safe and healthy school environment to reduce asthma
triggers.
- Prohibit tobacco use at all times, on all school property
(including all buildings, facilities, and school grounds), in any
form of school transportation, and at school-sponsored events on
and off school property (for example, field trips).37–41
- Prevent indoor air quality problems by reducing or eliminating
allergens and irritants, including tobacco smoke; dust and debris
from construction and remodeling; dust mites, molds, warm-blooded
animals, cockroaches, and other pests.42–45
- Use integrated pest management (IPM)§ techniques to control
pests.46,47
§ IPM is a proactive approach to pest management that
includes looking for signs of pests, controlling water and food
sources, removing pest pathways and shelters, and safely using
pest control products as needed.
5. Provide safe, enjoyable physical education and activity opportunities
for students with asthma.
- Encourage full participation in physical activities when
students are well.48,49
- Provide modified activities as indicated by a student’s
asthma action plan, 504 Plan, and/or IEP, as appropriate.1
- Ensure that students have access to preventive medications
before activity and immediate access to emergency medications
during activity.50–52
6. Coordinate school, family, and community efforts to better manage
asthma symptoms and reduce school absences among students with asthma.
- Obtain written parental permission for school health staff
and primary care providers to share student health
information.53
- Educate, support, and involve family members in efforts to
reduce students’ asthma symptoms and school absences.33,54
- Work with local community programs. Coordinate school and
community services, including community health care providers,
community asthma programs and coalitions, community
counselors, social workers, case managers, and before- and
after-school programs. Encourage interested school staff to
participate in community asthma coalitions.
Back to Top
|
|
|
Resources
Coordinated School Health Programs
- Centers for Disease Control and Prevention, National Center for Chronic
Disease Prevention and Health Promotion, Division of Adolescent and School
Health, Atlanta, Georgia. Healthy
Youth!
- Council of Chief State School Officers.
School health starter kit. Washington, DC: 2003.*
- Education Development Center, Inc. Talking about health is academic.
New York, New York: Teachers College Press, 2000.
- Education Development Center, Inc., Newton, Massachusetts.
Making health academic:
creating coordinated school health program.*
- Fetro J. Step by step to health-promoting schools. Santa Cruz,
California: ETR Associates, 1998.
- Marx E, Wooley SF, Northrop D, eds. Health is academic: a guide to
coordinated school health programs. New York, New York: Teachers College
Press, 1998.
- Tyson H. Special
report: a load off the teachers’ backs: coordinated school health programs.
Phi Delta Kappan January 1999.*
Asthma
- Allergy and Asthma Network Mothers of Asthmatics, Fairfax, Virginia.
School house: Keeping healthy
at school.*
- Centers for Disease Control and Prevention, National Center for
Environmental Health, Atlanta, Georgia. Resources include:
- Asthma Initiative of Michigan,
Lansing, Michigan.*
- National Asthma
Education and Prevention Program, National Heart, Lung, and Blood
Institute, National Institutes of Health, Bethesda, Maryland. Resources
include:
- National Education Association Health Information Network,
Washington, DC. Asthma and
schools.*
- National Library of Medicine, Bethesda, Maryland.
Breath of
life: an exhibition that examines the history of asthma, the experiences
of people with asthma, and contemporary efforts to understand the
disease.
Strategy 1: Management and Support
- American Academy of Pediatrics, Elk Grove Village, Illinois.
School
health: train the trainers kit.*
- National Association of State Boards
of Education. Fit, healthy and ready to learn. Alexandria, Virginia:
National Association of State Boards of Education, 2000.*
- National School Boards Association, Alexandria, Virginia.
NSBA’s school health programs.*
- Family Policy Compliance Office, U.S. Department of Education.
Family Educational
Rights and Privacy Act (FERPA) regulations. Washington, DC: U.S.
Department of Education, 2002.
Strategy 2: Health and Mental Health
- Asthma and Allergy Foundation of America, Washington, DC.
Student asthma
action card [pdf 165K].*
- U.S. Department of Health and Human Services.
Asthma objectives. Healthy
people 2010. 2nd edition. Volume 2. Washington, DC: U.S. Government
Printing Office, November 2000.
- National Association of School Nurses, Castle Rock, Colorado. Resources
include:
- National Assembly on School-Based Health Care, Washington, DC.
Publications and order forms.*
- National Asthma Education and Prevention Program.
Expert panel report 2:
guidelines for the diagnosis and management of asthma. Bethesda,
Maryland: National Institutes of Health, National Heart, Lung, and Blood
Institute, National Asthma Education and Prevention Program, 1997.
Strategy 3: Asthma Education
- American Lung Association, Washington, DC.
Open airways for schools, an
education program for students with asthma.*
- Asthma and Allergy Foundation of America, Washington, DC.
Asthma education
programs and materials.*
- Centers for Disease Control and Prevention, Atlanta, Georgia. Resources
include:
- National Asthma Education and Prevention Program,
Bethesda, Maryland. Resources include:
- National Asthma Educator Certification Board,
New York, New York.*
Strategy 4: Healthy School Environment
- Institute of Medicine.
Clearing the air: asthma and indoor air exposures.
Washington, DC: National Academy Press, 2000.*
- IPM Technical Resource Center at Department of Entomology, Purdue
University, West Lafayette, Indiana.
Integrated pest management for schools and childcare facilities.*
-
President’s Task Force on Environmental Health Risks and Safety Risks to
Children.
Asthma and the environment: a strategy to protect
children [pdf 150K]. Washington, DC: President’s Task Force on Environmental Health
Risks and Safety Risks to Children, May 2000.
- University of Florida, Gainesville, Florida.
School IPM: integrated pest
management in schools.*
- Centers for Disease Control and Prevention, Atlanta, Georgia. Resources
include:
- U.S. Environmental Protection Agency. Resources include:
Strategy 5: Physical Education and Activity
- Block ME. A teacher’s guide to including students with disabilities in
regular physical education. Baltimore, Maryland: Paul H. Brookes
Publishing, 2000.
- Centers for Disease Control and Prevention.
Guidelines for school and
community programs to promote lifelong physical activity among young
people. Atlanta, Georgia: Centers for Disease Control and Prevention,
1997.
- National Asthma Education and Prevention Program.
Asthma and physical
activity in the school. Bethesda, Maryland: National Institutes of
Health, National Heart, Lung, and Blood Institute, National Asthma
Education and Prevention Program, 1993.*
Strategy 6: Family and Community
- Allergy and Asthma Network Mothers of Asthmatics, Fairfax, Virginia.
Resources include:
- Welcome to Breatherville, USA.
Community resources for parents of children with asthma.*
- Toll-free hotline with trained staff to answer questions about asthma,
(800) 878-4403.
- American Academy of Allergy, Asthma, & Immunology, Milwaukee,
Wisconsin.
Resources on pediatric asthma.*
Back to Top
References
-
Kaiser Permanente/American Lung Association National Partnership on
Asthma. National asthma conference: asthma prevention, management,
and treatment: community-based approaches for the new millennium.
Washington, DC: Kaiser Permanente, American Lung Association, November
2000.
-
National Asthma Education and Prevention Program.
Resolution on
asthma management at school. Bethesda, Maryland: National Asthma
Education and Prevention Program, National Heart, Lung, and Blood
Institute, 1997.
-
National Asthma Education and Prevention Program.
How asthma-friendly
is your school? Bethesda, Maryland: National Asthma Education
and Prevention Program, National Heart, Lung, and Blood Institute, 1997.
-
Allensworth DD, Kolbe LJ. The comprehensive school health program:
exploring an expanded concept. J Sch Health 1987;57(10): 409–12.
-
National Asthma Education and Prevention Program. Managing asthma: a
guide for schools. Bethesda, Maryland: National Asthma Education and
Prevention Program, National Heart, Lung, and Blood Institute, 2002.
-
Public Health Service. Action against asthma: a strategic plan for
the Department of Health and Human Services. Washington, DC:
U.S. Department of Health and Human Services, Public Health Service, May
2000.
-
Lieu TA, Lozano P, Finkelstein JA, Chi FW, Jensvold NG, Capra AM.
Racial/ethnic variation in asthma status and management practices among
children in managed Medicaid. Pediatrics 2002;109:857–65.
-
Coover L, Vega C, Persky V, Russell E, Blasé R, Wolf R. Collaborative
model to enhance the functioning of the school child with asthma.
Chest 1999;116(suppl 4):193S–5S.
-
American Association for Health Education. Cultural awareness and
sensitivity: guidelines for health educators. Reston, Virginia:
American Association for Health Education, 1994.
-
American Association for Health Education. Cultural awareness and
sensitivity: resources for health educators. Reston, Virginia:
American Association for Health Education, 1994.
-
Gerald LB, Redden D, Turner-Henson A, Feinstein R, Hemstreet MP, Hains
C. A multi-stage asthma screening procedure for elementary school
children. J Asthma 2002;39(1):29–36.
-
Wilson JMG, Junger F. Principles and practice of screening for
disease. Geneva, Switzerland: World Health Organization, 1968.
Public health papers no. 34.
-
American Academy of Pediatrics, Committee on School Health. School
health policy and practice: criteria for successful screening. Elk
Grove Village, Illinois: American Academy of Pediatrics, 1993;89.
-
Yawn BP, Wollan P, Scanlon P, Kurland M. Are we ready for universal
school-based asthma screening?: An outcomes evaluation. Arch Pediatr
Adolesc Med 2002;156(12):1256–62.
-
Yawn BP, Wollan P, Scanlon PD, Kurland M. Outcome results of a
school-based screening program for undertreated asthma. Ann Allergy
Asthma Immunol 2003;90(5):508–15.
-
Boss LP, Wheeler LS, Williams PV, Bartholomew LK, Taggart VS, Redd SC.
Population-based screening or case detection for asthma: Are we ready?
J Asthma 2003;40(4):335–42.
-
Abramson MJ, Bailey MJ, Couper FJ, Drummer OH, Forbes AB, McNeil JJ. Are
asthma medications and management related to deaths from asthma? Am J
Respir Crit Care Med 2001;163:12–8.
-
Lwebuga-Mukasa J, Dunn-Georgiou E. A school-based asthma intervention
program in the Buffalo, New York schools. J Sch Health
2002;72(1):27–32.
-
National Institutes of Health. Clinical practice guidelines: expert
panel report 2: guidelines for the diagnosis and management of asthma.
Rockville, Maryland: U.S. Department of Health and Human Services,
National Institutes of Health, 2002. NIH publication 97-4051.
-
U.S. Department of Education.
Family Educational Rights and Privacy
Act (FERPA) regulations. Washington, DC: U.S. Department of
Education, 2002.*
-
Madden JA. Managing asthma at school. Educ Leader March
2000;57(6):50–2.
-
Evans R, Gergen PJ, Mitchell H, Kattan M, Kercsmar C, Crain E. A
randomized clinical trial to reduce asthma morbidity among inner-city
children: results of the National Cooperative Inner-city Asthma Study.
J Pediatr 1999;135(3):332–8.
-
Raskin L. Breathing easy: solutions in pediatric asthma.
Washington, DC: National Center for Education in Maternal and Child
Health, Georgetown University, February 2000.*
-
Lara M, Nicholas W, Morton SC, Vaiana M, Genovese B, Rachelefsky G.
Improving childhood asthma outcomes in the United States: a blueprint
for policy action. Pediatrics 2002;109(5):919–30.
-
Fritz GK, McQuaid EL, Spirito A, Klein RB. Symptom perception in
pediatric asthma: relationship to functional morbidity and
psychological factors. J Am Acad Child Adolesc Psychiatry
1996;35(8):1033–41.
-
Clark NM, Partridge MR. Strengthening asthma education to enhance
disease control. Chest 2002;121(5):1661–9.
-
Evans D, Clark M, Feldman C, Rips J, Kaplan D, Levison M. A school
health education program for children with asthma aged 8–11
years. Health Educ Q 1987; 14:267–79.
-
Evans D, Clark N, Levison M, Levin B, Mellins R. Can children teach
their parents about asthma? Health Educ Behav 2001; 28:500–11.
-
Spencer G, Atav S, Johnston Y, Harrigan J. Managing childhood asthma:
the effectiveness of the Open Airways for Schools program. Fam
Community Health 2000;23:20–30.
-
Gregory EK. Empowering students on medication for asthma to be active
participants in their care: an exploratory study. J Sch Nursing
2000; 16(1):20–7.
-
Fillmore EJ, Jones N, Blankson JM. Achieving treatment goals for
schoolchildren with asthma. Arch Dis Child 1997;77:420–2.
-
Atchison JM, Cuskelly M. Educating teachers about asthma. J Asthma
1994;31(4):269–76.
-
Henry RL, Hazell J, Halliday JA. Two hour seminar improves knowledge
about childhood asthma in school staff. J Paediatr Child Health
1994;30:403–5.
-
Hay GH, Harper TB, Courson FH. Preparing school personnel to assist
students with life-threatening food allergies. J Sch Health
1994;64(3):119–21.
-
Eisenberg JD, Moe EL, Stillger CF. Educating school personnel about
asthma. J Asthma 1993;30(5):351–8.
-
Lurie N, Straub MJ, Goodman N, Bauer EJ. Incorporating asthma education
into a traditional school curriculum. Am J Pub Health
1998;88(5):822.
-
Centers for Disease Control and Prevention.
Guidelines for school health
programs to prevent tobacco use and addiction. MMWR
1994;43(RR-2):1–18.
-
Centers for Disease Control and Prevention. Preventing tobacco use among
young people: a report of the Surgeon General. MMWR
1994;43(RR-4):1–10.
-
Clark NM, Brown RW, Parker E, Robins TG, Remick DG, Philbert MA.
Childhood asthma. Environ Health Perspect 1999;107(3):421–9.
-
Epps RP, Manley MW, Glynn TJ. Tobacco use among adolescents: strategies
for prevention. Pediatr Clin North Am 1995;42(2):389–402.
-
Morkjaroenpong V, Rand CS, Butz AM, Huss K, Eggleston P, Malveaux FJ.
Environmental tobacco smoke exposure and nocturnal
symptoms among inner-city children with asthma. J Allergy Clin
Immunol 2002;110(1):147–54.
-
Eggleston PA, Bush RK. Environmental allergen avoidance: an overview.
J Allergy Clin Immunol 2001;107(3):S403–5.
-
Dautel PJ, Whitehead L, Tortolero S, Abramson S, Sockrider MM. Asthma
triggers in the elementary school environment: a pilot study. J
Asthma 1999;36(8):691–702.
-
Tortolero SR, Bartholomew LK, Tyrrell S, Abramson SL, Sockrider MM,
Markham CM. Environmental allergens and irritants in schools: a focus on
asthma. J Sch Health 2002;72(1):33–8.
-
Campbell ME, Dwyer JJ, Goettler F, Ruf F, Vittiglo M. A program to
reduce pesticide spraying in the indoor environment: evaluation of the
“Roach Coach” Project. Can J Public Health 1999;90(4):277–81.
-
Greene A, Breisch NL. Measuring integrated pest management programs for
public buildings. J Econ Entom 2002;95(1):1013.
-
Herfurt D. Exercise and EIA. J Respir Care Practitioners 1997;
10(3):42–8.
-
Block ME, Garcia C, eds. Including students with disabilities in
regular physical education. Reston, Virginia: National Association
for Sport and Physical Education, American Association for Active
Lifestyles and Fitness, 1995.
-
Gean J, Schroth MK, Lemanske RF. Childhood asthma: older children and
adolescents. Clin Chest Med 1995;16(4):657–70.
-
Howenstine MS, Eigen H. Medical care of the adolescent with asthma.
Adolesc Med 2000;11(3):501–19.
-
Kumar A, Busse WW. Recognizing and controlling exercise-induced asthma.
J Respir Dis 1995;16(12):1087–96.
-
Majer LS. Managing patients who have asthma: the pediatrician and the
school. Pediatr Rev 1993;14(10):391–4.
-
Einhorn E, DiMaio M. An interdisciplinary program to control pediatric
asthma. Continuum May–June 2000;8–13.
Back to Top
|
|