The Last Word

Asthma Management in Schools

By Lani Wheeler, M.D.

Several federal agencies and dozens of professional and patient advocacy groups are helping schools develop asthma management programs. Across the country, 53 million young people attend schools, and almost 9 million children under 18 have been diagnosed with asthma. Asthma is one of the most common causes for school absenteeism, accounting for 14 million school days missed each year. In a classroom of 30 students, two students are likely to have had an asthma episode in the past year.

Schools primarily educate children and youth; can they really focus on managing asthma, too? Absolutely! Educators know that children must be healthy to learn. Wheezing, coughing, and shortness of breath don't promote learning. Asthma management is a part of coordinated school health programs in many schools.

Schools can start by establishing "asthma-friendly" policies. These include permitting students to carry and administer quick-relief asthma medicines, providing school nurses, and promoting physical activity for all students.

To help individual students, schools can request a copy of the student's asthma action plan from the student's family or physician. School nurses review the plan, determine the student's specific needs, and make sure that the student has immediate access to quick-relief asthma medications. For older students, this often means that students carry the inhaler, and a back-up supply is kept by the nurse. For very young students, teaching proper inhaler technique to a supervised health assistant delegated to administer the medicine may be needed. The best plan for each student is determined case-by-case with input from the student, parents, physician, and school nurse.

Many students need to learn more about managing their asthma. School nurses and community asthma educators provide asthma education programs such as Open Airways for Schools from the American Lung Association and Power Breathing by the Asthma and Allergy Foundation of America. Some school districts offer these programs in every school. Asthma education and awareness can be extended to teachers, school staff, parents, and to all students, including those without asthma. In addition, collaboration between school nurses and physical educators and coaches is especially important for youths with exercise-induced asthma (EIA).

Students who have EIA often require medication 15 to 20 minutes before physical activity. Using the student's asthma action plan, school nurses work with students and parents to figure out the best individualized approach. They then discuss the student's needs with physical education teachers and coaches, encouraging appropriate warm-up routines and ensuring that staff members know what to do if a student starts having a breathing problem. Occasionally, activities may need to be modified or students may need to take quick-relief medication; however, most students with asthma can fully participate in physical activities most of the time.

Improving indoor air quality (IAQ) can also help reduce or eliminate asthma triggers in schools. The Environmental Protection Agency reports that about 10,000 schools nationwide have used the agency's Indoor Air Quality Tools for Schools kit to assess their IAQ needs and guide inexpensive improvements. Ways to improve IAQ include routine cleaning and maintenance, quickly drying wet spots, and adopting integrated pest management techniques.

Schools can't manage asthma by themselves. Parents help by communicating directly with the school nurse and by giving permission to the doctor and school nurse to talk to each other. School health councils help schools locate community resources, such as local hospitals, health-care organizations, and asthma organizations, which can provide additional asthma education materials and programs for parents, as well as asthma camps for kids. Together, families, community groups, and schools can help children with asthma live and learn well.

To help your child's school be more "asthma-friendly," check out the following federal programs:

Lani Wheeler, M.D., is a medical officer with the Centers for Disease Control and Prevention, Division of Adolescent and School Health. She represents the American School Health Association on the NAEPP Coordinating Committee and chairs the NAEPP School Education Subcommittee.