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

Asthma in the Classroom: What do teachers need to

know?

Pulmonary Rehabilitation

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

Asthma is Common

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

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

Asthma Impact School

Asthma can affect… School attendance Ability to concentrate Overall academic

performance Overall quality of life

What is asthma?

Overview

Chronic lung disease that can affect a person’s breathing

Asthma can range from mild to severe

Image from www.mitchellzhomes.com/AZAPAA/azapaa_asthma.htm

What is Asthma?

http://www.mitchellzhomes.com/AZAPAA/azapaa_asthma.htm

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?”

Cough Wheezing/whistling with

breathing Hard to breathe Chest tightness Tired or fatigued

Common Asthma Symptoms

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

Environmental Asthma TriggersHow does the environment impact asthma?

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

Asthma Medications

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

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 Coalition’s “Asthma in the School Setting” http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf

Controller Medications

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

Symbicort


Asthma in the ClassroomAsthma Triggers

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

Triggers in the Classroom Allergens: Pets and Pests

Examples:

Pollen

Example - from plants in classroom or outdoors

Molds

Examples – from wet drywall, rug or saturated plants

Triggers in the Classroom Allergens

Near intake vent or window

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


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


No dust mites here!

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




Identify possible sources of mold

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


Prevent allergens from multiplying

Prevent exposure to allergens

Make sure ventilation system is working and report to custodian if it is not

Locate children’s clothes with smoke and pet allergens away from occupied areas and ventilation system


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

Triggers in the Classroom Irritants - Chemical

Airborne particles in the building - chalk dust, from buffing waxed floors

High air pollution daysNote: 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


Triggers in the Classroom Irritants - Particulate

Exhaust (indoor/outdoor)

Vehicle - school bus, delivery and car idling

Landscaping equipment - snow blower, lawn mower, leaf blower


o Exhaust - Office Equipment

Copier

Laminating machine

Laser printer


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!

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


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.

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 physician’s instructions to do so

Asthma can be controlled and children with asthma can lead active, healthy lives!


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


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

Asthma in the ClassroomWhat to be aware of

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

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 nurse’s office

Never send a child experiencing asthma symptoms alone to the nurse’s office


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!

Asthma in the ClassroomPotential Medication Side Effects

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


AsthmaMedication Devices

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

Asthma at SchoolAsthma Action Plans

All children with asthma should have a written Asthma Action Plan at school, home and physician’s 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

Asthma Action Plan- Example

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!

Questions?

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-disease/asthma

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

Pulmonary Rehabilitation

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