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Asthma Management in Schools

Asthma Management in Schools. September 17, 2007 *********************************************************** Brian Patrick Superintendent Townsend K-12 School District # 1. What is happening in Montana. Task Force SAM, MTSBA, DEQ, OPI, & Others

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Asthma Management in Schools

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  1. Asthma Management in Schools September 17, 2007 *********************************************************** Brian Patrick Superintendent Townsend K-12 School District # 1

  2. What is happening in Montana • Task Force • SAM, MTSBA, DEQ, OPI, & Others • AASA/NSBA & Center for Disease Control Joint Project • 5 States • Indiana, Kentucky, Michigan, Montana, and Wisconsin

  3. WHY TALK ABOUT ASTHMA? • Asthma can be deadly. • Most asthma episodes can be prevented. • There are legal requirements that affect how schools deal with students who have asthma. • Children with asthma account for almost 15 million missed school days a year, and miss more days on average than their friends who don’t have asthma.1 CDC. Asthma prevalence, health care use and mortality, 2002. Hyattsville, MD: U.S. Department of Health and Human Services; 2004.

  4. Could this happen in your district? Jury Awards $9 Million in Asthma Death at School A California jury that unanimously awarded a mother $9 million in damages for her 11-year old son’s fatal asthma attack at school found the school district guilty of negligence for failing to inform parents of an unwritten school policy that would have allowed the child to carry an inhaler. Gonzalez vs. Hanford Elementary School District, Nos. F033659, F034555, (Super. Ct. Nos. 0031 & 1109). June 2002.

  5. Asthma in Children Fact Sheet • Asthma is the most common chronic disorder in childhood, currently affecting an estimated 6.2 million children under 18 years; of which 3.9 million suffered from an asthma attack or episode in 2004. • In 2003, asthma accounted for an estimated 12.8 million lost school days in children. It is the leading cause of school absenteeism attributed to chronic conditions. • Asthma is the third leading cause of hospitalization among children under the age of 15. Close to 39 percent of all asthma hospital discharges in 2004 were in those under 15, however only 21 percent of the U.S. population was less than 15 years old. • In 2002, 641,242 emergency room visits were due to asthma in those under 15.

  6. Asthma in Children Fact SheetContinued • Current asthma prevalence in children under 18 ranges from 5.7 percent in South Dakota and Idaho to 11.9 percent in Delaware. • Asthma is characterized by excessive sensitivity of the lungs to various stimuli. Triggers range from viral infections to allergies, to irritating gases and particles in the air. Each child reacts differently to the factors that may trigger asthma, including: • respiratory infections, colds • allergic reactions to allergens such as pollen, mold, animal dander, feathers, dust, food, and cockroaches • vigorous exercise • exposure to cold air or sudden temperature change • cigarette smoke • excitement/stress • Within the last few years, mortality and hospitalizations due to asthma have decreased and asthma prevalence has stabilized, possibly indicating a higher level of disease management. • Asthma medications help reduce underlying inflammation in the airways and relieve or prevent airway narrowing. Control of inflammation should lead to reduction in airway sensitivity and help prevent

  7. What about those inhalers? Does Montana allow students to possess and self-administer prescribed medications at school?

  8. Do school facilities compromise student health and achievement? • Environmental triggers exacerbate asthma and other respiratory ailments. • 50% of schools serving over 20 million children have unsatisfactory environmental conditions such as poor ventilation, heating and lighting. • Studies support the link between poor indoor air quality and low student achievement.

  9. School facilities and achievement • Students whose school facilities are in poor condition have test scores about 5.5 percentage points below students whose school facilities are in fair condition, and about 11 percentage points below students in excellent facilities. • 90% of U.S. schools were built before 1980, and 50% before 1960.

  10. Asthma triggers in a classroom may include • Stuffed animals. • Carpeting. • General dusty clutter. • Plants. • Pets. • Mold. • Perfume, candles, air fresheners.

  11. To think about… • Do you know your district’s policy about the self-possession and use of inhalers (and other quick-relief medication) for students with asthma? • How well does your district monitor indoor air quality related to carpeting in classrooms? • What is your district’s policy on keeping pets or plants in the classroom?

  12. Be proactive • Create local policies that support asthma-friendly schools. • Provide school health services for students with asthma. • Offer asthma-management education to students, staff, and families. • Provide a safe and healthy environment by reducing asthma triggers in the school environment. • Coordinate school, family, and community resources to better manage asthma symptoms and reduce school absences.

  13. Resources for school leaders from AASA • AASA’s Indoor Air Quality & Asthma initiatives. • School Governance and Leadership (Spring 2003). • Schoolhouse in the Red (2004 Edition). • “Frequently Asked Asthma Questions” document. • Powerful Practices: A Checklist for School Districts Addressing the Needs of Students with Asthma.

  14. MASS Web site Information • Asthma Information May is Asthma Awareness Month • The American Association of School Administrators is committed to improving the lives of children through their health and wellness programs and resources. Since May is Asthma Awareness Month, we would like to highlight some facts, figures and activities: • Facts About Asthma • Asthma is a leading chronic illness among children and youth in the United States. • Asthma is one of the leading causes of school absenteeism. • In 2002, 14.7 million school days were missed due to asthma.1 • In 2003, five million school-aged children and youth were reported to currently have asthma • 3.1 million children had an asthma episode or attack within the previous year.2 • On average, in a classroom of 30 children, about three are likely to have asthma. • Low-income populations, minorities and children living in inner cities experience more emergency department visits, hospitalizations and deaths due to asthma than the general population.3 • Asthma attacks, also referred to as episodes, can be caused by tobacco smoke, dust mites, furred and feathered animals, certain molds, chemicals and strong odors in the school environment. • How can your district celebrate Asthma Awareness Month? • Download the Environmental Protection Agency’s Asthma Awareness Month Toolkit. • What is happening in your area for Asthma Awareness Month? Click on your state. • AASA receives funding to work on asthma and other related issues, including: • Asthma Leadership Project -- This project, funded by the Centers for Disease Control, focuses on building the capacity of school leaders to be proactive and take initiative on building asthma-friendly schools policies. Read more about our project. Resources available to you include: • Do you have questions about asthma? Read Questions School Leaders Frequently Ask About Asthma. • How well does your district do to address the needs of students with asthma? Find out with AASA’s Powerful Practices document (PDF). • For a basic primer education on asthma, read the Spring 2003 edition of School Governance & Leadership. • Does your school have a tobacco-free schools policy? What goes into a tobacco-free schools policy? Download a Fact Sheet (PDF) from the Campagin for Tobacco Free Kids. • Asthma, diabetes, mental health, childhood obesity, and other factors all affect a child’s ability to learn in the classroom. • Healthy School Environments -- The indoor air quality of your district’s schools is also of utmost importance – for students and staff both with and without asthma. AASA’s Healthy Schools Environment Project works with districts large and small to brainstorm ways to work together to improve the indoor air quality of all schools. • The Urban and Rural Healthy Schools Coalitions meet annually to discuss the unique needs of their districts. • Read about the unique challenges of urban districts in AASA’s latest publication Putting the Pieces Together: An Urban School Leader’s Guide to Healthy Indoor Environments. • If your district is interested in joining the Urban or Rural Healthy School Coalitions, contact Felisa Nobles at fnobles@aasa.org. • All districts have the opportunity to improve their indoor air quality through the free, comprehensive assessment tool from the Environmental Protection Agency called Tools for Schools. The kit has many useful components to help schools and school districts design and implement their IAQ programs. • Health is interrelated and should be treated as such. Asthma does not stand alone as a chronic disease issue. Combining issues into one comprehensive chronic disease policy may be something your district wants to look at more in-depth, if it does not already have a policy in place. However, each disease is unique and should be recognized for its own issues and special cases. For example, are students with asthma allowed to self-carry their medicines? • There are a wealth of resources and information available to school leaders to help address asthma and the school environment. Contact Kelly Beckwith at kbeckwith@aasa.org if you would like more information about this important topic. • The Center for Disease Control and Prevention (CDC) publication "Resources for Addressing Asthma in Schools"  lists valuable resources (including publications and web-site links) to help parents, health care workers and schools with asthma education and issues.  Click on the text below and a copy of this publication will download in a readable-printable format.  The PDF will allow you direct access to over 49 asthma related links and 20 web-sites.Resources for Addressing Asthma in Schools • 1 CDC. Asthma prevalence, health care use and mortality, 2002. Hyattsville, Maryland: US Department of Health and Human Services, CDC, National Center for Health Statistics, 2004.2 American Lung Association, Epidemiology and Statistics Unit, Research and Program Services. Trends in Asthma Morbidity and Mortality, May 2005.3 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; 109:857–865.

  15. Administrative Questions • Question 1: How can I obtain additional copies of the Asthma Wellness issue of School Governance & Leadership?Answer: The document can be downloaded from the AASA website. For hard copies, contact Kelly Beckwith at 703-875-0760 or kbeckwith@aasa.org.

  16. Administrative Questions • Question 2: Where can I get a copy of the Centers for Disease Control and Prevention’s Strategies for Addressing Asthma Within a Coordinated School Health Program? • Answer: Copies are available from the CDC: www.cdc.gov/healthyyouth/asthma. To request print copies, call 1-888-231-6405.

  17. Administrative Questions • Question 3: Where can I find basic information on asthma? • Answer: Asthma is a chronic lung condition that may cause repeated acute episodes characterized by breathing problems such as wheezing, coughing, chest tightness or pain, shortness of breath and lack of energy. Click on the links below to find additional basic information on asthma and schools.http://www.asthmaandschools.org/http://www.epa.gov/iaq/schools/asthma/http://www.cdc.gov/asthma/default.htm

  18. Administrative Questions • Question 4: Where can I find sample asthma action plans? • Answer: Every student with asthma needs to have an “asthma action plan” on file with their school nurse—this is the key to asthma planning at school. View a sample asthma action plan by visiting the following links:http://www.noattacks.org/AsthmaActionCardStudent.pdfhttp://www.on.lung.ca/asthmaaction/action_plan.html#samplehttp://www.health.ri.gov/disease/asthma/aap100a.jpg.

  19. Administrative Questions • Question 5: Where can I find more information on school policy and asthma? • Answer: Written policies promote effective management of asthma. Such policies may address a smoke free environment, medication administration, school wide emergency plans, staff training and educational programs for students. Policies may be asthma-specific, or focus on chronic diseases or on the school environment. Visit the following links for more information on potential policy options. • http://www.nasbe.org/HealthySchools/fithealthy.html**AASA has a limited number of free copies of NASBE's publication Fit, Healthy, and Ready to Learn. Contact Kelly Beckwith at kbeckwith@aasa.org or 703-875-0760 for more information!**http://www.nhlbi.nih.gov/health/public/lung/asthma/friendhi.htmhttp://www.nhlbi.nih.gov/health/public/lung/asthma/resolut.htmhttp://www.asthmaandschools.org/essentials/7-atschool.htmhttp://www.ashaweb.org/healthinaction.htmlhttp://www.rand.org/publications/MR/MR1330/MR1330.pdf

  20. Administrative Questions • Question 6: Where can I find information on best practices for managing asthma in schools? • Answer: The Centers for Disease Control and Prevention has developed Strategies for Addressing Asthma Within a Coordinated School Health Program with school health and school asthma experts. The six strategies and additional action items provide best practices guidance for schools and school districts. The National Asthma Education and Prevention Program (NAEPP) have published an updated version of Managing Asthma: A Guide for Schools. AASA is working with school districts to implement best practices for managing asthma in schools. Furthermore, CDC/DASH has a 5-page resource list for addressing asthma in schools. Click on the links below to find information on best practices for children with asthma.http://www.cdc.gov/healthyyouth/asthmahttp://www.nhlbi.nih.gov/health/prof/lung/initiatives/pediatricasthmaguidelines/default.stmhttp://www.nhlbi.nih.gov/guidelines/asthma/execsumm.pdf • http://www.cdc.gov/HealthyYouth/asthma/pdf/pubs-links.pdf

  21. Administrative Questions • Question 7: What programs are available to teach students and families about asthma? • Answer: There are many programs that serve as educational tools for children with asthma and families. Click on the links below to find detailed information about these programs.http://www.lungusa.org/events/astopen.htmlhttp://www.nhlbi.nih.gov/health/prof/lung/asthma/school/index.htmhttp://www.aanma.org/breatherville.htmhttp://www.starlight.org/site/c.hvKVLfMTIqG/b.1615255/k.2925/Asthma_CD_ROM_Quest_for_the_Code.htm**AASA**AASA has a limited number of free copies of Quest for the Code. Contact Kelly Beckwith at kbeckwith@aasa.org or 703-875-0760 for more information!**

  22. Administrative Questions • Question 8: Where can we find information on asthma and athletes? • Answer: Athletes that have been diagnosed with asthma should be encouraged to fully participate in physical activities and have easy access to pre-exercise medicine when indicated. Activities should be modified if it is indicated in the action plan. Click on the links below to find additional information on asthma and athletes.http://www.nhlbi.nih.gov/health/public/lung/asthma/phy_asth.htmhttp://allergies.about.com/library/blaaaai072902b.htm.

  23. Administrative Questions • Question 9: Where can I get a copy of a sample letter from a school to a physician that encourages cooperation on asthma management in school? • Answer: A sample “Dear Doctor” letter has been developed by the American Academy of Pediatrics. The letter can be obtained by downloading a copy of the Spring 2003 edition of School Governnance & Leadership.

  24. Administrative Questions • Question 10: Where can I find information about funding for asthma programs? • Answer: The following websites will provide information about funding for asthma. • Centers for Disease Control & Prevention: http://www.cdc.gov/od/pgo/funding/funding.htm • National Heart Lung & Blood Institute: : http://www.nhlbi.nih.gov/funding/index.htm • Agency for Healthcare Research & Quality: http://www.ahrq.gov • Robert Wood Johnson Foundation's "Allies Against Asthma": http://www.asthma.umich.edu/ • American Lung Association: http://www.lungusa.org - click on Research

  25. Administrative Questions • Question 11: Where can I get more information about indoor air quality issues? • Answer: Contact Ericka Plater Turner at 703-875-0731 or eturner@aasa.org about indoor air quality and the Tools for Schools Kit. This free kit is designed to help school leaders identify, resolve and prevent indoor air quality issues that effect children and staff health and performance.

  26. Administrative Questions • Question 12: Where can I find information about funding for Indoor Air Quality? • Answer: There are few opportunities for funding of Indoor Air Quality; however, some states are given funding to implement indoor air quality programs. Click on the link to get information on funding: http://www.epa.gov/air/grants_funding.html.

  27. Administrative Questions • Question 13: Where can I find information about liability and litigation of asthma and Indoor Air Quality (IAQ) issues? • Answer: Liability and litigation for asthma and IAQ is emerging as a big problem for school districts. Many schools have been closed for days, weeks and in some cases permanently.For additional information, click on the links below:http://www.wrightslaw.com/info/mediation.7steps.htmhttp://reason.com/0204/fe.cs.asthma.shtml.

  28. BACK-TO-SCHOOL ASTHMA: WHAT CAN PARENTS DO? • For parents of children with asthma, back-to-school shopping lists and chores also should include being prepared for a seasonal spike in asthma attacks. Several actions will help parents stay on top of their child’s asthma management and their communication with teachers, nurses and others at school. • Asthma management: • See your child’s doctor—If your child is due for a check-up with his or her physician, make sure that happens before school begins! • Know your child’s triggers—Be aware of what may be triggering asthma attacks, and work to keep him away from those allergens and triggers. Asthma triggers may include: exercise, smoke, pollen, dust, air pollution, animal fur, colds, flu and other respiratory infections. • Understand your child’s asthma control—Keep track of nighttime coughing and/or waking, which may mean that asthma is not being well controlled, as well as actual asthma attacks. Work with your physician to be sure asthma is under control before school starts, which may decrease the chances of it worsening at the beginning of the year. • Have a written Asthma Action Plan—Work with your child’s physician to complete a plan, which should include individualized information about your child’s asthma symptoms, daily medications, rescue inhaler or nebulizer treatments, any physical activity limitations or need for inhaler before strenuous activities, and specific instructions about what to do and whom to call if an asthma attack does not improve with medication. A free Asthma Action Plan form is available online at www.lungusa.org, or call 1-800-LUNG-USA for a copy.

  29. BACK-TO-SCHOOL ASTHMA: WHAT CAN PARENTS DO? Continued • Schedule flu shots—Talk to you child’s physician now about getting immunized against influenza in September or October. Preventing influenza may lessen asthma episodes and trips to the ER. Flu shots for people with asthma have been proven safe through research conducted by the American Lung Association. • School support & communications: • Share and discuss the Asthma Action Plan—Give a copy of the written plan with your school nurse or other health staff, as well as the classroom teacher, physical education teacher and school coach(es). Take time to talk to the nurse and teachers about your child’s triggers, typical symptoms, medications, etc. Communication is key to preparing the adults responsible for your child at school! • Be aware of indoor & outdoor air pollution as triggers—Help teachers and staff understand how indoor air can impact people with asthma. Identify your child’s particular environmental triggers and work toward minimizing your child’s exposure to them at school. Be sure your school administration has a plan to minimize children’s exposure to smog and particle pollution according to the local Air Quality Index report; daily information and health advisories are available at www.epa.gov/airnow. • Identify how to make your school “asthma-friendly”—The American Lung Association’s comprehensive asthma management program for schools includes a baseline school questionnaire that can help guide parents, as well as staff, to understand all elements of the school systems that can impact children with asthma. The free “How Asthma Friendly Is Your School?” is available at www.lungusa.org. • Review the Powerful Practices – This checklist developed by AASA, is intended for school administrators. It helps districts identify areas in which it is currently doing well, as well as areas in which it may want to focus more energy on its asthma management policies. The free checklist is available at www.aasa.org/focus. • For more information about American Lung Association asthma programs, research, and advocacy, visit www.lungusa.org or call 1-800-LUNG-USA. For more information about the American Association of School Administrators health and wellness initiatives, please visit www.aasa.org/focus.

  30. Additional Resources • Strategies for Addressing Asthma Within a Coordinated School Health Program; Centers for Disease Control and Prevention - http://www.cdc.gov/healthyyouth/asthma/strategies.htm • Managing Asthma: A Guide for Schools; National Asthma Education and Prevention Program (NAEPP) http://www.nhlbi.nih.gov/health/prof/lung/asthma/asth_sch.htm • Fit, Healthy, and Read to Learn: National Association of State Boards of Education - http://www.nasbe.org/HealthySchools/fithealthy.html • Quest for the Code Asthma CD Rom Game; Starlight Starbright Children’s Foundation -http://www.starlight.org/site/c.fuLQK6MMIpG/b.1352333/k.2867/Asthma_CD_ROM_Quest_for_the_Code.htm • Schooled in Asthma; American Academy of Pediatrics - http://www.aap.org/schooledinasthma/ • Tools for Schools; Environmental Protection Agency - http://www.epa.gov/iaq/schools/toolkit.html • Open Airways for Schools (for Elementary School children) - http://www.lungusa.org/ • Power Breathing™ (for Teens) - http://www.aafa.org/display.cfm?id=4&sub=79&cont=436

  31. References CDC.Asthma prevalence, health care use and mortality, 2002. Hyattsville, Maryland: US Department of Health and Human Services, CDC, National Center for Health Statistics, 2004. Gonzalez vs. Hanford Elementary School District, Nos. F033659, F034555, (Super.Ct. Nos. 0031 & 1109). June 2002 Indoor Air Quality and Student Performance. EPA, March 2001, Revised 2003. School Facilities: The Condition of America’s Schools. US General Accounting Office 2000. Schneider, M. Do School Facilities Affect Academic Outcomes? National Clearinghouse for Educational Facilities, November 2002.

  32. Checklist for Superintendents • Education – self & staff • Check Policy • School Wellness • School Nurse/School Secretary • Asthma Plan of Action in Place • Identify Students • DEQ Checklists – Tools for Schools

  33. For More Information For more information on AASA’s efforts to address asthma in schools please visit www.aasa.org/focus. AASA staff contacts: Kelly Beckwith -kbeckwith@aasa.org Rebecca Nelson - rnelson@aasa.org This document was developed by AASA under a cooperative agreement with the Division of Adolescent and School Health of the U.S. Centers for Disease Control and Prevention; grant number U58/CCU820135-01. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

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