asthma school resource manual - utah department …...asthma school resource manual 1-2 asthma data:...

Asthma School Resource ManualAsthma School Resource ManualAsthma School Resource ManualAsthma School Resource ManualAsthma School Resource Manual

AcknowledgementsAcknowledgementsAcknowledgementsAcknowledgementsAcknowledgements

Vicki Berg, RN, CDEAshley Valley Medical Center

Kathy Briggs, RN, NCSNSchool NurseGranite School District

Meg Danielson, RN, BSNQuality Improvement SpecialistIHC Health Plans

Rebecca Giles, MPH, CHESAsthma Program ManagerUtah Department of Health

Caroline E. Green, CHES, BSNState School Nurse ConsultantUtah Department of Health

Sharon Hendrickson, RNSchool NurseWeber School District

Paula Johnson RN, BSNBureau Manager of Public Health NursingDavis County Health Department

Libbey Mathews, BSHealth Program SpecialistAsthma ProgramUtah Department of Health

Gary Peterson, RNAsthma Program CoordinatorPrimary Children’s Medical Center

Virginia J Sanchez, RNSchool NurseGranite School District

Lee StoorSpecial Education CoordinatorAlpine School District

Lana Sullivan RN, BSNSchool NurseDavis County Health Department

Becky Toone, RNSchool NurseWeber School District

Vicki WheelerAssociate DirectorAmerican Lung Association of Utah

Mindy Williams, MPHGrant CoordinatorAsthma ProgramUtah Department of Health

Cherissa WoodProgram SpecialistAmerican Lung Association of Utah

David C. Young, PharmD.Associate Professor, ClinicalUniversity of Utah College of Pharmacy

Clip art provided by www.clipart.com

The Utah Department of Health Asthma Program would like to acknowledge themany individuals and agencies who gave their time and resources to create thismanual. We especially appreciate the State of Connecticut Department of PublicHealth, Bureau of Community Health for the use of their manual, Managing Asthmain Connecticut Schools.


Table of ContentsTable of ContentsTable of ContentsTable of ContentsTable of ContentsTable of Contents

Foreward .................................................................................................................................. iSection 1: Asthma Basics................................................................................................. 1-1Section 2: School Administration .................................................................................. 2-1Section 3: School Nurses ................................................................................................ 3-1Section 4: All School Staff .............................................................................................. 4-1

Teaching Staff ............................................................................................................... 4-5Physical Education Teachers ...................................................................................... 4-7Custodial Staff ............................................................................................................ 4-10Food Services Staff .................................................................................................... 4-14

Section 5: Asthma Resources ......................................................................................... 5-1State Resources............................................................................................................. 5-1National Resources ...................................................................................................... 5-1Education Programs ................................................................................................... 5-4Books ............................................................................................................................. 5-7Family ............................................................................................................................ 5-9Glossary of Terms .................................................................................................... 5-11


i

ForewardForewardForewardForewardForeward

IntroductionIntroductionIntroductionIntroductionIntroduction

This manual has been prepared as aguide for all school staff who are keyplayers in promoting student health andhealth services in the school. Adminis-trators, secretaries, teachers, nurses,coaches, and custodial staff are part ofone team who work together topromote the health of students andstaff and to create a healthy schoolenvironment. The manual is dividedinto specific sections for targetedaudiences to provide them with theinformation they need to understand,manage, and control asthma in theschool. The information is presented ina simple yet comprehensive manner.Included within the manual arereferences and resources for furtherinformation, as well as handouts thatcan be reproduced and distributed tocolleagues and parents.

Strategies for Addressing AsthmaStrategies for Addressing AsthmaStrategies for Addressing AsthmaStrategies for Addressing AsthmaStrategies for Addressing Asthma

Within a Coordinated School HealthWithin a Coordinated School HealthWithin a Coordinated School HealthWithin a Coordinated School HealthWithin a Coordinated School Health

ProgramProgramProgramProgramProgram

The Centers for Disease Control andPrevention *(CDC) has identified sixstrategies for schools and districts toconsider as they develop coordinatedplans for addressing asthma in schools.

The six strategies for addressingasthma within a coordinated schoolhealth program are:

~~~~~ Establish management and sup-port systems for asthma-friendlyschools.

~~~~~ Provide appropriate school healthand mental health services forstudents with asthma.

~~~~~ Provide asthma education andawareness programs for studentsand school staff.

~~~~~ Provide a safe and healthy schoolenvironment to reduce asthmatriggers.

~~~~~ Provide safe, enjoyable physicaleducation and activity opportuni-ties for students with asthma.

~~~~~ Integrate school, family, and com-munity efforts to better manageasthma symptoms and reduceschool absences among studentswith asthma.(Please refer to the booklet in the pocket,“Strategies for Addressing AsthmaWithin a Coordinated School HealthProgram.”)

*CDC is recognized as the lead federal agencyfor protecting the health and safety of people -at home and abroad, providing credibleinformation to enhance health decisions, andpromoting health through strong partnerships.


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Asthma BasicsAsthma BasicsAsthma BasicsAsthma BasicsAsthma Basics

Asthma OverviewAsthma OverviewAsthma OverviewAsthma OverviewAsthma OverviewPeople who have asthma experienceperiods of breathlessness, wheezing,coughing, and chest tightness; theseperiods are called attacks or episodes.Sometimes these attacks can be lifethreatening. The specific cause(s) ofasthma are not known. However,people with asthma can lead normal,productive lives with effective asthmamanagement and control of asthma

symptoms. Asthma that is not con-trolled has a significant impact on theperson with asthma, the family,caregivers, and others. Asthma is theleading cause of missed days fromschool due to a chronic illness and canresult in missed days of work, visits tothe hospital, interrupted sleep, limitedphysical activity, and the disruption offamily and caregiver routines.

Asthma: A chronic inflammatory diseaseof the lungs.

Source: National Health Interview Survey, National Center for Health Statistics, National Center for Disease Control andPrevention, 2001.

Diagnosed with asthma in their lifetime.


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Asthma Data:Asthma Data:Asthma Data:Asthma Data:Asthma Data:The incidence, severity, and mortality associ-ated with asthma are increasing.Overall Utah Data

~~~~~ About 7.5% of Utahns are undermedical care for asthma.

~~~~~ Utahns spent more than $8.3million for asthma hospitalizationsin 2002.

Children, Ages 0-17 Data~~~~~ Asthma is the most common

chronic illness among children.~~~~~ Approximatly 5.0% of Utah’s

children under the age of 18 haveasthma.

~~~~~ Childhood asthma is a leadingcause of missed school dayswithin the United States.~~~~~ Each year more than 10 million

school days are missed.~~~~~ Some 2,400 children under the age

of 17 were hospitalized in 2002due to asthma in Utah.

Sources: Utah Health Status Survey 2001; UtahHospital Discharge Database 2002; UtahEmergency Department Encounter Database,2002

Asthma Signs andAsthma Signs andAsthma Signs andAsthma Signs andAsthma Signs andSymptomsSymptomsSymptomsSymptomsSymptoms

As staff members, it is important tounderstand how to recognizeasthma warning signs and to educatestudents with asthma about the earlysigns of an asthma episode so that thestudent can take the appropriate medi-cation to keep his/her asthma undercontrol.

What to Look For:~~~~~ Retractions~~~~~ Nasal flaring~~~~~ Depressed sternal notch~~~~~ Nausea/vomiting~~~~~ Fatigue~~~~~ Decreased peak flow value~~~~~ More serious symptoms in-

clude:~~~~~ Dyspnea (shortness of

breath)~~~~~ Diaphoresis (perspiration)~~~~~ Unwillingness/inability to

speak or lie down~~~~~ Anxious look~~~~~ Stooped body posture

Other Signs and Symptoms:~~~~~ Cough or wheeze after physical

activity.~~~~~ Breathing problem during particu-

lar season.~~~~~ Cough, wheeze, or chest tightness

after exposure to allergens.~~~~~ Colds that last more than 10 days.~~~~~ Symptoms not relieved when

rescue medication is used.

What to listen for:~~~~~ Complaints of chest tightness or

pain~~~~~ Irregular breathing~~~~~ Prolonged expiration~~~~~ Rapid heart rate~~~~~ Grunting~~~~~ Abnormal breath sounds:

~~~~~ Wheezing~~~~~ Decreased or absent breath~ ~ ~ ~ ~ Rhonci



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Common TriggersCommon TriggersCommon TriggersCommon TriggersCommon TriggersThe factors that make asthma worse orcause an asthma epidsode.Exercise

~~~~~ running or playing hard-especiallyin cold weather

Upper respiratory infections~~~~~ colds or flu

Laughing or crying hardAllergens

~~~~~ Pollens from trees, plants andgrasses, including freshly cut grass

~~~~~ Animal dander-from pets with furor feathers

~~~~~ Dust and dust mites-in carpeting,pillows and upholstery

~~~~~ Cockrach droppings~~~~~ Molds

Irritants~~~~~ Cold air~~~~~ Strong smells and chemical sprays,

including perfumes, paint andcleaning solutions, chalk dust, lawnand turf treatments

~~~~~ Weather changes~~~~~ Cigarette and other tobacco

smoke

What to do in theWhat to do in theWhat to do in theWhat to do in theWhat to do in theevent of an asthmaevent of an asthmaevent of an asthmaevent of an asthmaevent of an asthmaattack at school:attack at school:attack at school:attack at school:attack at school:

(Refer to the laminated “General Emergency Proto-col” for a quick reference.)

~~~~~ Reassure student and attempt tokeep him/her calm and breathingslowly and deeply. Review thestudent’s Asthma Action Plan,current medications, and emer-gency medications.

~~~~~ Have student sit upright and checkbreathing with peak flow meter, ifappropriate.

~~~~~ Administer prescribed medicationas directed.

~~~~~ Student should respond to treat-ment within 15 to 20 minutes. Re-check with peak flow meter.

~~~~~ If NO change or breathing be-comes significantly worse, call foremergency help and contact parentor guardian immediately.

~~~~~ Seek immediate emergency care ifstudent exhibits any of the follow-ing:

~~~~~ Coughs constantly.~~~~~ Is unable to speak in com-

plete sentences withouttaking a breath.

~~~~~ Has lips, nails, mucous mem-branes that are gray or blue.

~~~~~ Demonstrates severe retrac-tions and/or nasal flaring.

~~~~~ Is vomiting persistently.~~~~~ Has 50% reduction in his/

her personal best peak flowreading and shows no im-provement after 15 to 20minutes.

~~~~~ Has pulse greater than 120beats per minute.

~~~~~ Has respiration greater than30 breaths per minute.

Source: Asthma and Allergy Foundation ofAmerica



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Interpreting PeakInterpreting PeakInterpreting PeakInterpreting PeakInterpreting PeakFlow RatesFlow RatesFlow RatesFlow RatesFlow Rates

Peak flow meter recordings need tobe interpreted carefully, and theyshould be done in the presence of anadult because they are effort-depen-dent. In most children with asthma,peak flow readings are an accurateand reliable measure of resistance topulmonary airflow. However, in veryyoung children, children with severeasthma, and in children with smallairway obstruction, the data becomesmore difficult to interpret.

The Asthma Action Plan uses asthmasymptoms and/or personal best peakflow rates to determine the zone thestudent falls under to effectivelymanage his/her asthma. The follow-ing list can be used as a guide inunderstanding the characteristics ofthe different levels of peak flow rates.

These zones are guidelines only. Spe-cific zones and management shouldbe individualized for each child.

Source: American Lung Association(1997).Facts about . . . Peak Flow Meters.


Green = 80% to 100% of personal best

Signals all clear. Asthma is under reasonably good control. No symptoms are present, and the routine treatment plan for maintenance control can be followed

Yellow = 50% to 79% of personal best

Signals caution. Asthma is not well controlled. An acute exacerbation may be present. Maintenance therapy may need to be increased. Call the practitioner if the child stays in this zone.

Red = below 50% of personal best

Signals a medical alert. Severe airway narrowing may be occurring. A short acting bronchodilator should be administered. Notify the practitioner if the peak expiratory flow rate (PEFR) does not return immediately and stay in yellow or green zones. Contact the child's parents immediately and send for medical attention.


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Frequently AskedFrequently AskedFrequently AskedFrequently AskedFrequently AskedQuestions about AsthmaQuestions about AsthmaQuestions about AsthmaQuestions about AsthmaQuestions about Asthma

Q: I think that having animals in myclassroom is important for students.What if I just don’t allow the studentwith asthma to handle the animals?

A: The allergen associated with animalsis the dander (e.g., oils, skin, droppingsthat settle on its fur). That dander canbecome airborne, settling on furnitureand students. It can affect a studenteven if the student isn’t actually han-dling the animal. Prohibiting certainstudents from handling the animalssingles them out. Consider reptiles as agood alternative to furry or hairy ani-mals.

Remember that animal dander in theenvironment can persist for monthsafter the animal is gone and is difficultto remove.

Q: I worry that students may use theirasthma as an excuse to get out ofactivities in school such as tests, physi-cal education class, etc. How do Iremain firm in my expectations with-out jeopardizing the student’s health?

A: Students should be given the ben-efit of the doubt until a pattern ofavoidance behavior emerges. In thatcase, the school nurse and parentshould be involved in discussion withthe teacher about the teacher’s

concerns. A peak flow meter may beused to help decide whether or not astudent should be excused from anactivity. At no time should a student beencouraged to “tough it out” insteadof taking a needed quick-relief medica-tion.

Q: I worry that students may sharetheir medications with other studentswho may want a “buzz” from theinhaler.

A: When students are allowed to carrytheir own medications, they and theirparents need to understand that this isa privilege that could be taken away.Making students aware that they maybe putting other students in physicaldanger if they share their medicationmay help avoid this problem.

Q: What should I do when a studentwho has exercise-induced asthmacomes to the office for an inhalerbefore physical education, but thestudent’s peak flow reading is in the“green zone?” Should I administer themedication anyway?

A: Yes! The quick relief medicationgiven before exercise will prevent thestudent from having problems duringphysical education, which may triggerthe airways to constrict.

Source: Asthma Management in School Education,American Lung Association of Washington


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The Asthma Action PlanThe Asthma Action PlanThe Asthma Action PlanThe Asthma Action PlanThe Asthma Action Plan

The Asthma Action Plan is anindividualized management plan. Theprimary care provider assists thestudent and family in developing amanagement plan. This information ishelpful for the school nurse to developa care plan for use at school. The planshould outline the medicalmanagement for asthma, including:

~~~~~ Instructions for decision makingduring an exacerbation or attack;

~~~~~ Medications and how to adjust forincreasing severity of symptoms;

~~~~~ Symptoms and peak flow zones, ifappropriate, that predict a flare up,and;

~~~~~ A list of triggers to avoid at homeand in school.

This plan is very beneficial for the staffbecause it provides comprehensiveinformation needed for interventionand education of students and sup-ports consistent communication withthe family and primary care provider.

Throughout the school year, nurses canalso help support ongoing communica-tion with parents, guardians, primarycare providers, and school personnel.The Asthma Action Plan (located in thepocket) provides an example of howthis can be done by facilitating directcommunication between the school

nurse and the student’s health careprovider through the use of the medicalrelease form. This collaborative ap-proach to communication helps ensurethat students with asthma receive theappropriate care and treatment whileenjoying their school experience.

Other informationOther informationOther informationOther informationOther informationSchools need to KnowSchools need to KnowSchools need to KnowSchools need to KnowSchools need to Know

About AsthmaAbout AsthmaAbout AsthmaAbout AsthmaAbout Asthma

~~~~~ There is no known cure forasthma, but there are ways tocontrol asthma. If asthma is notcontrolled properly, and if it is nottaken seriously, one can die ofasthma.

~~~~~ Children from low-income familiesor who are from minority popula-tions are more likely to haveasthma and to have higher emer-gency room and hospitalizationrates for their asthma.

~~~~~ It is important to consult theschool nurse to know which stu-dents have Asthma Action Plans,covering asthma management andthe prevention of asthma attacks.


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It is best to say:It is best to say:It is best to say:It is best to say:It is best to say: Instead of saying:Instead of saying:Instead of saying:Instead of saying:Instead of saying:


Use words that can be clearly understood, without too muchmedical or asthma jargon.

These common words may mean something different tochildren.


Stay away from Avoid (may mean “ignore”)Sick or have a cold Have an infectionRunning, playing and sport Exercise (this may mean calisthenics)Making choices Decision-makingJoin in ParticipateAll the time AlwaysLet it dry on a towel Let it air dry (without using a fan)

People with asthma AsthmaticsThings that start attacks TriggersAsthma clues Signs of asthma, early warning signsHandling or controlling asthma Managing asthmaBreathing meter, your meter Peak flow monitoringHow medicines make you feel Side effectsHow much to take DoseHow much medicine each person can take Tolerate medicineWet stuff you cough up MucousBreathing machine NebulizerThings you are allergic to AllergenBothers you Irritate (physically)Upsets you Irritate (emotionally)Swollen InflammationMedicines that open the airways fast Bronchodilator


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Be careful to avoid words or expressions that make assump-tions about a child’s living situation that makes him/her feelleft out.

Source: A Guide for Helping Children withAsthma. National Cooperative Inner City AsthmaStudy (NCICAS)



At home At your housePeople in your family Your caretakers, mother, fatherThe doctor or nurse Your doctorThe room where you sleep Your bedroom


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School AdministrationSchool AdministrationSchool AdministrationSchool AdministrationSchool AdministrationAdministrators are vital to ensuringthat students and staff with asthmareceive the support they need. Byassuring that the school has establishedasthma policies, and that parents,students, and staff know and under-stand the policies, administrators candemonstrate their dedication to thehealth of their staff and students. Inaddition, by creating a healthy schoolenvironment, student achievement andeducational outcomes can improve.(Refer to the pocket for a copy of “Strategiesfor Addressing Asthma Within a Coordi-nated School Health Program.”)

The following are key roles for adminis-trators to follow to ensure that theirschool is “asthma-friendly.”

Establish and support a schoolasthma policyWork with the school board andschool nurse to establish policies, whichsupport students with asthma andstaff. In May of 2004, a new “Use ofAsthma Medication by Pupils inSchool,” SB 32 went into effect. It issuggested that school districts ensurethat their policies correlate with thenew bill.

Promote a healthy work/schoolenvironmentMake sure that the school buildingsand grounds are smoke-free. Prohibitany environmental tobacco smoke onschool grounds, or at any school-related activities, such as sportingevents, field trips, or dances. Environ-mental tobacco smoke is a commontrigger of asthma. By taking a simplestep, like promoting a smoke-freecampus, administrators help to mini-mize asthma triggers and protectstudents. For more information aboutUtah’s Indoor Clean Air Act, visitwww.tobaccofreeutah.org.

Ensure that the school is maintain-ing good indoor air quality (IAQ)Government research demonstratesthat many schools have problems withpoor air quality. Work with school staff,including custodians, to implement theEPA’s Tools for Schools Program. Thisprogram is designed to provide schoolswith the resources they need to manageair quality both effectively and inexpen-sively.(Please refer to the website for additionalinformation www.health.utah.gov/asthma).

School AdministratorsSchool AdministratorsSchool AdministratorsSchool AdministratorsSchool Administrators


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Implement Integrated Pest Man-agement (IPM) to reduce pests andtoxic pesticides in the schoolsIPM is based on preventing pests bydecreasing the resources they need tosurvive. When pests become a prob-lem, alternatives to pesticides are usedto reduce the pest population. Admin-istrators should collaborate with custo-dial staff to ensure that IPM is effec-tively implemented in the school. (Referto the pocket for an additional handout aboutIPM.)

Support staff and students withasthmaSupport asthma education programsfor students and staff that can beprovided by the school nurse. Adminis-trators should make sure that all schoolstaff, including teachers, counselors,custodians, bus drivers, and coaches,are educated about asthma signs andsymptoms and asthma management. Itis also important to educate all studentsabout asthma, so that students withoutasthma are aware of the condition andhow to help fellow students withasthma. Administrators can also helpby supporting a healthy environmentand advocating for students withasthma through the American LungAssociation’s “Open Airways” pro-gram. (Refer to the pocket for additionalprogram and contact information.)

Ensure that the school is providingappropriate school health servicesEnsure school nurses are involved inpolicy development related to medica-tion administration and asthma policies.It is also important to make sure thatthere are school staff trained for emer-gency situations when the school nurseis unavailable. Administrators shouldmake sure that there is a plan in placeto ensure that students with asthmahave immediate access to medications,if necessary, as prescribed by theirhealth care provider.

Encourage use of an Asthma ActionPlan for all students with asthmaThe Asthma Action Plan is an individu-alized management plan developed bythe school nurse with the student’sfamily and health care provider. Thisplan supports communication amongthe school staff, parents, and the healthcare provider. (Refer to the pocket for asample Asthma Action Plan or download itat health.utah.gov/asthma.)

Promote collaboration with parents,community, and the PTO/PTASupport the involvement of parents,community health care providers, andlocal asthma programs in asthma-relatedactivities at school. Encourage the PTO/PTA to sponsor asthma-related informa-tion sessions, or training for parents. (i.e.American Lung Association’s OpenAirways Program).



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Ensure that students are providedwith opportunities for appropriatedaily physical activityEstablish policies and procedures thatpromote participation in physicalactivity for all students with asthma.This should include access to asthmamedications before physical activity. Inaddition, all coaches, teachers andphysical education teachers should beencouraged to communicate activitylimitations to the school nurse and/orparents, as this may be an indication ofpoorly controlled asthma. It is alsoimportant to ask the school nurse forinformation about students withasthma in their classes.

Use the “How Asthma-Friendly isYour School?” form.This form is used to assess how pre-pared your school is to offer a support-ive environment for students withasthma. (Refer to the pocket for a “HowAsthma-Friendly is Your School” assessmentsheet.)

Tips for AdministratorsTips for AdministratorsTips for AdministratorsTips for AdministratorsTips for Administrators~~~~~ Evaluate your school’s policies,

procedures, and activities relatedto asthma.

~~~~~ Collaborate with school nurses todevelop these policies.

~~~~~ Prioritize areas of weakness andestablish an action plan to addressthose needs. (i.e. Identify who hasasthma.)

~~~~~ Develop an Indoor Air Quality(IAQ) management team using aprogram like the EnvironmentalProtection Agency’s (EPA) IAQTools for Schools to evaluate theneeds and issues in the school.

~~~~~ Support and encourage educationof staff and students about asthmaand its signs and symptoms.

~~~~~ Be aware of where the HealthCare Plans are kept in the school.


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School NurseSchool NurseSchool NurseSchool NurseSchool Nurse’’’’’s Roles Roles Roles Roles RoleThe school nurse plays an integral partin the health and wellness of schoolchildren, particularly with regard tochronic conditions such as asthma. Inthe school setting, students withasthma experience different levels ofseverity ranging from mild to severe aswell as different levels of managementand control. Therefore, it is importantfor the school nurse to have updatedand accurate health records on stu-dents in order to effectively manage astudent’s asthma. The Asthma ActionPlan can assist with this directly. (Referto the pocket for a sample Asthma ActionPlan form or download one athealth.utah.gov/asthma.)

The following are some major roles forthe school nurse in properly managingstudents with asthma in the schoolsetting:

~~~~~ Assist students with asthma inmanaging their condition inschool through an Asthma ActionPlan that includes medicationadministration plans andpromotes self-administrationwhen appropriate.

~~~~~ Be alert to students who are notdiagnosed with asthma, but ex-hibit the signs and symptoms.Refer them to their primary care

provider for further evaluation.~~~~~ Obtain authorization from parents

to communicate with the medicalprovider through the use of amedical release form, if appropri-ate.

~~~~~ Provide care coordination forstudents with asthma. If there aresigns of exacerbation or evidenceof inadequate control, communi-cate with parents and refer thestudent to his/her primary careprovider. Encourage direct com-munication with the student’sprimary care provider, whenneeded.

~~~~~ Foster effective communicationamong community based clinics,individual practitioners, and emer-gency room staff.

~~~~~ Train staff on the administrationof asthma medication to students.

~~~~~ Work collaboratively with theschool district medical advisor toplan school health programs onasthma.

~~~~~ Consult with planning and place-ment teams as needed when medi-cal problems, such as asthma,interfere with education.

~~~~~ Provide asthma education tostudents, families, and staff.

School NursesSchool NursesSchool NursesSchool NursesSchool Nurses


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School nurses also play a key role inidentifying students who do not have aprimary care provider and/or healthinsurance. Nurses can encourage par-ents to use the school-based healthcenter and to apply for CHIP(Children’s Health Insurance Program)or Medicaid. It is important to ensuregood communication, particularly in ahealth emergency, with all care provid-ers.*Please refer to the resources sectionfor CHIP and Medicaid contact infor-mation.

Managing AsthmaManaging AsthmaManaging AsthmaManaging AsthmaManaging AsthmaManagement of asthma involves sev-eral approaches, including preventionof asthma attacks, by minimizingcontact with triggers, education, goodcommunication, and use of medica-tions.

What medications are used in themanagement of asthma? Asthmamedications belong to two broadcategories based on whether theyprovide quick relief (“rescue”) orlong-term control (“controller”) ofasthma symptoms. Generally, quickrelief or rescue medications(bronchodilators) open the airways byrelaxing the muscles around the bron-chial tubes. Bronchodilators are takenwhen symptoms begin to occur orwhen they are likely to occur (e.g.,physical education classes or sports

events). Long-term control medica-tions (anti-inflammatory) reduce in-flammation of the airways. Typically,anti-inflammatory drugs are taken on aregular basis, usually once or twice daily,even in the absence of symptoms.(Refer to the pocket for a list of Common AsthmaMedications).

Whose responsibility is it to deter-mine whether or not a student canself administer his/her medica-tions? It is the responsibility of thestudent, the parent/guardian, and theprimary care provider to determinewhether a student is capable of inde-pendently administering medications.

Under the Use of Asthma Medication byPupils in School bill (effective May 3,2004), the student’s primary care pro-vider must complete an Authorizationfor Self-Administration of Medicationat School form, in order for a studentto be permitted to carry an inhaler andself-administer the medication. Theform must also be signed by the par-ent/guardian. If a student is respon-sible for self-administering his/her ownmedications, the student will havepossession of the medication, and he/she may take the inhaler as needed,whether it be on routine basis or foracute asthma attacks. (Refer to the pocketfor an approved Self-administration Authori-zation form and fact sheet.)



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Social/Emotional AspectsSocial/Emotional AspectsSocial/Emotional AspectsSocial/Emotional AspectsSocial/Emotional AspectsAs a part of routine asthma educationand management, the school nurseshould assess the social and emotionalgrowth of students with asthma, andpromote self-esteem in an effort tomake students with asthma feel com-fortable with their illness. The nursecan try to minimize feelings of insecu-rity regarding asthma and help stu-dents fit in with the rest of their peersby doing the following:

~~~~~ Assess social/emotional growthrelated to student’s asthma andself-care:

~~~~~ Is the student feeling that he/sheis different from other students?

~~~~~ Is the student avoiding takingmedication; toughing it out dur-ing an attack?

~~~~~ Is the student notifying schoolpersonnel about medication needsand/or use of self-administering?

~~~~~ Is the student sharing medica-tions with other students?

~~~~~ Is the student avoiding physicalactivity out of fear of asthmasymptoms rather than actualoccurrence of symptoms?

Promote self-esteemPromote self-esteemPromote self-esteemPromote self-esteemPromote self-esteem~~~~~ Assist student in providing infor-

mation about asthma care toothers.

~~~~~ Provide positive feedback forgood decisions.

~~~~~ Increase independence in plan ofcare.

Source: Asthma Management in Education Setting,American Lung Association of Washington

Tips for the School NurseTips for the School NurseTips for the School NurseTips for the School NurseTips for the School Nurse(Remember to always keep the confidentialityof the student and their family in mind.)

~~~~~ Make staff aware of students withallergies and asthma.

~~~~~ Give each teacher a list of HealthCare Plans to read and sign.

~~~~~ Have a telephone conversation ormeeting with parents, guardians,and students regarding asthmamanagement and treatment forthe student.

~~~~~ Have a completed copy of astudent’s Asthma Action Plan onrecord and share information withschool staff when necessary.

~~~~~ Tell appropriate school staff mem-bers about students with a historyof asthma, when necessary, toensure student safety.



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~~~~~ Work closely with school staff andoffer assistance in integratingasthma into curricula, includinghealth, science, and physical edu-cation. It is also very beneficial toprovide educational opportunitiesfor the staff.

~~~~~ Serve as a resource for schoolstaff and families by havingasthma information readily avail-able.

~~~~~ Collaborate with the parent/teacher organizations at school toprovide asthma education pro-grams for families and community.(i.e. Open Airways, Please refer tothe pocket for additional information.)

~~~~~ Identify and keep a confidentiallist of students who are in needof additional attention based onthe severity of their asthma and/or excess absences.



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School Nurse ChecklistSchool Nurse ChecklistSchool Nurse ChecklistSchool Nurse ChecklistSchool Nurse ChecklistPlanning for Care as School Begins

The following checklist is recom-mended for all students identified withasthma. School nurses may also needto be alert to students who have symp-toms of asthma and have not yet beenidentified. This may include studentswho are coughing a lot, having troublewith physical activity, or visiting theschool nurse office regularly.

~~~~~ Send an asthma questionnairehome for parents to provideadditional information about thestudent’s asthma.

~~~~~ Call or meet with the student andfamily.

~~~~~ Discuss parent/student expecta-tions of asthma care while atschool.

~~~~~ Obtain Asthma Action Plans foreach student with asthma, includ-ing students who self-administermedications.

~~~~~ Determine equipment and sup-plies needed for school, includinga 3-day disaster supply.

~~~~~ Discuss plans for communicationwith parents and health care pro-vider.


~~~~~ Discuss role of health serviceswith personnel involved.

~~~~~ Communicate with necessaryschool staff about students withasthma. For example, discuss anypet allergies with the schoolteacher, food allergies with teach-ers and nutrition staff/food ser-vice, and the need to warm upbefore physical activity with physi-cal education teachers andcoaches.

Source: Asthma Management in School Education,American Lung Association of Washington


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It is important for school staff to be aware ofthings that may impact a student with asthma.This includes understanding activities or condi-tions that may cause an asthma attack andrecognizing early signs of an asthma episode.

Due to the limited numbers of publicschool nurses employed in Utah (ap-proximately 120 school nurses), notevery school has a full-time schoolnurse. Therefore, nurses schedule briefon-going visits to their assignedschools and are available via cell phoneor pager when their medical expertiseis needed. Since school nurses are notpresent in school every day, it is impor-tant that ALL staff members under-stand how to recognize asthma warn-ing signs, and help educate studentswith asthma about the early signs ofan asthma episode.

Asthma is a big concern to schooladministrators, parents, and teachersbecause it is the leading cause ofschool absenteeism due to a chronicillness. In Utah, more than 36,000children have been diagnosed withasthma. (Refer back to the Asthma Basicssection for additional asthma data.)Students with asthma may havetrouble keeping up-to-date with assign-ments because of missed days of schooland classroom time. Therefore, it isimportant for staff to:

All School StaffAll School StaffAll School StaffAll School StaffAll School Staff

~~~~~ Be sensitive to the needs of anystudent with asthma;

~~~~~ Understand what causes asthmaattacks and how to minimize them;

~~~~~ Understand early warning signs,and;

~~~~~ Be educated on medication admin-istration.

While there is no cure for asthma, it canbe controlled by understanding asthma,triggers for asthma attacks, and how tosuccessfully minimize environmentalexposures. It is important to be awareof the early warning signs, and what todo in case of an attack. After attendingan inservice about asthma, refer to yourschool nurse and/or The AsthmaSchool Resource Manual for additionalinformation and skills.

Asthma attacks can occur anywhere inthe classroom, on the playground orsports fields, on school buses, or duringfield trips. This is why it is essential forall staff to be educated about asthma. Itis not a role solely for the school nurse.In the case where a school nurse isunavailable, other staff may need totake responsibility for helping a studentwith asthma.


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Asthma is a physicalAsthma is a physicalAsthma is a physicalAsthma is a physicalAsthma is a physicalconditionconditionconditionconditioncondition

Asthma is a real, chronic disease of thelungs; it is not something made up orimagined. Just like any chronic disease,students with asthma may have diffi-culty coping with their disease. Theymay feel left out or “different” fromtheir peers, particularly when they areunable to participate in physical activi-ties with the rest of their classmates. Ifa student is unable to participate, he/she should be assessed by the schoolnurse because he/she may not be onthe correct treatment. The schoolnurse should communicate with thestudent’s parents and primary careprovider to advocate for a change intreatment. Students on an appropriatetreatment plan should be able to tolerate thesame activities as other students.

Students with asthma may have troublekeeping up with school-work because ofdays missed from school due to theirasthma. Teachers may notice low self-esteem, withdrawal from activities,stress, and/or discouragement overmanaging asthma. In these cases, teach-ers should seek assistance from theschool guidance counselor and schoolnurse, so that the child can get individu-alized counseling to deal with thoseissues.

All School StaffAll School StaffAll School StaffAll School StaffAll School Staff

Recognize that asthma is a health con-dition, and try to be understanding if astudent says that he/she is unable toparticipate in class or tests, etc. Do notassume that the student is just trying toget out of activities in school. However,if a pattern emerges where a student isconstantly avoiding exams and/orother activities, a discussion with theschool nurse and parent(s) should takeplace.


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Since students spend a majority oftheir school day in the classroom, it ishelpful for teachers to understandasthma and how to support any studentswith this disease. In addition to recog-nizing the early warning signs of anasthma attack and understanding howto reduce asthma triggers in the class-room, there are certain steps teacherscan take to help students feel morecomfortable about their asthma whenat school.

~~~~~ Encourage students with asthma toparticipate in all activities, includingphysical education;

~~~~~ Develop a protocol for making upmissed school-work with parentsand students with asthma;

~~~~~ Check to see which students haveHealth Care Plans;

~~~~~ Educate other students in theclassroom about asthma.

Unlike other school staff, teachers havea special relationship with their studentsin that they spend more time withthem during the day and may knowmore about them. Therefore, they havethe opportunity to notice any emo-tional and/or physical changes in stu-dents. Teachers can assess the socialand emotional growth of students withasthma and help to promote their self-esteem. Teachers can also help mini-mize any feelings of insecurity regardingtheir asthma and help studens fit inwith the rest of their peers by evaluat-ing the following questions:

~~~~~ Is the student feeling that he/she isdifferent from other students?

~~~~~ Is the student avoiding taking medi-cations; toughing it out during anattack?

~~~~~ Is the student reluctant to go to theoffice for medications?

~~~~~ Is the student notifying schoolpersonnel about medication needsand/or use if self-administering?

~~~~~ Is the student sharing medicationswith other students?

~~~~~ Is the student avoiding physicalactivity out of fear of anticipatedasthma symptoms rather than theactual occurrence of asthma symp-toms?

Teaching StaffTeaching StaffTeaching StaffTeaching StaffTeaching Staff


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Field TripsField TripsField TripsField TripsField TripsWhen planning a field trip for theclassroom, teachers should consult withthe school nurse and parents about thelocation and general environment to bevisited. Sites such as zoos, smoky areas,nature areas, and botanical gardensmay trigger asthma. Make sure that thestudent’s medications, peak flow meter(if prescribed) and Asthma ActionPlan are brought with the student onthe field trip.

Source: Asthma Management in Education Setting,American Lung Association of Washington


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Preparing for asthmaPreparing for asthmaPreparing for asthmaPreparing for asthmaPreparing for asthmain the classroomin the classroomin the classroomin the classroomin the classroom

Teaching equipment~~~~~ Clean chalkboards when students

are not in the classroom and cleanerasers outside.

~~~~~ Paints and markers often havestrong fumes. Replace tops whennot in use or use unscented mark-ers.

~~~~~ Stuffed animals and toys shouldbe made of synthetic material.Store in plastic bags or washseveral times a year. Keep plasticstorage bags away from studentswhen not in use.

~~~~~ Use animals with no fur in theclassroom, such as fish or snakes.The allergen particle from petswith fur is smaller than the dustparticle and remains in the air fora longer period of time.

Furniture~~~~~ Bookshelves trap dust easily. Dust

weekly when the students are notin the classroom.

~~~~~ Lamps should have plain shadesrather than pleated shades thatcan trap more dust.

Windows~~~~~ Check pollen count before open-

ing windows for “a little fresh air.”


Teachers and Staff~~~~~ Avoid perfumes, scented talcum

powder, and hair sprays.

~~~~~ Smokers need to know that thesmoke they bring from the smok-ing area lingers in their hair andon their clothes.

~~~~~ Avoid over watering plants, whichmay contribute to mold growth.

Classroom cleaning supplies~~~~~ If you have cleaning materials

(chemicals) in the classroom besure there are danger stickers onthem, as many children can notread yet. Some cleaning productshave strong fumes. Replace capsquickly and use when the studentsare not in the classroom, when-ever possible.

~~~~~ Avoid using aerosol sprays withstudents around.

~~~~~ Use natural cleaning agents.

~~~~~ White or apple cider vinegarremoves mold, mineral deposits,and crayon marks.

~~~~~ Baking soda is a good generalcleaner that can also be used as aroom rug deodorizer or refrigera-tor deodorizer.

~~~~~ Club soda is a good spot remover.


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~~~~~ Clorox bleach solution is a viricide,mold remover, and cleaning agent.

~~~~~ Use liquid rather than bar soap(mild or unscented) for handwashing.

Source: Chicago Public School

Tips for StaffTips for StaffTips for StaffTips for StaffTips for Staff~~~~~ Know the early warning signs of

an asthma episode.

~~~~~ Get information on managingasthma in the classroom from theschool nurse and understand thesteps to take in case of an asthmaepisode.

~~~~~ Develop a clear procedure withthe student and parent for han-dling schoolwork missed due toasthma.

~~~~~ Understand that a student withasthma may feel:

~~~~~ Drowsy or tired;~~~~~ Different from the other

kids;~~~~~ Anxious about access to

medication;~~~~~ Embarrassed and/or with-

drawn about the disruptionto school activities that anasthma episode causes.

~~~~~ Help students feel more comfort-able by recognizing these feelings.Try to maintain confidentiality.

Educate classmates about asthmaso they can be more understand-ing.

~~~~~ Know the possible side effects ofasthma medications and how theymay impact the student’s perfor-mance in the classroom. Refer anyproblem to the school nurse andparent(s). Common side effects ofmedicine that warrant referral are:nervousness, nausea, jitteriness,hyperactivity, and drowsiness.

~~~~~ Reduce known allergens in theclassroom to help students withallergies. Common allergens in theclassroom include: chalk dust, ani-mals, and strong odors (perfumes,paints).

~~~~~ Encourage the student with asthmato participate fully in physical activi-ties.

~~~~~ Allow a student to engage in quietactivity if recovering from an acuteepisode.

Source: Managing Asthma: A Guide for Schools,National Heart, Lung, and Blood Institute(NHLBI), National Institutes of Health, USDepartment of Health and Human Servicesand the Fund for the Improvement and Reformof Schools and Teaching, Office of EducationalResearch and Improvement (OERI), US De-partment of Education, September 1991. NIHPublication No. 912650


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Physical Education TeachersPhysical Education TeachersPhysical Education TeachersPhysical Education TeachersPhysical Education Teachers

Coaches, physical education teachers,and/or athletic directors need to learnabout asthma and be sensitive to theneeds of any student with asthma. Thisincludes:

~~~~~ Understanding what causes asthmaattacks and how to minimize them;

~~~~~ Understanding early warning signs;

~~~~~ Access to and awareness of astudent’s Asthma Action Plan;

~~~~~ Education on medication adminis-tration;

~~~~~ Access to medication in case ofan asthma attack.

Students with asthma should be in-cluded in physical activities as much aspossible. If not, they may risk experi-encing being left out or isolated, whichcan result in low self-esteem, lack ofmotivation to participate in activities, orteasing by classmates. Staff and studentsshould be encouraged to help studentswith asthma participate in activities tohelp reduce any stigma.

To assist students with asthma andincrease participation in physical activi-ties, modifications to type, length, and/or frequency of activity may be neces-sary. Modifications are particularlyimportant if a student has just experi-enced an attack or if he/she asks to beexcused from physical activities.

Exercise-Induced AsthmaExercise-Induced AsthmaExercise-Induced AsthmaExercise-Induced AsthmaExercise-Induced AsthmaRegular exercise is a major contribu-

tor to healthy lifestyles for all ages.However, exercise is a common triggerfor asthma and this should be recog-nized and understood by school staff.

Children with asthma can,and should, participate

in physical activity as much aspossible.

Exercise-induced asthma (EIA) occurswhen physical activity causes a narrow-ing of the bronchial tubes calledbronchoconstriction.

Bronchoconstriction can cause wheez-ing, coughing, chest tightness, and/orshortness of breath both during andafter exercise. Other symptoms caninclude fatigue or chest congestion.Some say that EIA feels like being “outof shape.” Not all people with asthmaexperience symptoms of EIA whenthey exercise. However, 80% to 90% ofpeople who have asthma also have EIA.Furthermore, one can have EIA withouthaving chronic asthma.

The severity of EIA often correlateswith the type and intensity of the exer-cise and the environment in which it isperformed. For example, people withEIA are more likely to experience symp-toms when running; they are less likelyto experience symptoms when cyclingor swimming. Asthma varies from


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student to student, therefore, it isimportant for school staff to under-stand individualized needs of theirstudents. A student’s Asthma ActionPlan may include individualized guide-lines on physical activity. Physical edu-cation teachers, coaches, and athleticdirectors should have easy access tothis information from the school nurse.If a student experiences frequentasthma symptoms while exercising, thismay suggest that his/her asthma is notwell managed. This is important infor-mation to communicate with theschool nurse.

Five Ways to a Wheeze-Five Ways to a Wheeze-Five Ways to a Wheeze-Five Ways to a Wheeze-Five Ways to a Wheeze-Free WorkoutFree WorkoutFree WorkoutFree WorkoutFree Workout

~~~~~ Warm up early~~~~~ Drink lots of fluids~~~~~ Go nasal - breathe through the

nose~~~~~ Avoid high noon~~~~~ Wear a mask

Activities Less Likely toActivities Less Likely toActivities Less Likely toActivities Less Likely toActivities Less Likely toCause Exercise-InducedCause Exercise-InducedCause Exercise-InducedCause Exercise-InducedCause Exercise-Induced

Asthma:Asthma:Asthma:Asthma:Asthma:~~~~~ Baseball~~~~~ Swimming~~~~~ Football~~~~~ Tennis~~~~~ Golf~~~~~ Weightlifting

Athletes With AsthmaAthletes With AsthmaAthletes With AsthmaAthletes With AsthmaAthletes With AsthmaAsthma hasn’t stopped these athletesfrom performing at their best:

~~~~~ Jerome Bettis, Running Back,Pittsburgh Steelers

~~~~~ Tom Dolan, Olympic Medalist,swimming

~~~~~ Amy Van Dyken, Olympic Medal-list, swimming

~~~~~ Jackie Joyner-Kersee, OlympicGold Medalist in Track and Field

~~~~~ Art Monk, NFL Reciever~~~~~ Gregg Louganis, Olympic Gold

Medalist in Diving~~~~~ Isaiah Thomas, Basketball player~~~~~ Dominique Wilkens, Basketball

player

Source: Asthma Magazine, May/June 2001Volume 6, Number 2, Mosby Inc., Managementof Exercise-Induced Asthma: Helpful Hints for SportsCoaches, from the website:www.asthmaaustralia.org.au/brochures/exercise.htm



4-9

Tips for Coaches,Tips for Coaches,Tips for Coaches,Tips for Coaches,Tips for Coaches,Physical EducationPhysical EducationPhysical EducationPhysical EducationPhysical Education

Teachers, and AthleticTeachers, and AthleticTeachers, and AthleticTeachers, and AthleticTeachers, and AthleticDirectorsDirectorsDirectorsDirectorsDirectors

~~~~~ Make sure to know who hasasthma in the class or on theteam.

~~~~~ Make sure that students with aphysician’s order to take medication(bronchodilator) prior to exercise,do so, and have access to theirmedications at practice and games.Be aware that after taking medica-tions, students may feel jittery ornervous, and have an increasedactivity level.

~~~~~ Include adequate warm-up andcool-down periods. These helpprevent or lessen episodes ofexercise-induced asthma.

~~~~~ Remember that a student whoexperiences symptoms or who hasjust recovered from an asthmaepisode is at even greater risk foradditional asthma problems. Ob-serve the student for asthmasymptoms, and check thestudent’s peak flow meter, ifapplicable. Review the student’sAsthma Action Plan if there areany questions or concerns.

~~~~~ Monitor the environment forpotential allergens and irritants; forexample, a recently mowed field orrefinished gym floor. If outdoor

activities are planned, be sure tocheck ozone levels. If an allergenor irritant is present, consider atemporary change in location.* Visit www.health.utah.gov/athma forpollen counts, ozone levels and other airquality index (AQI) information.

~~~~~ Make exercise modifications asnecessary to get appropriate levelsof participation. For example, ifrunning is scheduled, the studentcould walk the whole distance, runpart of the distance, or alternaterunning and walking.

~~~~~ Consult the student’s AsthmaAction Plan, parent/guardian, orhealth care provider regarding thetype and length of any limitations.Assess the student and schoolresources to determine how thestudent can participate most fully.

~~~~~ Keep the student involved whenany temporary, but major modifi-cation is required. Ask the studentto act, for example, as a score-keeper, timer, or equipment han-dler until he/she can return to fullparticipation. Dressing for physi-cal education class and participat-ing at any level is better thanbeing left out or left behind.

Source: Asthma and Physical Activity in theSchool. Making a Difference, National Heart,Lung and Blood Institute, National Institutesof Health, Taken from the internet February2004, www.nih.nhlbi.gov



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Avoiding environmental triggers is animportant part of managing a student’sasthma. Since children spend much oftheir time inside a school, it is impor-tant to be aware of the quality of airinside the school. The school custodialstaff plays a vital role in assuringhealthy indoor air quality. A healthyschool environment leads to healthier,more productive students and staff.Many indoor air quality problems canbe prevented or lessened by takingappropriate action. Cleaning methodsand materials significantly impact theparticulate and volatile organic com-pound levels in schools.

Each day, one in five Americansspends part of their day in a school

building, most of whom are children.

The Environmental Protection Agencyhad developed an indoor air quality(IAQ) Tools for Schools program thatfocuses on evaluating and maintaininga healthy school environment. Thisprogram concentrates on solving andpreventing indoor air quality problems,thus decreasing the risk of exposure tostudents with asthma. (Refer to thepacket for additional information aboutEPA’s Tools for Schools Program)

OutdoorOutdoorOutdoorOutdoorOutdoorThere are also asthma triggers in theoutdoor environment that can exacer-bate or make a student’s asthma worse.These include ozone air pollution, auto-mobile and diesel bus exhaust, andpollen. While it is not always easy toavoid these triggers, simple steps can betaken to help reduce exposure.

~~~~~ Ozone levels are generally higheston hot and humid days. Therefore,reducing and/or restricting out-door activities (particularly strenu-ous activities) on these days willreduce exposure to ozone.

~~~~~ Diesel buses should not be allowedto idle outside of the school build-ing, since the exhaust can bedrawn into the building.

~~~~~ Lawn mowing can increase theamount of pollen in the air, so inorder to reduce exposure, lawnmowing activities should not bedone prior to outdoor schoolactivities.

~~~~~ Following EPA’s guidelines, theUtah Asthma Task Force releasedguidance for school superinten-dents and principals for whenoutdoor activities (i.e. sports prac-tice and recess) should be canceleddue to outdoor air quality. (refer tothe pocket for a copy of the guidance orvisit the web at health.utah.gov/asthma).

Custodial StaffCustodial StaffCustodial StaffCustodial StaffCustodial Staff

Most of us spend up to90% of our days indoors.


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IndoorIndoorIndoorIndoorIndoorStaff should be aware of asthma trig-gers found in the school environment.Common things that may induce orworsen asthma symptoms includepests (cockroaches, rats), mold frommoisture in the classroom, dander fromfurry or feathered pets in the class-room, strong smells, perfume, cleaningsolutions, paint, and/or chalk dust.

CleaningCleaningCleaningCleaningCleaningCarpets can be a significant source ofdirt, dust mites, and mold, all of whichare asthma triggers. To help reducethese, carpeted areas should be vacu-umed daily. All other rooms should bevacuumed every other day with acommercial quality high efficiencyparticulate arresting (HEPA) filter orcleaner. All carpets should be steamcleaned once a year with truck-mounted 190 degree F steam. Thecarpet must be thoroughly dry within24 hours to avoid microbial growth.

Hard Floors that are kept clean are lesslikely to be a source of dirt, dust mites,or other asthma triggers. Dust withstatic electricity or mineral oil treatedmops daily, and wet mop weekly.

Bookshelves trap dust easily. All hori-zontal surfaces should be dusted weeklywhen students are not in the classroom.

Cleaning Supplies can contain chemi-cals that irritate students and staff withasthma. Work with a buildings mainte-nance supervisor to evaluate all materi-als that can add chemicals to the air ofclassrooms and replace with safer,effective alternatives when possible.

Pests, including cockroaches and mice,pesticides, and herbicides can beasthma triggers. Integrated Pest Man-agement (IPM) can solve most pestproblems. IPM is based on preventingpests by decreasing the resources (i.e.food crumbs, etc.) they need to survive,and does not involve automatic applica-tion of pesticides. When pests becomea problem, alternatives to pesticides areused to reduce the pest population.

(Refer to the pocket for procedures on how to imple-ment Integrated Pest Management).



4-12

HVAC SystemsHVAC SystemsHVAC SystemsHVAC SystemsHVAC SystemsHeating, Ventilation, and AirConditiong

A significant percentage of indoor airproblems and complaints can be attrib-uted to the HVAC system. It has beenshown that through inspection androutine maintenance, indoor air qualityproblems can be reduced. Commonproblems include blocked fresh airintakes, dirty filters, or mold buildup.The following steps will help these typesof problems.

~~~~~ Conduct routine inspections ofthe HVAC system.

~~~~~ Clean fan blades and front gratemonthly. Face fan to blow outtoward the window to decreasebringing pollen and pollution intothe classroom.

~~~~~ Do not put towels under windowunits to collect condensation. Thisis an excellent place for mold andbacteria to grow.

~~~~~ Clean or change window air condi-tioner filters every 2 weeks.

~~~~~ Avoid using belt-type humidifiers.

~~~~~ Use air conditioners or a dehu-midifier to keep relative humidityin the classroom low, between 35to 45%.

~~~~~ Establish a routine schedule forchanging air filters.

FloorsFloorsFloorsFloorsFloors~~~~~ Remove rugs if possible, and keep

floors clean. Bare wood or tilefloors are best.

~~~~~ Carpet squares trap dust. Cleanthem weekly. Avoid vacuumingwhen students are in school.

WindowsWindowsWindowsWindowsWindows~~~~~ Avoid curtains. If you need a

valance, choose synthetic fibersinstead of natural fibers. Washvalances or curtains twice a year.

~~~~~ Roller shades are better thancurtains. Clean with damp clothweekly.

Classroom cleaningClassroom cleaningClassroom cleaningClassroom cleaningClassroom cleaningsuppliessuppliessuppliessuppliessupplies

~~~~~ Some cleaning products havestrong fumes. Replace caps quicklyand use when the students arenot in the classroom, wheneverpossible.



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School StaffSchool StaffSchool StaffSchool StaffSchool Staff~~~~~ Avoid perfumes, scented talcum

powder, and hair sprays.

~~~~~ Smokers need to know that thesmoke they bring from the smok-ing area lingers in their hair and ontheir clothes.

Use naturalUse naturalUse naturalUse naturalUse naturalcleaning agentscleaning agentscleaning agentscleaning agentscleaning agents

~~~~~ White or apple cider vinegar re-moves mold, mineral deposits, andcrayon marks.

~~~~~ Baking soda is a good gen-eral cleaner that can also beused as a room rug deodor-izer or refrigerator deodor-izer.

~~~~~ Club soda is a good spotremover.

~~~~~ Clorox bleach solution is aviricide, mold remover, andcleaning agent.

~~~~~ Use liquid rather than barsoap (mild or unscented) forhand washing.

~~~~~ Clean woodwork weeklywith a damp cloth.

Source: Chicago Public Schools


Tips for CustodiansTips for CustodiansTips for CustodiansTips for CustodiansTips for Custodians~~~~~ Work with school administration

and the school nurse to identifyareas in the school that may con-tribute to indoor air pollution.

~~~~~ Identify barriers to maintaininggood indoor air quality (IAQ).Once the barriers are identified,discuss strategies with schooladministration and consult withdistrict custodial management onhow to best implement the strate-gies.

~~~~~ Determine what is reasonable withregard to cleanliness and elimina-tion of environmental pollutants inthe school.

~~~~~ Use the Integrated Pest Manage-ment Plan.

~~~~~ Periodically meet with school ad-ministration to assess how goodthe indoor air quality is beingmaintained.


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Food Services StaffFood Services StaffFood Services StaffFood Services StaffFood Services Staff

The Link Between FoodThe Link Between FoodThe Link Between FoodThe Link Between FoodThe Link Between FoodAllergies and Asthma?Allergies and Asthma?Allergies and Asthma?Allergies and Asthma?Allergies and Asthma?

While research suggests that foodallergies can bring on an asthma attack,it is not a common cause of asthma.However, it is important for parents tocommunicate to staff so that staffmembers understand what the child isallergic to, how to identify the food(s),recognize symptoms, and initiate treat-ment, if necessary. Since an allergicreaction can occur anywhere, it isrecommended that teachers, foodservice staff, and school nurses areaware of the children who have foodallergies and that they know what todo if a reaction occurs. Anyone with aprevious history of an allergic reactionto food is at risk for a repeat reaction.Avoidance is the only way to preventan allergic reaction. In addition tofood, the most common causes ofsevere allergic reactions include insectstings, latex and medications.

According to the Food Allergy Net-work, people who have food allergiesand asthma are at increased risk forsevere allergic reactions.

Information AboutInformation AboutInformation AboutInformation AboutInformation AboutAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxis

Research demonstrates that childrenwith asthma are at a greater risk forsevere allergic reactions to food. Themost serious kind of allergic reaction isanaphylaxis. Anaphylaxis is a sudden,severe, and potentially fatal allergic

reaction that can involve various areasof the body. Symptoms can occurimmediately or after several hours. Thepotential severity of a reaction is diffi-cult to predict ahead of time so it isnecessary to approach each episode ofanaphylaxis as potentially life-threaten-ing.

It is important to understand and recog-nize the signs of anaphylaxis. A studentwith an anaphylactic reaction may expe-rience any of the following symptoms:

~~~~~ Itching and swelling of the lips,tongue, or mouth;

~~~~~ Itching and/or a sense of tightnessin the throat, hoarseness, andhacking cough;

~~~~~ Hives, itchy rash, and/or swellingof the face or extremities;

~~~~~ Nausea, abdominal cramps, vomit-ing, and/or diarrhea;

~~~~~ Shortness of breath, repetitivecoughing and/or wheezing;

~~~~~ “Thready” pulse, “Passing out.”

These eight foods account for 90%of all allergic reactions:

~~~~~ Egg~~~~~ Fish~~~~~ Milk~~~~~ Peanuts~~~~~ Wheat~~~~~ Soy~~~~~ Tree nuts (Walnuts, pecans, etc.)~~~~~ ShellfishSource: The Food Allergy Network


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Food Services StaffFood Services StaffFood Services StaffFood Services StaffFood Services Staff

The symptoms of an allergic reactioncan change suddenly and becomeserious and/or life threatening. Chil-dren with a history of anaphylaxis orsevere allergic reaction may have anEpiPen at school as ordered by theirprimary care provider. The schoolnurse will provide EpiPen educationwhen applicable. (Refer to your schooldistrict policy for individual cases re-garding EpiPen use and training.)Notify the school nurse at the firstsigns of an allergic reaction. They willrefer to the student’s emergency careplan for appropriate treatment and formedication administration. Call 911and the student’s parentsimmediatly in a serious allergicreaction situation. Also have thestudent’s health care provider’s nameand telephone number available.

Tips on Nutrition for:Tips on Nutrition for:Tips on Nutrition for:Tips on Nutrition for:Tips on Nutrition for:School Staff (Teachers/Coaches)

~~~~~ Inquire about each student’s foodallergies during parent-teacherconferences. Relay this informa-tion to the school nurse.

~~~~~ Work with the parents to protectstudents from life-threatening foodallergy reactions.

~~~~~ Keep students with food allergiesaway from foods known to causeallergies.

~~~~~ Educate students in the classroomabout food allergies.

School Nurse~~~~~ Review all student registration

forms noting any “health con-cerns” listed by parents whichwould identify food allergies, stu-dents who have asthma and otherchronic illnesses and the need formedication during school hours.Share this information with thefood service director and teacherswho have students with these prob-lems. Provide a copy of the child’sHealth Care Plan to their teacher.

~~~~~ Educate school personnel aboutfood allergies and asthma, and stepsthey can take to prevent food allergyreactions from occurring. This in-service should include informationabout anaphylaxis, choking inci-dents, and the policy and procedurethey should follow for emergencyresponse.

~~~~~ Maintain communication withparent, student, and health careprovider to make sure that theAsthma Action Plan is up-to-dateand that it reflects any food allergiesor special food needs. Keep thestudents’ Asthma Action Plans in areadily accessible location.

~~~~~ Educate all staff on emergencyresponse to asthma episodes, food-induced anaphylaxis, and EpiPenpractices.

Consult the school nurse aboutstudents with food allergies.


5-1

Asthma ResourcesAsthma ResourcesAsthma ResourcesAsthma ResourcesAsthma Resources

The following organizations andwebsites are a sample of the nationaland local resources available on asthma,including information specifically forschools. This list is not an all-inclusivelist.

UtahUtahUtahUtahUtah~~~~~ American Lung Association

of Utah(801)484-44561-800-LUNG-USAwww.lungusa.org/utah

~~~~~ Children’s Health InsuranceProgram (CHIP)www.utahchip.org

~~~~~ IHC Online Asthma Resourcewww.ihc.com/asthma

~~~~~ Medicaid Informationhealth.utah.gov/medicaid

~~~~~ School Asthma AllergyWebpage of Utahwww.schoolasthmaallergy.com/UT

~~~~~ Utah QuitNetA free, on-line resource for quittingtobacco usage.www.utah.quitnet.org

~~~~~ Utah Collaborative MedicalHome Pagemedhome.med.utah.edu

~~~~~ Utah Department of Health(801)538-6101health.utah.gov

~~~~~ Utah Department of HealthAsthma Program801-538-6141health.utah.gov/asthma

~~~~~ Utah School NursesAssociationwww.utsna.org

NationalNationalNationalNationalNational~~~~~ American Lung Association

www.lungusa.org

~~~~~ Allergy and Asthma Network/Mothers of Asthmatics, Inc.1-800-878-4403 or(703)641-9595www.aanma.org

~~~~~ American Academy of Allergy,Asthma, and Immunology1-800-822-2762www.aaaai.org

~~~~~ American Academy of Pediat-rics1-800-433-9016 or(847)228-5005www.aap.org

~~~~~ American College of Allergy,Asthma, and Immunology1-800-842-7777www.allergy.mcg.edu


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~~~~~ Asthma Action Americawww.asthmaactionamerica.com

~~~~~ Asthma and AllergyFoundation of America1-800-2-Asthmawww.aafa.org

~~~~~ Centers for Disease Controland Prevention, NationalCenter for EnvironmentalHealthwww.cdc.gov/nceh/asthma

~~~~~ Food Allergy Network1-(800) 929-4040www.foodallergy.org

~~~~~ Kids On the Block1-800-368-KIDS or(410)290-9095www.kotb.com

~~~~~ National Association of SchoolNurses1-877-627-6476www.nasn.org

~~~~~ The National Center forEducation in Maternal andChild Healthwww.ncemch.org

~~~~~ National Heart, Lung, andBlood Institute/////NationalAsthma Education andPrevention Program(301)592-8573www.nhlbi.nih.gov

~~~~~ National Jewish Medical andResearch Center (Lung Line)1-800-222-5864www.njc.org

~~~~~ National Parent Teacher Assoc.1-800-307-4PTAwww.pta.org

~~~~~ National Poison PreventionHotline1-(800) 222-1222

~~~~~ U.S. Department of Health andHuman Services1-877-696-6775www.os.dhhs.gov

~~~~~ U.S. Environmental ProtectionAgency/Indoor Air QualityInformation Clearinghouse1-800-438-4318www.epa.gov/iaq

* The Utah Department of Health(UDOH) Asthma Program is not responsiblefor the content of these websites. The websitesare recommendatioons only.



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Other UsefulOther UsefulOther UsefulOther UsefulOther UsefulAsthma WebsitesAsthma WebsitesAsthma WebsitesAsthma WebsitesAsthma Websites

~~~~~ www.asthmaandschools.orgIncludes information aboutasthma-related resources forschool personnel working withgrades K to 12. Includes simple,searchable database links to edu-cational materials, medical infor-mation, websites, and other re-sources useful for anyone whoworks in a school serving childrenand youth.

~~~~~ www.asthmaaustralia.org.auProvides asthma education, infor-mation, research, communityadvocacy, and support to peoplewith asthma and their families.

~~~~~ www.asthmainamerica.comProvides national and regionalsurvey data and statistics onasthma. Lists general informationon asthma, asthma management,asthma guidelines, and otherresources.

~~~~~ www.asthmamoms.comProvides extensive lists of links toasthma-related information forfamilies, including resources aboutasthma triggers, medications, legis-lation, medical literature, statistics,initiatives, and camps. Includesinformation in English and Span-ish, from AsthmaMoms, a net-work of concerned parents ofchildren with asthma.


~~~~~ www.mayoclinic.comTheir Allergy and Asthma Centerprovides patient education factsheets about asthma as well asother resource information.

~~~~~ www.mchlibrary.info/docu-ments/asthma.htmlOffers a selection of recent, high-quality resources and tools forstaying abreast of new develop-ments on asthma in children andfor conducting research. Containscitations for journal articles andother print resources and links toWeb sites, electronic publications,databases, and discussion groups.

~~~~~ www.starbright.orgBy bringing together the fields ofentertainment, technology andpediatric healthcare,STARBRIGHT creates innovativemedia-based programs that helpseriously ill children and teensbetter cope with their disease -and enhance their quality of life.Freeinteractive CD-ROM gamesrelated to asthma are availablefrom this site.

~~~~~ schoolipm.ifas.ufl.edu/ipm_fac.htmProvides information and re-sources for parents, school admin-istrators, school staff, and custodi-ans on integrated pest manage-ment in schools.


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Educational ResourcesEducational ResourcesEducational ResourcesEducational ResourcesEducational ResourcesThere are a variety of educationalprograms and materials available forschool staff that teach students bothwith and without asthma abouthealthy behaviors, asthma manage-ment, and treatment. Many of theseprograms and materials are availablethrough national organizations suchas the American Lung Association(ALA), American Academy ofAsthma, Allergy, and Immunology(AAAAI), or Asthma and AllergyFoundation of America (AAFA), aswell as their local chapters.

Asthma EducationAsthma EducationAsthma EducationAsthma EducationAsthma EducationProgramsProgramsProgramsProgramsPrograms

A major component of asthma edu-cation programs is teaching studentsand their families greater awarenessand sensitivity towards children withasthma. The following asthma educa-tion programs are just a sample ofwhat is available for school-agedchildren. Each program incorporatesdifferent teaching methods and tech-niques for interactive learning.

Preschool Ages:“A is for Asthma (A es para asma)”:A childhood asthma awareness projectdesigned for childcare professionals. Itincludes a lively video in both Englishand Spanish, featuring favorite SesameStreet characters. The video and teach-ing information point out importantmesssages about asthma.

Elementary School Age:“Open Airways for Schools”: “OpenAirways for Schools is a major initiativeof the American Lung Association.Currently in more than 20,000 schoolsnationwide, “Open Airways for Schools”is making a difference in the lives ofchildren suffering from asthma. Thiscurriculum was designed to teach elemen-tary age children how to detect the warn-ing signs of asthma, and includes steps tohelp prevent an asthma attack. Throughgroup discussions, stories, games androle-play, volunteer instructors empowerchildren to better manage their asthma.Graduates of this award-winning pro-gram have experienced fewer and lesssevere asthma attacks, and they areperforming better academically.For more information, please call 801-484-4456 or 1-800-LUNGUSA.


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Middle School and High SchoolAgesPower Breathing: By providing abasic understanding of asthma and itsmanagement in a peer-friendly envi-ronment, the Power Breathing™ pro-gram empowers and motivates teensto take control of their asthma on apersonal level.

This three-session program assiststeens in learning about asthma, devel-oping decision-making skills needed tomake appropriate choices in managingtheir asthma, and integrating asthmamanagement into their day-to-daylifestyles. Specific fears and concernsteenagers experience in their uniquesocial situations are addressed in apeer-friendly environment and alterna-tive strategies are explored to achieveeffective asthma management. Ele-ments include hands-on instruction,problem-based learning, discussion,strategic thinking, video animation,and Class Dismissed!, a board game totest asthma knowledge.Power Breathing conforms to theNational Heart, Lung and BloodInstitute’s 1997 Guidelines for theDiagnosis and Management ofAsthma. The cost is $295.00. To orderby phone, call Asthma and AllergyFoundation of America at 1-877-2-ASTHMA or call the national numberat 1 -800-2-ASTHMA.Order online: www.aafa.org

Not On Tobacco (N-O-T) is a state-of the-art program specifically de-signed for teenagers who want to stopsmoking. This program was developedby the American Lung Association, incollaboration with researchers at WestVirginia University.

The N-O-T program consists of a 10-session curriculum, plus booster ses-sions to reinforce what the group haslearned. The program is gender sensi-tive and emphasizes daily life manage-ment skills, such as stress management,and healthy behaviors, including nutri-tion and exercise. Initial results from anongoing national evaluation show thatN-O-T does help teens stop smokingor reduce the number of cigarettesthey smoke, which is often the firststep to quitting entirely. For moreinformation, call the American LungAssociation of Utah at 801-484-4456or at 1-800-LUNG-USA.


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All School Ages

Utah Tobacco Quit Line: The UtahTobacco Quit Line providesprofessional counseling over thetelephone, mails quitting resources, andprovides other services to help peoplequit smoking or chewing tobacco. Thenumber is toll-free and there are nocharges for these services for allUtahns. Relatives or friends can alsocall to learn how to help their lovedones quit using tobacco. English: 1-888-567-TRUTH (1-888-567-8788) orSpanish: 1-877-2NO-FUME (1-877-266-3863).

Utah QuitNet: Utah QuitNet is anonline support program to help peoplequit using tobacco. It includes tools tohelp tobacco users create quitting plansand track progress, quittinginformation, peer support throughmessage boards and email, expertadvice and other services to helppeople quit using tobacco. Theseservices are free to all Utahns at:www.utah.quitnet.com



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BooksBooksBooksBooksBooksThese books may be useful whenteaching children the facts of asthma.They are meant to inform and enter-tain. They are also a good way ofhelping families share reading timetogether. Check for them at the com-munity library or the local bookstore.

~~~~~ The ABC’s of Asthma: by KimGosselin.Very easy ABC book. Providesbasic information about asthma.(ages 5-7)

~~~~~ All About Asthma: by WilliamOstrow and Vivian OstrowWritten by a young boy withasthma and his mother. Talks tokids the way kids talk. A realisticbook about asthma and its effectson a child. (ages 7-11)

~~~~~ The Babysitter’s Club: Welcometo the BSC, Abby: by Ann M.Martin#90 in the Babysitter’s Club series.Abby, a new girl in town, joins theclub. Trouble comes when she isrushed to the hospital with anasthma attack while babysitting.Deals with mature family subjectmatter and a young girl’s concernsabout controlling asthma. (ages11-15)

~~~~~ I’m Tougher Than Asthma: byAlden R. Carter and Siri M.CarterWritten by a young girl withasthma and her mother. Includesphotos of author and her family.Includes a resource section. (ages5-10)

~~~~~ Jackie Joyner-Kersee: ChampionAthlete:Story of the athlete’s career, includ-ing her struggle with asthma. (ages13-17)

~~~~~ Kids Breathe Free: A Parent’sGuide for Treating Childrenwith Asthma: Pritchett & HullAssociates, Inc.Written for parents, but the simpletext and cartoon pictures make it agood book to share with children.Includes charts, treatment plans,and resource (Parents and Childrenages 5-9)

~~~~~ The Lion Who Had Asthma: byJonathan LondonWritten for the young child withasthma. Sean loves to pretend he isa lion, but must first cope with hisasthma. Easy text and colorfulpictures. (Pre-school to grade 2.)

~~~~~ Sportsercise! : by Kim GosselinJustin is afraid to join his schoolteam due to asthma. But aftertalking to his doctor and teachers,he takes control and goes on towin the Sportsercise trophy.



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~~~~~ Taking Asthma to School: byKim GosselinTold by a child with asthma. Livelypictures. Includes the “Asthma KidsQuiz’ and ten tips for teachers.Great to share in class. (Teachersand Children ages 6-9)

~~~~~ Zooallergy: by Kim GosselinStory of a trip to the allergist andthen a trip to the zoo. Fun is hadby all as the characters identifyasthma triggers. (ages 6-9)

~~~~~ Aaron’s Awful Allergies: by T.Harrison and E. FernandesWhen five-year old Aaron finds outhe’s allergic to his dog, cat, sixkittens, and two guinea pigs, he’ssad. So sad because his doctor andparents say he can’t keep his pets-they have to go! Just as you dab atear at your eye, Aaron discovers asolution to his problem-one thatmay work at your house too.

~~~~~ How Asthma Makes MeFeel: A Commemorative Bookof Artwork and Essays byYoung People with asthma:Sponsored by Sepracor Inc.(Allergy & Asthma NetworkMothers of Asthmatics)AANMA invited childrenthroughout the United States tosubmit artwork and essays aboutliving with asthma. The compellingentries are presented in this book.



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FamilyFamilyFamilyFamilyFamily

When a student has asthma, it is aconcern for his/her entire family. There-fore, it is helpful to have an understand-ing of what a family experiences whendealing with a chronic health condition.The school staff, including the schoolnurse can help provide support to fami-lies in managing a student. Staff canalso assist families by providing educa-tional resources and materials aboutasthma and organizing training work-shops on asthma for the school com-munity. Staff have the opportunity toeducate families on asthma triggers inthe home and can help to empowerfamilies to take charge and create ahealthy environment. In Utah, thereare also a number of local community-based organizations, including theAmerican Lung Association of Utah.

CommunicationCommunicationCommunicationCommunicationCommunicationEffective communication plays a majorrole in helping a student manage theirasthma and can help to ensure thathealth needs are met in a timely fash-ion. Open communication with thefamily of a student with asthma andthe primary care provider is essentialfor successful asthma management.The Asthma Action Plan can helpfacilitate a relationship with the schooland health care provider. (Refer to thepocket for a sample Asthma Action Plan).

Home EnvironmentHome EnvironmentHome EnvironmentHome EnvironmentHome EnvironmentChildren should be protected fromsecond-hand smoke in the home.Since children are still developing,exposure to the poisons in second-hand smoke put them at greater risk.Children may experience severe healthproblems, including asthma, decreasedlung function, and lower respiratorytract infections. Therefore, it is impor-tant to take all the necessary steps toensure a smoke-free home. If house-hold members wish to quit smoking,there is support for them through theUtah Tobacco Quit Line, 1-888-576-TRUTH (1-888-567-8788), in Englishor 1-877-2-NO-FUME (1-877-266-3863).

Things parents can do to help theirschool raise awareness aboutasthma:

~~~~~ Volunteer to help your schoolprovide in-service programs andeducational resources on asthmaand other health-related issues.

~~~~~ Contact your school nurse aboutyour child’s needs.

~~~~~ Call the American Lung Associa-tion of Utah at 1-800-LUNG-USAor 801-484-4456 for additionalinformation.

~~~~~ Encourage the PTA or PTO to getinvolved in asthma-related initia-tives.


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FamilyFamilyFamilyFamilyFamily

~~~~~ Sponsor asthma-related events orfairs at the school to help raiseawareness for the community.

~~~~~ Support, sponsor, and/or partici-pate in support groups for childrenand/or families with asthma.

~~~~~ Support/volunteer for the “OpenAirways” program. (Refer to thepocket for additional program informa-tion and a contact telephone number.)


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Allergen: A foreign substance that leadsto an allergic reaction. Examples aredust, molds, and pollens.

Allergic asthma: Asthma attacks orflare-ups that are caused by an allergicreaction.

Allergic conjunctivitis: Sometimescalled “pink eye”, allergic conjuctivitis isone of the most common and treatableeye conditions in children and adults.Allergic conjuctivitis is an inflammationof the conjuctiva, the tissue that linesthe inside of the eyelid and helps keepthe eyelid and eyeball moist.

Allergic Reaction: An acquired abnor-mal immune response to a substance(allergen) that does not normally cause areaction.

Allergic rhinitis: Allergic rhinitis,sometimes called “hay fever,” is aninflammation of the nasal passages thatis caused by an allergic reaction. Allergicrhinitis can affect the nose, sinuses orbronchial tubes.

Allergist: A doctor who specializes indiagnosing and treating allergies.

Alveoli: Tiny air sacs located at the endof the airway tubes.

Anaphylaxis/anaphylactic reaction:A sudden allergic reaction that can bedeadly. It is characterized by swelling ofthe tongue and throat, difficulty breath-ing, and low blood pressure.

Anti-inflammatory Medication:A medicine that reduces the symptomscaused by swelling of the airways. Ithelps control asthma over the long term.Corticosteroids are an example of antiin-flammatory medications.

Antihistamines: A medicine (or chemi-cal) which blocks or counteracts thephysiological action of histamine. Therelease of histamines is usually whatcauses asthma symptoms such as sneez-ing, coughing, and wheezing.

Asthma: A chronic disease caused byinflammation that affects the airways inthe lungs resulting in difficulty withbreathing. Asthma attacks are set offby allergens, infections, exercise, cold airor other factors.

Asthma Action Plan (Health CarePlan): A set of specific instructions fora person with asthma. The zones tellhow to keep asthma under control,depending on how somone is feeling.

Glossary of TermsGlossary of TermsGlossary of TermsGlossary of TermsGlossary of Terms


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Atopic dermatitis: One type ofexzema that comes and goes repeat-edly, and usually occurs in people whohave inherited tendency to have aller-gies. In about 70 percent of cases,either the patient or a family memberhas allergic asthma, hay fever, or foodallergies.

Atopic eczema appears early in life,usually in babies between 2 monthsand 18 months old. In babies, atopicexzema primarily affects the face, neck,ears and torso. It also appears on thetops of feet or the outside surface ofelbows. Atopic eczema also is seen inolder children, teen-agers and adults,where it usually involves the skin insidethe creases of the inward bend of theelbow, knee, ankle, or wrist joints, thehands, or the upper eyelids.

Bronchial Tubes: The two tubes thatbranch off the airway (trachea) andcarry air into the lungs.

Bronchoconstriction or Broncho-spasm: Tightening of the airways,such as during an asthma attack, de-creasing the amount of air movinginto the lungs.

Bronchitis: An inflammation of thelining of the bronchial tubes, the hol-low air passages that connect the lungsto the windpipe (trachea). The inflam-mation can be caused by infection orby other factors that irritate the air-ways, such as cigarette smoking, aller-gies and exposure to fumes from somehemicals.

Bronchodilator Medications: Agroup of drugs that widen the airwaysin the lungs, providing quick relief.These are known as “rescue” medica-tions.

Contact dermatitis: A form of skininflammation that occurs because theskin has been exposed to a substancethat irritates it or that causes an allergicreaction.

Controller Medications: Thesemedications work over the long termto treat inflammed airways affected byasthma, thus reducing the risk of anasthma attack.

Corticosteroid drugs: A group ofanti-inflammatory drugs that reducethe swelling of the airways.

Croup: A spasmodic swelling of theairway, especially of infants marked byepisodes of difficult breathing, stridor(a high pitched noise upon breathingin), and a hoarse grating cough.

Dander: Small scales from animal skin.This is a common allergen.

Epinephrine/Epi Kit/EpiPen: achemical which acts as a muscle relax-ant in bronchial tubes, and is oftenused during a life-threatening asthmaattack. Also called adrenaline.


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a

Exercise-Induced-Asthma: Anasthma attack or flare-up that is causedby exercise.

Hay fever: An acute allergic rhinitisand conjunctivitis that is sometimesaccompanied by asthmatic symptoms.

Health Care Plan (Asthma ActionPlan): A set of specific instructionsfor a person with asthma. The zonestell how to keep asthma under control,depending on how somone is feeling.

Immune System: The system withinthe body that locates harmful foreignsubstances and works to get rid of thembefore they make you sick.

Immunologist: A specialist in immu-nology, which is the science that dealswith the immune system, the body’sability to fight disease and the body’simmune responses.

Immunotherapy: Treatment of, orprevention against, disease by attempt-ing to produce active or passive immu-nity.

Inflammation: Redness and swelling ina body tissue such as the nose, lung orskin due to chemical or physical injury,infection, or exposure to an allergen.

Inhaled Steroids: Medicines thatprevent asthma symptoms if takenregularly at adequate doses. The medi-cine is taken via inhaler only.

Inhaler: A device that delivers medica-tions in a fine mist that is inhaled bybreathing deeply.

Latex allergy: An allergic response(swollen eyes, rash, sneezing, asthmaattack, etc. . . ) that is caused by contactwith latex (often contained in balloons,rubber gloves, etc.

Nebulizer: A machine that pumps airthrough a liquid medicine making themedicine bubble until a fine mist isformed that is breathed in. It is usuallyused in the hospital or at the health careprovider’s office.

Peak Flow Meter: A small tube-likehandheld device used to measure thespeed at which a person can push airout of their lungs. Monitoring peakflow can tell how well asthma is beingcontrolled even before symptoms ap-pear.

Pollen: A fine dust type material con-tained in a seed plant that may cause anallergic response when a person is ex-posed to it.

Pulmonologist: A specialist in lungconditions and diseases.

Quick-Relief Medication: Medicationsthat can quickly relieve symptoms andrestore normal breathing. They donothing to prevent future asthma flare-ups.


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Reactive airway disease: A generalterm used when a patient is havingtrouble breathing or wheezing and yetmay not have a formal diagnosis ofasthma. Often used as a diagnosiswhen the clinician is uncertain if thesymptoms are true asthma symptoms.

Relief (Rescue) Medications:Short-term medications that providequick relief to the airways during anasthma attack.

Respiratory System: The group oforgans responsible for breathing. Thisincludes the nose, throat, airways, andthe lungs.

Retractions: Occurs during a moresevere asthma attack. You can see thechest sucking in below the ribs orbelow the neck when you inhale.

Seasonal allergies: Allergies or allergicsymptoms (sneezing, coughing, runnynose and eyes, asthma attacks) thatoccur during specific seasons.

Sinusitis: Inflammation of the sinuscavities.

Spacer: A device that attaches to aninhaler that helps direct the medicationinto the lungs. These are useful for veryyoung children who have trouble gettingenough medicine into their lungs withan inhaler alone.

Stridor: A harsh vibrating sound heardduring respiration when the airway hassome obstruction, such during anasthma attack when the airway is swol-len.

Symptoms: Physical changes or feel-ings that show a disease or conditionexists. For asthma these may be cough-ing, wheezing, breathing difficulty, or atightness in the chest.

Triggers: Activities, conditions, orsubstances that cause the airways toreact and asthma symptoms to occur.Some examples of possible asthmatriggers are dust mites, mold, changes intemperature, tobacco smoke, and furrypets. Triggers are different for eachperson.

Urticaria: Another word for “hives”,or swollen areas of skin due to an aller-gic response.

Wheeze: A whistling sound that occurswhen a person is having difficulty breath-ing in or out, such as during an asthmaattack.

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