School Asthma Management Policies and Procedures

What School System Leaders Can Do

The CDC has identified six strategies for addressing asthma as part of a coordinated school health program (CDC, 2002b). Note that every strategy may not be feasible for your district. AASA encourages superintendents and board members to join with staff, students and community members to prioritize the strategies based on your needs and the needs of your students. If your district is just beginning to address this health issue, focus initially on children whose asthma seems poorly managed as indicated by frequent absences, trips to the school nurse, emergency room visits and hospitalizations.

1. Establish management and support systems for asthmafriendly schools. Identify your district’s needs, designate a health coordinator, and develop written policies and procedures management. The National Asthma Education and Prevention Program (NAEPP) suggests that school districts develop and implement districtwide guidelines and protocols applicable to chronic illnesses generally and specific protocols for asthma and other common chronic illnesses of students. Dr. Howard Taras, medical consultant with the San Diego schools and chair of the American Academy of Pediatrics (AAP) Committee on School Health agrees. “My recommendation is generally that we address all chronic illnesses that cause children to be absent. Let’s not make asthma the disease du jour.”

2. Provide appropriate school health and mental health services for students with asthma. Make sure students with asthma have an asthma action plan developed by a physician and provided to the district by parents, ensure safe and immediate access to prescribed medications, and use standard emergency protocols for students in respiratory distress. If you need to send a letter to a physician regarding an asthma action plan, you can use the model “Dear Doctor” letter provided by the American Academy of Pediatrics. In spite of the common practice of maintaining zero-tolerance drug policies in schools, limiting student access to life-saving asthma medications is a dangerous decision. In Houston ISD, students are allowed to carry their own inhalers if the physician says it is necessary; thus the physician makes the medical decision about student responsibility. Dr. Don Kussmaul, superintendent of the Dubuque (IA) Schools Unit 119, points out that if a child needs an inhaler, it is much more useful in his or her pocket than at home or in the office.

3. Provide asthma education and awareness programs for students and school staff. Ensure that students with asthma receive education on basic management and emergency response and provide school staff and parents with the same type of information. Make sure that physical education teachers and coaches have adequate training—can they help prevent an asthma attack and redirect student activities without stopping a child’s participation?

4. Provide a safe and healthy school environment to reduce asthma triggers. Ensure a smoke-free environment at all district-sponsored activities, on all district-owned properties and any form of school transportation. Promote good indoor air quality by reducing or eliminating allergens and irritants. Although school districts have no control over the quality of the air outdoors, there are questions that can provide you with some policy guidance: Does the district have a policy limiting students' outdoor activity on high ozone, high pollution, high pollen and extremely cold days? What is the procedure regarding field trips scheduled on such days? Have you considered equipping staff members on student field trips with cellular phones or other communication devices in case of asthma emergencies?

5. Provide opportunities for safe, enjoyable physical activity. Encourage full participation in physical activities when students are well, provide modified activities as indicated by the action plan, 504 Plan or IEP, as appropriate, and ensure that students have access to medications before activity. With proper management, children with asthma can walk to school, participate participate fully in school activities and potentially become a top athlete. Jackie Joyner-Kersee and Greg Louganis have asthma, and at least one in six athletes representing the United States at the 1996 Olympic Games had a history of asthma (J Allergy Clin Immunol 2000; Vol. 106, No. 2: 260- 266).

6. Coordinate school, family and community efforts to better manage asthma symptoms and reduce school absences among students with asthma. Obtain written permission for school health staff and physicians to share student health information. It is important to work with local communities to educate families about asthma symptoms to help reduce student absences. Proactive leadership by superintendents and boards can create a coordinated, supportive environment for children with asthma. By working together, and with other school district staff, families and the community, the impact of asthma on students can be lessened.

Individual Student Asthma Action Plans

Every student with asthma needs to have an “asthma action plan” on file with the school nurse—this is the key to asthma planning at school. The action plan, completed by the child’s physician, describes:

• Medication(s) taken—what, when, how, and possible side effects
• Whether the child needs to carry his/her medications at all times
• Any specific allergies, and their symptoms
• Triggers for asthma symptoms
• When to take a peak flow measurement & what measurements indicate trouble
• What symptoms indicate a potential emergency
• What steps to take in the event of an emergency
• Parent and physician contact information & phone numbers
• Specific instructions regarding environmental conditions, e.g., child participation in field trips on high ozone days