Supporting Students with Asthma

Five million children in the U.S. are living with asthma and the number is steadily increasing. Most live in cities, are poor, or are African American or Latino (Noble, 1999). Schools-especially those in urban areas with deteriorating physical plants and limited resources-can find it challenging to promote the good health, positive development, and educational achievement of children with asthma, although they are required to do so under the Individuals with Disabilities Education Act (IDEA) of 1990. Many schools, however, discover that maintaining a healthy physical environment and incorporating information about asthma into the curriculum benefits the entire school community.

This digest briefly describes asthma symptoms and "triggers." It also presents some suggestions for maintaining a school environment conducive to the attendance of children with asthma and for developing a curriculum conducive to their academic achievement.

The Nature and Prevalence of Asthma in Children

Asthma is a non-contagious chronic lung condition caused by a tightening of the airways of the lungs and production of extra mucus. An asthma attack, which may last a few minutes or several days, results in breathing problems such as coughing, wheezing, chest tightness, and shortness of breath. One or more factors, called "triggers," can provoke an attack. Triggers include: infections, physical over-exertion, and emotional factors; and exposure to allergens (i.e., pollen, mold, animal dander), irritants (i.e., chalk dust, smoke, pesticides), and strong odors (i.e., some personal care products) (Awareness, 1995; Majer & Joy, 1993).

Individuals can control asthma with oral medication taken regularly to prevent attacks and with medication inhaled at the onset of an attack. People with asthma carry a peak flow meter, a hand-held tool for measuring their air flow to determine whether an attack is imminent. With help from medical providers and caregivers, and age-appropriate printed materials (such as those available from the American Lung Association), children can learn to monitor their asthma and self-medicate. Taking such control of their illness not only decreases its symptoms but promotes children's feelings of self-confidence and accomplishment (Asthma, 1991).

Children in poor urban areas (especially those living in shelters) and children of color suffer disproportionally from asthma. There are several reasons why their risk is so high: (1) they get inferior medical care, often limited to emergency room visits, which includes no education about how to control the disease and no follow-up attention; (2) they live in homes and neighborhoods, and attend schools, that are overcrowded and laden with pollutants that irritate their lungs; and (3) they experience the high illness-inducing stress that accompanies poverty (Bernstein, 1999; Noble, 1999).

Schoolwide Initiatives

Schools can take many measures to ensure the health, safety, and emotional comfort of students with asthma. The most effective school asthma management program is a cooperative effort involving health providers, school staff, parents, and students, although coordinated by one staff member (National Heart, Lung, and Blood Institute, NHLBI, 1991). There are several effective interdisciplinary programs for creating a healthy school environment, such as the Healthy Schools Networks in Boston and New York, that can serve as models (Goldberg, 1996). Several Federal programs, including those funded by IDEA, provide aid for cleaning up schools.

Environmental Quality

Most improvements in environmental quality benefit everyone in the school building because pollutants have a universally negative effect. For example, schools should undertake extensive building repairs, painting, cleaning, and extermination during long vacations. They should replace plastic furniture and carpeting, which often emit noxious gases. They should limit use of cleaning supplies and equipment that emit toxic fumes and strong odors and require good ventilation when they are used. They should have the entire building (particularly the heating and ventilation system) cleaned regularly to eliminate dust mites, mold, mildew, animal dander, feathers, cockroaches, and other possible asthma and allergy triggers, and make sure that leaks of water and plaster dust are stopped and quickly cleaned up. They should regularly monitor the air quality of schools, especially those in sealed buildings and try to increase the ventilation so that pollutants can escape (Goldberg, 1997a; NHLBI, 1991).

Schools may not be able to eliminate other pollutants, such as chalk dust. They can, however, find out which of them are triggers for particular students and try to limit the student's exposure to them. Further, sensitive scheduling can keep students with specific sensitivities away from certain art supplies and animals, which may enhance the education of some students but sicken students with asthma.