1. Asthma is not just a Wheeze
Introduce yourself. Most people know someone who has asthma. It is the most common chronic health problem for children.

2. What is Asthma
Asthma is a chronic lung disease, which is characterized by attacks of breathing difficulty.
Asthma is caused by spasms of the muscles in the walls of the air passages in the lungs. It is not contagious but tends to run in families.
It can be very severe or very mild, but most asthma can be well controlled with treatment.

3. Goals for today Recognize the signs and symptoms of an asthma attack
Understand the plan for an asthma attack at school
Deliver proper treatment
Asthma can be a frightening experience for the child experiencing the symptoms, but also for the people around them. Knowing how to handle this kind of emergency at school is paramount. Early recognition and treatment can save not only distress, but maybe a life as well.

4. Signs and symptoms Coughing Tightness in chest Wheezing
Gasping for air
Prolonged expiration
Color changes (pale or blue).
Asthma can be aggravated or triggered by allergy to pollen or dust, viral illness, cold, emotions, or exercise. There is no cure but asthma can be controlled with proper diagnosis and management

5. Treatment Avoiding trigger Recognizing symptoms Medication Exercise
Allergies
Illness
Weather and Air Quality
Recognizing symptoms
Medication
Triggers include exercise, allergies, and viral illness. Many students may need to take some medication (MDI) before they exercise. Maybe you have noticed some athletes on television using their inhalers before they compete. The weather can also play a role in asthma control. Cold weather can trigger some asthma and air quality can be a large factor. Air quality can dictate whether or not the student can go to recess outside. Asthma medicines fall into two categories: quick-relief (or rescue) medicines and preventive (controller) medicines. Both treatments have their place. Preventive asthma medicines can help prevent asthma symptoms and attacks from starting. The triggers for asthma can be unique for every child. Some common sense can help reduce their frequency and severity. Preventive medication is taken at home on a daily basis, but never used to treat an asthma attack.

6. What to do for an asthma attack
If you note the symptoms of an asthma attack, prompt treatment is necessary.
Stop the student from what they are doing and have them sit upright.
Quick-relief medicines provide fast relief from the common symptoms that accompany asthma attacks. Examples of some quick-relief medicines include: Albuterol, Proventil, Ventolin, Maxair, Atrovent.

7. Types of inhalers
There are many different types of inhalers. (Child specific information should be included.)

8. Use of a Peak Flow Meter
Green Zone (80 to 100 percent of your personal best number) signals all clear. No asthma symptoms are present, and you may take your medicines as usual. Yellow Zone (50 to 80 percent of your personal best number) signals caution. You may be having an episode of asthma that requires an increase in your medicines. Or your overall asthma may not be under control, and the doctor may need to change your medicine plan.
Red Zone (below 50 percent of your personal best number) signals a medical alert. You must take an inhaled beta2-agonist right away and call your doctor immediately if your peak flow number does not return to the Yellow or Green Zone and stay in that zone.
A peak flow meter is an inexpensive, hand held device used to measure how the air is moving out of the lungs. Not all doctors use a peak flow meter, but it can be helpful in monitoring asthma and with determining the severity of an asthma attack. The use of a peak flow meter is a tool that needs to be established before an asthma attack ever starts. It in no way will assist the child with his/her breathing, but if they are skilled using the device and know their target ranges, it can give you important information about what they need.

9. Using an inhaler can be tricky
Care must be taken that the inhaler is used correctly to ensure that the medication gets to the lungs and not the back of the throat.
Many people are afraid that the student will become “dependent” on the medication or that they will “build up a resistance” to the medication. This simply is not true. Obviously you do not want your student to over use any medication, but if they are experiencing an asthma attack they need their medication as soon as possible.

10. Using the inhaler
A metered dose inhaler (MDI) delivers a specific amount of medicine in aerosol form. This makes it possible to inhale the medication, instead of taking it in pill form. MDI's are commonly used to treat asthma, COPD, and other respiratory conditions.
Knowing where the inhaler is kept and having an extra inhaler on hand is very important. Many students are carrying their own inhalers. This helps for independent, prompt treatment. At school, however, it might be a good idea to have a back-up inhaler in case for any reason, the student does not have the inhaler with them. The student’s inhaler could be empty or not functioning. Being prepared will make this experience a whole lot easier for everyone involved.

11. Take off the cap and shake the inhaler hard.

12. Breathe out all the way.

13. Hold the inhaler 1 to 2 inches in front of the mouth (about the width of two fingers).

14. Start breathing in slowly through the mouth, and then press down on the inhaler one time. Breathe in slowly and as deeply as possible.

15. Slowly count to 10 while they hold their breath (if they can)
Slowly count to 10 while they hold their breath (if they can). This lets the medicine each deep into the lungs. . This is referred to as a puff.

16. If the doctor prescribed more than one puff of medicine, repeat this procedure, starting with step 2. For inhaled quick-relief medicine (beta-agonists), wait about one minute between puffs. There is no need to wait between puffs for other medicines.

17. Rinse the mouth afterward to help reduce unwanted side effects.

18. When to call 911
If the student is getting worse or has no improvement in minutes
If color changes are noted
If they are unable to speak in full sentences

19. At School… Have a Classroom Health Care Plan
Know where the medication is to be stored.
Consider having a back-up inhaler at a central location
Remember minutes count

20. Prepared by: Mary Clark RN, NCSN
Reviewed by: Paula Peterson APNP
Primary Children’s Hospital
Salt Lake City, Utah
JMJ Publishers
1156 Wilson Ave.
Salt Lake City, Utah 84105