1. Asthma: What YOU Need to Know
MEL
Material: Papers/Pens for Magic Minute
5 Fanny Packs for Triggers Answers
Daily Physical Activity and Asthma Education in Ontario Schools
Provided by Ophea in partnership with
the Public Health School Asthma Pilot Project

2. Objectives
To educate workshop participants with need to know information regarding daily physical activity (DPA) and asthma awareness;
To inform Physical Health Promoters of Ophea’s Asthma Education Initiative and Public Health School Asthma Pilot Project resources
POLL:
Helpful for us to know what your comfort /backgound is re: asthma
Worked with kids with asthma
Who feels comfortable about their asthma knowledge
Who here is comfortable in managing p.a. and asthma

3. Agenda Agenda Asthma Initiatives Overview Asthma Review
School Policies
Students with Asthma
Planning and Implementing Physical Activities
What you need to know about asthma and physical activity
Q & A
(MEL)

4. Initiative Overview
Ophea’s (Ontario Physical and Health Education Association) Asthma Education Initiative is designed to increase the skills and knowledge of educators about asthma management and prevention in schools.
Managed by Ophea Curriculum and School-Based Health Resource Centre in support of the Ontario Asthma Plan of Action, funded by the Government of Ontario.
(MEL)

5. Asthma Education Initiative
Overview
Asthma Education Initiative
Ophea Asthma Education Initiative –
Communications and Public Education Approach:
RESOURCE/MATERIALS DEVELOPMENT
INTEGRATED COMMUNICATIONS STRATEGY
PARTNERSHIP BUILDING
INTEGRATION WITH OTHER RESOURCE CENTRE FUNCTIONS, PRODUCTS AND SERVICES

6. Initiative Overview
Partners - Asthma Society, The Lung Association, Anaphylaxis Canada, Allergy/Asthma Information Association and the Public Health School Asthma Pilot Project.
The Public Health School Asthma Pilot Project (PHSAPP) works with community agencies, school boards, and administrators to develop educational materials, activities, recommendations and guidelines related to asthma prevention and control in schools.
(MEL)
The Creating Asthma Friendly Schools Resource Kit is available online at

7. Asthma Review >15% of children in Ontario have asthma
Leading cause of hospitalizations in children and school absenteeism
>50% have poor control of the disease
80% of asthma deaths could be prevented with proper education
Asthma and anaphylaxis commonly
co-exists in children
(REB) Why is it so important that we all work together to better understand and promote asthma awareness in schools? - You can see in the slide presented that there are so many reasons why this is so important to the school community. By being present in today’s workshop, I know that you already have an interest in this very important topic and this first component of today’s workshop is to assist you in identifying what you already know and what more you need to know.

8. Asthma Is… Inflammation of the airways Causes:
-extra-sensitive or twitchy airways
Causes:
muscles around airways tighten
lining of the airways becomes swollen
mucous production increases
(REB)

9. Asthma Review Wheezing Coughing Chest tightness Shortness of breath
Asthma Symptoms include..
Wheezing
Coughing
Chest tightness
Shortness of breath
Difficulty breathing
(REB) I mentioned the importance of knowing how to identify and eliminate asthma triggers and I hope you were paying attention because I am going to quiz you on this in just a few minutes. But before I do, let’s review some of the symptoms of asthma as well as the types of medication.
Triggers cause the muscles around the bronchiole tubes to tighten and the airway lining to inflame. This generates excessive mucous production. Symptoms of asthma include, wheezing, coughing, chest tightness, shortness of breath leading to sever breathing difficulties. It is important to note: that each case varies, often the only symptom of asthma is chronic coughing. Symptoms may come and go depending on the level of inflammation.
There are two types of asthma medication and it is important to know the difference.
Controllers, also referred to as “preventors” prevent the airway inflammation. Controllers are generally taken at home, not given by school staff. There are some children who take higher doses and occasionally may have to take their controller/preventor at school. Controllers are NOT to be used for quick relief of symptoms.
Relievers, also referred to as “rescue” medication: opens the airway quickly, usually contained in a blue inhaler, prescribed only when needed, often prescribed minutes before exercise to be taken right away when symptoms appear. If you observe the student using the reliever more than 3 times a week (other than before exercise) or requiring the reliever medication more than every 4 hours inform the parent(s)/caregiver(s) immediately.

10. Your goal is to identify at least 5.
Magic Minute
In the next 60 seconds, write down as many examples of asthma triggers as you can.
Your goal is to identify at least 5.
Hint: A trigger is any thing or condition that causes inflammation in the airways, which then leads to asthma symptoms.
(REB) In the previous slide I mentioned, that one of the ways to avoid asthma episodes is to be able to identify and eliminate asthma triggers. What I would like for you to do now is to identify as many asthma triggers that you can think of using your scrap piece of paper and pen.
For each correct trigger you identify give yourself 1 point.
Asthma Triggers examples include; smoke, furry or feathered pets, dust & dust mites, pollen, air pollution, cold air, cold/flu, chalk dust, indelible markers, dusty gym mats, old books, mould, cleaning products, fumes and perfumes. Exercise or vigorous physical activity can also be a trigger for Asthma, which we will discuss in more detail later.

11. Asthma Triggers Exercise Cold Air Dust Mites Pets Colds or flu Mould
Asthma triggers are things that make people’s asthma worst. They can include things such as
Exercise
Cold Air
Dust Mites
Pets
Colds or flu
Mould
(REB) I mentioned the importance of knowing how to identify and eliminate asthma triggers and I hope you were paying attention because I am going to quiz you on this in just a few minutes. But before I do, let’s review some of the symptoms of asthma as well as the types of medication.
Triggers cause the muscles around the bronchiole tubes to tighten and the airway lining to inflame. This generates excessive mucous production. Symptoms of asthma include, wheezing, coughing, chest tightness, shortness of breath leading to sever breathing difficulties. It is important to note: that each case varies, often the only symptom of asthma is chronic coughing. Symptoms may come and go depending on the level of inflammation.
There are two types of asthma medication and it is important to know the difference.
Controllers, also referred to as “preventors” prevent the airway inflammation. Controllers are generally taken at home, not given by school staff. There are some children who take higher doses and occasionally may have to take their controller/preventor at school. Controllers are NOT to be used for quick relief of symptoms.
Relievers, also referred to as “rescue” medication: opens the airway quickly, usually contained in a blue inhaler, prescribed only when needed, often prescribed minutes before exercise to be taken right away when symptoms appear. If you observe the student using the reliever more than 3 times a week (other than before exercise) or requiring the reliever medication more than every 4 hours inform the parent(s)/caregiver(s) immediately.

12. Asthma Medication There are two types of asthma medication:
CONTROLLERS: also referred to as “preventers”
RELIEVERS: also referred to as “rescue” medication
(REB)

13. Controllers Controls asthma symptoms
Decreases and prevents swelling of the airways
Can take days to weeks of regular use to work effectively
Usually given 2 times a day- in the morning and night time
Various colours (orange, purple, brown, red)
(REB)

14. Relievers A rescue medication-usually blue in colour:
Provides relief quickly, within minutes
Relaxes the muscles of the airways
Is taken only when needed or prior to exercise/activity if indicated
Needs to be accessible at all times
(REB)

15. School Policies - DPA Daily Physical Activity WHAT WHEN WHERE WHY WHO
(MEL)
WHAT?
-must consist of at least 20 minutes of sustained moderate to vigorous physical activity daily.
DPA must be scheduled during instructional time (not during lunch, recess, or breaks).
WHEN?
20 minutes of Daily Physical Activity is only one component of a quality health and physical education program and should not replace existing physical education programs.
WHERE?
DPA can occur in a variety of locations, including classrooms, the outdoors, the gymnasium, and multipurpose rooms.
HOW
By Teachers or student leaders in classrooms or other locations as noted above
All activities must be adapted, as appropriate, to ensure that students with special needs can participate. Such adaptations must be consistent with the accommodations and/or modifications that are typically found in a student's Individual Education Plan.
Since individual classes may be at different stages of implementation, daily physical activity may initially occur in several short sessions (a minimum of 10 min each) over the course of the school day.
The 20 minutes is for Grades 1-8 however Kindergarten teachers are encouraged to implement this initiative as well.

16. School Policies - Asthma
Many schools do not have asthma policies in place currently
PHSAPP is focusing on Policy and Procedures development at School Board level
Draft in Hamilton and Halton
(MEL)
SB level = to affect more schools
Halton is intending on rolling out the policy in the spring this year

17. Overview of Students with Asthma and Physical Activities
What is Exercise-Induced Asthma (EIA)?
One of the most common triggers
Symptoms may occur during or after vigorous physical activity
Common in cold environments and during high pollen count days.
Use the “reliever” inhaler minutes prior to exercise if indicated by a physician.
(MEL)
Caused by cooling and drying of the sensitive airway when breathing through mouth. This cooling and drying effect causes the airway to narrow resulting in symptoms.
Exercise-induced asthma comes on after approximately 10 minutes of vigorous physical activity, or following cessation of vigorous activity. It is more common when activities are done in cold environments and during high pollen count days.
Often exercise-induced symptoms of asthma can be prevented by using the reliever inhaler minutes prior to exercise if indicated by a physician.
There are many professional athletes who have Exercise-Induced Asthma and when well controlled they experience little to no interference with their regular physical activities. Gary Roberts from the Toronto Maple Leafs, Curt Hartnett (Canadian Olympian Cyclist)

18. Planning and Implementing Physical Activity
Pre-Activity
KNOW who has asthma
WARM UP gradually
USE RELIEVER mins prior if prescribed
KNOW the SYMPTOMS
(REB)

19. Planning and Implementing Physical Activity
Pre-Activity continued…
5. ACCESS to medication EASY.
KNOW how to handle a situation and how to contact EMS
ENCOURAGE and support the student with asthma to participate as fully as possible in all school activities
(REB)
7. Know how to handle worsening asthma.
8. Notify parents/guardians well in advance of school trips. Give location and describe the activities that will occur.
9. Activity locations may need to be altered to avoid or reduce exposure to allergies/triggers.
10. For all off site activities ensure there is a suitable means of communication to access Emergency Medical Assistance 911.
11. Leave medical information for a supply teacher in a prominent place (e.g. names of students who require their reliever prior to physical activity, location of medication, etc.)
12. Encourage and support the student with asthma to participate as fully as possible in all school activities.

20. Planning and Implementing Physical Activity
During Activity
DO NOT participate in activity if asthma symptoms present.
STOP if symptoms occur until he/she is fully recovered.
USE RELIEVER INHALER if necessary
REST until fully recovered before they begin participation again.
(REB)
Let’s take a closer look at what to do DURING physical activity…
DO NOT have a student participate in physical activity if the student is currently experiencing asthma symptoms. This can lead to an asthma attack.
Use preventative measures to allow participation in exercise and/or vigorous physical activity:
Warm Up. Allow for a continuous progressive warm-up to warm the bronchiole airways. (e.g. walking and or other low to moderate level activities)
When prescribed, have the student use the blue reliever inhaler minutes prior to exercise.
Understand how to handle symptoms associated with exercise.
3. Asthma symptoms can come on during or following physical activity. A good warm up and cool down may avoid the development of symptoms. If symptoms occur after physical activity begins, STOP the student until he/she is fully recovered. A fully recovered student will be able to:
Breathe at a normal rate.
Will not be wheezing/coughing.
Will be able to carry on a conversation without any breaks.
4. If a student needs to take their reliever inhaler while participating in physical activity, allow them to do so and have them rest until they are fully recovered before they begin participation again. (i.e. 2 puffs of the reliever, one puff at a time with 30 seconds between puffs)
5. Monitor use of inhalers. Keep track of the number of times a student uses their inhaler, as well as the time when the reliever medication was used if possible. Inform the student’s parents.
6. If physical activity is in an area with high asthma triggers, watch for symptoms with a keen eye.

21. Planning and Implementing Physical Activity
5. If symptoms do not improve and student’s condition worsens…
This is an emergency situation:
Call 911, wait for the ambulance, DO NOT drive the
student.
Give the reliever inhaler immediately.
Continue to give the reliever inhaler every few minutes
until help arrives.
Contact parents.
(REB)
7. If any of the following sever symptoms of asthma are observed…
Not improving after taking the reliever inhaler within 5-10 minutes.
Unable to catch their breath.
Can only say 3-5 words before needing to take another breath.
Breathing is difficult and fast
Lips or nail beds are blue or gray.
Ribs show during breathing (the skin between the ribs and neck are sucked in with each breath).
Any doubts about the student’s condition:
This is an emergency situation:
Call 911, wait for the ambulance, DO NOT drive the student.
Give the reliever inhaler immediately.
Continue to give the reliever inhaler every few minutes until help arrives.
Contact parents.

22. Planning and Implementing Physical Activity
Post Activity
NOTE: EIA can occur following activity. Where possible, continue to monitor the student
PRAISE for the student’s efforts.
MONITOR use of inhaler over time. Inform the parent if the student uses their reliever medication:
More than 3 times a week for symptomatic relief (not counting pre-exercise medication used before physical activity.)
During activity, even though they pre-medicated prior to physical activity.
More than every 4 hours.
(REB)
And lastly, what to do POST physical activity…
Exercise-induced asthma can occur following activity; even up to 30 minutes after stopping. Where possible, monitor the student closely and ask the students how they feel after the activity. Remind the student to tell someone if they are developing symptoms.
Provide positive praise for the student’s efforts.
Monitor use of inhaler over time. Inform the parent if the student uses their reliever medication:
More than 3 time a week for symptomatic relief (not counting pre-exercise medication used before physical activity.)
During activity, even though they pre-medicated prior to physical activity.
More than every 4 hours.

23. Asthma Scenarios What should you do?
A parent has sent a letter to you explaining that their child has exercise induced asthma and must take 2 puffs of their inhaler prior to any exercise. You have the student do this; however after ten minutes of exercise, the student wants to take more.
What should you do?
(MEL)
Now that you have a better understanding of all the components including what activities are best for students with asthma as well as what to do pre-post and during…let’s take a minute to discuss the following scenario and come up with some solutions.
Take a minute to jot down some of your ideas, by yourself or as a group and then together we will share our ideas.
Have the student STOP participating, sit and rest. If symptoms are not relieved, have the student use their reliever again – 2 puffs, on puff at a time with 30 seconds between puffs.
If after 10 minutes there is no improvement, or if at anytime the symptoms get worse, call EMS
Communicate to parents that pre-treatment was administered as directed, but it did not protect the student from developing symptoms.
This usually means the underlying condition (inflammation of the airway) is not well controlled and the parents should consult the child’s physician prior to participating in vigorous exercise.

24. What Educators Need to Know: Roles and Responsibilities
Encourage students to participate in activities to the best of their abilities.
Encourage students to carry their own inhaler medication with them at all times.
Provide opportunities for students to learn about asthma.
Know who has asthma.
Know the triggers
Know who needs assistance.
Know the emergency plan.
Know and use preventive measures.
Communicate with parents
(MEL)
The following outlines what as public health you need to know, roles and responsibilities related to asthma awareness within the school community. For more information, on this or matters related to policies and procedures, consult your local school board.
Know which students in the class have asthma and/or use an inhaler medication. Have a record of each asthma students information in the classroom to provide easy access for those working in the classroom.
Know the asthma triggers for students. Take action to reduce student’s exposure to asthma triggers whenever possible.
Know which students require assistance to use their inhaler. Feel comfortable with your ability to assist a student with asthma to use an inhaler.
Know the emergency plan for handling worsening asthma.
Know how and use preventive measures to allow participation in exercise and/or physical activity. Use a warm-up and cool-down period.
Inform parents when students show signs of worsening asthma at school.
Notify parents/guardians well in advance of school trips and identify activities involved.
Encourage students with asthma to participate in all school activities to the best of their abilities.
Encourage students to carry their own inhaler medication with them at all times. For students who are not allowed to carry their inhaler, the inhaler medication should be kept in their classroom for easy access.
Provide opportunities for students to learn about asthma.

25. What Public Health Reps Need to Know
Advocate
for opportunities to learn about asthma.
to have a school wide process in place and emergency plan for handling worsening asthma.
for opportunities to identify and reduce common asthma triggers.
access to information to help in creating asthma friendly schools.
the expectation that children with asthma will participate in activities.
how and use preventive measures to allow participation in
exercise and/or physical activity
and….Integrate Asthma Key Messages
into your PH resources!
(MEL)
The following outlines what as public health you need to know, roles and responsibilities related to asthma awareness within the school community. For more information, on this or matters related to policies and procedures, consult your local school board.

26. Think, Pair, Share
For one minute, THINK about how you can apply this knowledge to the work you do with schools/youth.
Divide yourselves in PAIRS
SHARE your ideas with a partner; do they have anything to add?
Volunteers can share with the group

27. Question and Answer Period…
Public Health: Challenges and Successes Creating Asthma Friendly Schools
Question and Answer Period…
REB and MEL
An opportunity is now available to you to ask any questions or provide comment on the information that was provided during todays’ workshop. Does anyone have any questions for Rebecca of the Public Health School Asthma Pilot Project?
If no, Rebecca could you share with the group some of the challenges or successes you experienced in implementing the pilot project in your school community? What were some of the barriers and how did you over come them?

28. Asthma & Physical Activity
Prevention
Caused by
Triggers

29. Resources What Educators Need to Know about Daily Physical
Activity and Asthma
4-15 copies of the folder, which include an
Asthma/DPA poster, were distributed to all
Ontario elementary schools (English and French) in January 2007.
Currently only available to schools/school boards

30. Resources Ophea’s Asthma Ed. Initiative
Various asthma resources specifically targeting the school community for download or FREE to order in Ontario
The Lung Association
The Lung Association also provides a FREE asthma information telephone helpline where you can obtain advice and general information from a Certified Asthma Educator, through Ontario’s Asthma Action Helpline. Call you can also a Certified Asthma Educator at
Public Health School Asthma Pilot Project
Creating Asthma Friendly Schools
The Asthma Society
Offers virtual support groups on their website.
Allergy/Asthma Information Association
Anaphylaxis Canada
(MEL)
For more asthma/allergy/anaphylaxis information you may contact one or more of the following agencies/organizations.

31. Evaluation and Thank You
Please take a minute
to complete the evaluation.
Any additional questions, please contact
Mélanie Guertin, Ophea’s Asthma Education Initiative Projects Leader * OR
Elizabeth Conti, Public Health School Asthma Project Coordinator *
(MEL)
Thank you for coming to today's workshop, if you have any further questions, please do not hesitate to contact me. If you could take a moment to fill out this quick evaluation after today’s session, I would really appreciate it. All comments are confidential and will not be associated with your name.