1. Asthma and IAQ Lani Wheeler, MD, Medical Officer Sarah Merkle, MPH, Program Analyst Division of Adolescent and School Health Centers for Disease Control and Prevention

2. Asthma is a Major Public Health Problem Nearly 5 million children have asthma (6.9% of children under 18) It is one of the most common chronic childhood illnesses It is a leading cause of school absences

3. 2 or more children are likely to have asthma In a classroom of 30 children,

4. What is Asthma? A disease that: Is chronic Produces recurring episodes of breathing problems Coughing Wheezing Chest tightness Shortness of breath Cannot be cured, but can be controlled

5. What are the Symptoms of Asthma? Shortness of breath Wheezing Tightness in the chest Coughing at night or after physical activity; cough that lasts more than a week Waking at night with asthma symptoms (a key marker of uncontrolled asthma)

6. What Happens During an Episode of Asthma? The lining of the airways becomes swollen (inflamed) The airways produce a thick mucus The muscles around the airways tighten and make airways narrower

7. What Makes Asthma Worse? Allergens Warm-blooded pets (including dogs, cats, birds, and small rodents) House dust mites Cockroaches Pollens from grass and trees Molds (indoors and outdoors)

8. What Makes Asthma Worse? (cont.) Irritants Cigarette smoke and wood smoke Scented products such as hair spray, cosmetics, and cleaning products Strong odors from fresh paint or cooking Automobile fumes and air pollution Chemicals such as pesticides and lawn treatments

9. What Makes Asthma Worse? (cont.) Infections in the upper airways, such as colds (a common trigger for both children and adults) Exercise Strong expressions of feelings (crying, laughing) Changes in weather and temperature

10. Is There A Cure For Asthma? Asthma cannot be cured, but it can be controlled. You should expect nothing less.

11. How Is Asthma Controlled? Follow an individualized asthma management plan Avoid or control exposure to things that make asthma worse Use medication appropriately Long-term-control medicine Quick-relief medicine

12. How Is Asthma Controlled? (cont.) Monitor response to treatment Symptoms Peak flow Get regular follow-up care

13. How are Asthma Episodes Controlled? Know the signs that asthma is worsening Treat symptoms or drop in peak flow at first signs of worsening Monitor response to therapy Seek a doctor’s help when it is needed

14. What Should People with Asthma Be Able To Do? Be active without having asthma symptoms; this includes participating in exercise and sports Sleep through the night without having asthma symptoms Prevent asthma episodes (attacks) Have the best possible lung function (e.g., good peak flow number) Avoid side effects from asthma medicines

15. Asthma Goals For School Health Healthy school environment Health services in school Asthma education Supportive policies Sound communication

16. Goal: Healthy School Environment Enforce no-smoking policies Reduce exposures to triggers: tobacco smoke, chemical vapors, furry or feathered animals, mites, cockroaches, chalk dust, mold Keep temperature and humidity at appropriate settings Maintain HVAC systems Dry up damp and wet areas within 1-2 days

17. Goal: Health Services in School Provide full-time nursing services Include nursing assessments, care plans in student records Teach and monitor correct inhaler techniques, peak flow meter use Train, supervise and delegate to health assistants and education staff, as appropriate

18. Goal: Asthma Education Provide asthma awareness for all students Teach asthma management to students with asthma Provide asthma education for faculty and staff Teach parents how to manage asthma

19. Goal: Supportive Policies Identify students with asthma Provide quick, reliable access to medications Establish individualized student asthma management plan Establish individualized student emergency plan for asthma episodes Promote safe and full participation in all school activities Monitor students’ asthma

20. Supportive Policies Identify Students Review student health records Interview parents Interview school health staff

21. Supportive Policies Provide Access to Medication Ensure reliable access to medication for all school activities Allow self-administration as appropriate Provide for nebulizer treatment as needed

22. Supportive Policies Establish Student Asthma Management Plan Address triggers Record personal best peak flow Specify routine medications Outline signs and symptoms of worsening asthma Specify medications required for emergencies and how to monitor response to them. Indicate emergency contacts Place plan in student’s health record Make copies for off-campus activities

23. Supportive Polices Establish Plan for Asthma Episodes Develop school wide emergency plans/procedures Include respiratory distress treatment protocols Include plan for someone without an individualized plan Include an emergency plan for asthma episodes in the individualized student asthma management plan.

24. Supportive Policies Promote Participation in All Activities, including Physical Activities Encourage student participation Allow pretreatment and or warm-up before physical activity Allow access to quick relief medication Modify activity or substitute with less strenuous option

25. Supportive Policies Monitor Students’ Asthma Watch for symptoms of uncontrolled asthma Monitor absenteeism due to asthma Refer for home teaching as needed

26. Goal: Sound Communication Form linkages among school, home and health care providers Observe and report symptoms, medication use Review difficulties student may have with daily school management plan Resolve problems with school performance related to asthma Encourage active student participation in school activities

27. Asthma Resources For School Health National Asthma Education and Prevention Program (NAEPP) Website and Materials Start at www.nhlbi.nih.govwww.nhlbi.nih.gov Check out health information for lung diseases NAEPP Partner Organization Website and Materials Start at www.nhlbi.nih.govwww.nhlbi.nih.gov Go to NAEPP homepage; click on “roster” to link with partners