Asthma in the Classroom:
What do teachers need to know?
Pulmonary Rehabilitation
Asthma Impact
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Asthma…
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affects over twenty five million people
nationwide
causes 10.5 million lost school days annually
third-ranking cause of hospitalization among
those younger than 15 years of age
Estimated cost of asthma in the U.S. is $56
billion per year (direct and indirect costs)
Source: EPA Asthma Facts 2013, http://www.epa.gov/asthma/pdfs/asthma_fact_sheet_en.pdf
Asthma is Common
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Nationally, 9.5% of children
have asthma
Rates are twice as high for
schoolchildren in some cities in
MA
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Holyoke- 18.7%
Springfield- 17.2%
High rates of uncontrolled
asthma
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asthma hospitalizations are
more than double the state rate
in both Holyoke and Springfield
Sources: National Health Interview Survey Data, 2011,
http://www.cdc.gov/asthma/nhis/2011/table4-1.htm,
Baystate Health Community Health Needs Assessment 2013
CDC. Asthma’s Impact on the Nation,
http://www.cdc.gov/asthma/impacts_nation/infographic.htm
Asthma Impact
School
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Asthma can affect…
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School attendance
Ability to concentrate
Overall academic
performance
Overall quality of life
What is asthma?
Overview
What is Asthma?
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Chronic lung disease that can affect a
person’s breathing
Asthma can range from mild to severe
Image from www.mitchellzhomes.com/AZAPAA/azapaa_asthma.htm
What is Asthma?
In asthma, two main things happen:
1. Muscles tighten
around the airways
(bronchoconstriction)
2. The insides of the airways
swell (inflammation) and
make mucus
*Modified from GSK Programs to Go “What do you really know about asthma?”
Common Asthma Symptoms
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Cough
Wheezing/whistling with
breathing
Hard to breathe
Chest tightness
Tired or fatigued
Asthma Triggers
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What is an “asthma trigger”?
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Types of asthma triggers
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Allergens – things that trigger allergies
Irritants – substances that irritate respiratory passages
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Other – infections, exercise, cold air
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Things in the environment that can cause a person with
asthma to have asthma symptoms (commonly called
“attacks”, “flare-ups” or “exacerbations”)
Asthma triggers are different for everyone
Environmental Asthma Triggers
How does the environment impact asthma?
Environment can affect
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who can get asthma
when someone gets asthma
how bad the asthma is
Asthma Medications
Two main types of asthma medication:
 Rescue/quick-relief medications
 Controller medications
Quick Relief Medications
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Provide quick treatment to reduce airway
blockage when having asthma symptoms
Stops tightening of muscles around airway
(bronchospasm)
Example: Albuterol
*modified from Arizona Asthma Coalition’s “Asthma in the School Setting”
http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf
Controller Medications
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Taken DAILY to control persistent asthma
Used to stop chronic inflammation
Examples: Flovent, Advair, Pulmicort,
Symbicort
*modified from Arizona Asthma Coalition’s “Asthma in the School Setting”
http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf
Asthma in the Classroom
Asthma Triggers
Triggers in the Classroom
Allergens: Pets and Pests
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Examples:
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Dust mites
Example - found in classroom carpets
and clutter
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Animal dander – Pets and Pests
Example - from class pets or pet hair
on student clothes
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Cockroach droppings
Triggers in the Classroom
Allergens
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Examples:
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Pollen
Example - from plants in
classroom or outdoors
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Molds
Examples – from wet drywall,
rug or saturated plants
Near intake vent or
window
Create an Asthma Friendly Classroom
Keep classroom allergen free!
No dust mites here!
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Make sure classroom is clean
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Dust with damp rag (microfiber if possible)
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Wash blankets, furry costumes and stuffed
animals weekly in hot water
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Use throw rugs, whenever possible, that can
be machine washed periodically or replaced
Furry pets may be a trigger and
should be avoided in classroom per
protocol
*modified from Arizona Asthma Coalition’s “Asthma in the School Setting”
http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf
Create an Asthma Friendly Classroom
Keep classroom allergen free!
No dust mites here!
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Make sure classroom is cleanable
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Remove clutter to prevent accumulation
of dust
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Clear areas for custodians to dust, mop
and vacuum
Create an Asthma Friendly Classroom
Keep classroom allergen free!
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Prevent allergens from entering or multiplying
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Stay inside/close windows on high pollen days
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Keep pet and people food tightly covered to prevent
attracting pests and having food spoil
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Avoid hissing cockroaches as pets if they are a
trigger for students or staff
*modified from Arizona Asthma Coalition’s “Asthma in the School Setting”
http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf
Create an Asthma Friendly Classroom
Keep classroom allergen free!
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Identify possible sources of mold
Create an Asthma Friendly Classroom
Keep classroom allergen free!
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Prevent allergens from multiplying
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Keep plants well drained
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Locate items that leak away from
carpet
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Locate plants away from air vents
to prevent circulation of allergens
(mold & pollen)
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Identify sources of water leaks and
report to maintenance
Create an Asthma Friendly Classroom
Keep classroom allergen free!
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Prevent exposure to allergens
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Make sure ventilation system is
working and report to custodian if
it is not
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Locate children’s clothes with
smoke and pet allergens away
from occupied areas and
ventilation system
Triggers in the Classroom
Irritants - Chemical
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Products with fragrance or odor
 Personal Care Products - perfume,
scented lotions
 Curriculum Products – permanent
markers, scented markers
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Cleaning and maintenance products
 air fresheners
 solvent-based cleaning products
 disinfectants and sanitizers – i.e.
bleach
Triggers in the Classroom
Irritants - Particulate
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Airborne particles in the
building - chalk dust, from
buffing waxed floors
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High air pollution days
Note: Though it should not be found in the
classroom, it is important to be aware
that second-hand smoke is a strong
asthma trigger as many children have
family members that smoke
*modified from Arizona Asthma Coalition’s “Asthma in the School Setting”
http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf
Triggers in the Classroom
Irritants - Particulate
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Exhaust (indoor/outdoor)
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Vehicle - school bus, delivery
and car idling
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Landscaping equipment snow blower, lawn mower,
leaf blower
Triggers in the Classroom
Irritants - Particulate
o
Exhaust - Office Equipment
 Copier
 Laminating
 Laser
machine
printer
Create an Asthma Friendly Classroom
Keep classroom free of chemical irritants!
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Create a fragrance free classroom
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Avoid use of perfumes, powders, lotions, air fresheners, scented
markers, etc.
Use safe products
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Check with your school district about using green cleaning products
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No fragrances here!
Springfield Public School District has a list of approved cleaning
products for use– and teachers should not bring in products from home.
Use microfiber whenever possible
Do not dust or clean while children are present
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Only use cleaning products when children are absent
Only trained custodians using approved products should disinfect
after hours
*modified from Arizona Asthma Coalition’s “Asthma in the School Setting”
http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf
Create an Asthma Friendly Classroom
Keep classroom irritant free!
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Stay inside/close windows on
poor air quality/high ozone
days
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Make sure ventilation system is
working properly
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Promote anti-idling policies at
your school
*modified from Arizona Asthma Coalition’s “Asthma in the School Setting”
http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf
Indoor Air Quality (IAQ) Reporting
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If you find a ventilation or odor problem OR
If you suspect that staff or students have a
reaction or symptoms due to conditions in
the building
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Report it to your principal who has the authority
to have it investigated.
Ask your principal to report back on any action
based on the investigation.
Check with your district to see if there is a
specific protocol for investigating IAQ problems.
Asthma Triggers at School
Exercise
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Exercise and asthma
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If a child with asthma is wheezing during exercise, it is a
sign of uncontrolled asthma
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Exercise can trigger asthma
Some children with asthma take quick-relief medication
before they exercise
Children with asthma should warm-up before exercise
They should talk to their doctor to see if they need to adjust
their medications
Children with asthma should not be excluded from
exercise or recess unless they have written physician’s
instructions to do so
Asthma can be controlled and children
with asthma can lead active, healthy lives!
*modified from Arizona Asthma Coalition’s “Asthma in the School Setting”
http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf
Asthma Triggers at School
Weather & Outdoor Air
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Check the weather and outdoor air forecast
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Cold air can make asthma worse
High air pollution/ozone days can trigger asthma
Pollen can trigger asthma
On cold days, wearing a scarf over nose and
mouth warms and humidifies air
Close windows and limit exposure to outdoor air
on high pollution, ozone and pollen days
*modified from Arizona Asthma Coalition’s “Asthma in the School Setting”
http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf
Asthma Triggers at School
Other
Some other asthma triggers
 Respiratory infections
 Food Additives
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Some food additives such as sulfites can trigger
asthma flare-ups
Emotional Stress
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Stress during an asthma flare-up can produce rapid
breathing or hyperventilation which can make the
episode worse
*modified from Arizona Asthma Coalition’s “Asthma in the School Setting”
http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf
Asthma in the Classroom
What to be aware of
Asthma in the Classroom
Know Early Warning Signs of Asthma Episode
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cough
wheeze
chest tightness
shortness of breath
runny or stuffy nose
sneeze
headache
funny feeling in chest
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stomach ache
poor appetite
itchy throat or chin
glassy eyes
feeling tired
coughing or waking at
night
*modified from ALA Asthma Education Certification Course and “Developing an Effective Asthma Action Plan” by Dr.
Matthew Sadof
Asthma in the Classroom
Asthma Episodes
What to do during an asthma episode
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Stay calm
Keep child calm
Have the child try to stay relaxed and focus on
breathing
Contact the school nurse
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Always make sure the nurse is available before
sending a child to the nurse’s office
Never send a child experiencing asthma symptoms
alone to the nurse’s office
*modified from Arizona Asthma Coalition’s “Asthma in the School Setting”
http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf
Asthma in the Classroom
Danger Signs of Asthma Episode
Know danger signs of an asthma episode
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Difficulty speaking
Lips or fingernails turn gray or blue
Heart rate is very fast
Noisy breathing (may not be present if severe airway
constriction)
Visible drawing in or sinking of chest (retractions) when
student inhales
Quick-relief medicine does not improve the signs listed above
Contact school nurse immediately!
Asthma in the Classroom
Potential Medication Side Effects
Be Aware of Potential Medication Side Effects
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Anxiety
Restlessness
Hyperactivity
Rapid heartbeat
Thrush
Sore throat
*modified from Arizona Asthma Coalition’s “Asthma in the School Setting”
http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf
Asthma
Medication Devices
Be Aware of Types of Medication
Devices
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Metered dose inhalers
Nebulizer
Dry powder inhalers
Spacers
Asthma at School
Asthma Action Plans
All children with asthma should have a written
Asthma Action Plan at school, home and physician’s
office
Asthma action plans provide information on
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How to assess and monitor asthma symptoms and lung
function (green, yellow and red zones)
Medications to take and when to take them
What to do during an asthma flare-up when things get
worse
Triggers to avoid
*modified from ALA Asthma Education Certification Course and “Developing an Effective Asthma
Action Plan” by Dr. Matthew Sadof
Asthma Action Plan- Example
Classroom Asthma Management
Summary
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Create a healthy classroom by reducing exposure to
triggers!
Encourage policies in your school to reduce triggers
Be aware of asthma symptoms
Know warning signs of an asthma episode and what to do
Encourage all children with asthma to have an Asthma
Action Plan on file with the school nurse
Together we can help children in our schools
control asthma so that they can lead active,
healthy lives!
Questions?
Thank you!
If you have any questions about asthma or
would like more information, visit:
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Pioneer Valley Asthma Coalition, www.pvasthmacoalition.org
American Lung Association, www.lung.org/lung-disease/asthma
Brought to you by:
Pulmonary Rehabilitation
Presentation developed by: Michele Hart, RN, BSN, AE-C, Baystate Pulmonary Rehab; Ann Ottalagana, American Lung
Association; Kathleen Szegda, and Sarita Hudson, Pioneer Valley Asthma Coalition