Asthma
MANAGING ASTHMA IN
SCHOOL
Presented by Amy Zimmerman, Director Chicago
Medical-Legal Partnership for Children, HDA
Background
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Asthma is the most common chronic condition of
childhood
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10 million children (13.5% of children <18 yrs) in
the U.S. have asthma (NHIS 2006)
In some minority Chicago communities, as many
as 1 in 4 children have asthma
Many have asthma that’s poorly controlled
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Hospitalization, ED, mortality and morbidity rates
higher in inner-city, minority Chicago communities
Healthy Home, Healthy Child
(HHHC)
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The Westside Children’s Asthma Partnership, Healthy Home,
Healthy Child (HHHC), is a collaboration involving the Sinai
Urban Health Institute, Health & Disability Advocates
(HDA)/Chicago Medical Legal Partnership (CMLPC), and
Metropolitan Tenants’ Organization (MTO).
HHHC seeks to reduce asthma mortality and morbidity by
tackling the complex circumstances faced by the families of
asthmatic children.
CMLPC provides free legal assistance to resolve issues that
impact the family’s ability to properly manage their child’s asthma.
Comprehensive, individualized asthma education focuses on
improving medical management (e.g., recognizing and
responding to attacks, medications) and reducing exposure to
home triggers
Community Health Educators make 6 home visits over the course
of a 12-month intervention period
HHHC Participants
Participant data
 Average age of child is 7
 91% of children are on Medicaid or Kidcare
 Had an average of almost 3 asthma attacks
and 5 wheezing episodes in 30 days
 Had an average of 3.5 Emergency Room
visits in the last year
 Mother is the caregiver in 91% of cases
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Only 15.4% had an Asthma Action Plan
Only 7.1% had a 504 plan.
What it takes to carry inhaler in
CPS
Physician’s Request for Student to Carry
Inhaler on Person
 Physician’s Request for SelfAdministration of Medication
 Physician’s letter of diagnosis
 Parent Request of Self-Administration of
Medication
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Public Act 096-1460
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School Code Amendment (105 ILCS 5/2230)
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Doctor's signature is no longer required for
student to carry and self-administer asthma
inhaler in school; only parent permission and
prescription label are necessary.
Effective Date: 8/20/2010
Public Act 096-1460 part I

Section 5. The School Code is amended by changing Section 22-30 as follows:
 Sec. 22-30. Self-administration of medication.
 (a) In this section:
"Asthma inhaler" means a quick reliever asthma
inhaler.
 "Self-administration" means a pupil's discretionary use of and ability to
carry his or her prescribed asthma medication.
 (b) A school, whether public or nonpublic, must permit the selfadministration of medication by a pupil with asthma or the use of an
epinephrine auto-injector by a pupil, provided that:
 (1) the parents or guardians of the pupil provide to the school (i) written
authorization from the parents or guardians for the self-administration of
medication or (ii) for use of an epinephrine auto-injector, written authorization
from the pupil's physician, physician assistant, or advanced practice
registered nurse; and (2) the parents or guardians of the pupil provide to the
school (i) the prescription label, which must contain the name of the
medication, the prescribed dosage, and the time at which or circumstances
under which the medication is to be administered, or (ii) for use of an
epinephrine auto-injector, a written statement from the pupil's physician,
physician assistant, or advanced practice registered nurse containing the
following information: (A) the name and purpose of the medication or
epinephrine auto-injector; (B) the prescribed dosage; and (C) the time or
times at which or the special circumstances under which the medication or
epinephrine auto-injector is to be administered.
Public Act 096-1460 part II
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(c) The school district or nonpublic school must inform the parents or
guardians of the pupil, in writing, that the school district or nonpublic
school and its employees and agents are to incur no liability, except for
willful and wanton conduct, as a result of any injury arising from the selfadministration of medication or use of an epinephrine auto-injector by the
pupil regardless of whether authorization was given by the pupil's
parents or guardians or by the pupil's physician, physician's assistant, or
advanced practice registered nurse. The parents or guardians of the
pupil must sign a statement acknowledging that the school district or
nonpublic school is to incur no liability, except for willful and wanton
conduct, as a result of any injury arising from the self-administration of
medication or use of an epinephrine auto-injector by the pupil regardless
of whether authorization was given by the pupil's parents or guardians or
by the pupil's physician, physician's assistant, or advanced practice
registered nurse and that the parents or guardians must indemnify and
hold harmless the school district or nonpublic school and its employees
and agents against any claims, except a claim based on willful and
wanton conduct, arising out of the self-administration of medication or
use of an epinephrine auto-injector by the pupil regardless of whether
authorization was given by the pupil's parents or guardians or by the
pupil's physician, physician's assistant, or advanced practice registered
nurse.
CPS Asthma Reporting
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For years, 3% of CPS students were identified as
having asthma
Most recently, a data run of IMPACT (student
information system) showed 4% of CPS students have
asthma
However, this rate may be much higher
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For example, a study conducted in the 2007-2008 school year
that surveyed 4,881 children citywide found that 13.56% of
children have been diagnosed with asthma, while another
10.84% show symptoms but are undiagnosed; the same study
conducted in the 2008-2009 school year (surveying 4,934
children) found that 18.06% of children have been diagnosed
with asthma, while another 14.94% show symptoms but are
undiagnosed.
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Ongoing surveys conducted by the Mobile C.A.R.E. Foundation,
CPS Asthma Reporting
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What Should Happen—and why it DOESN’T
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Parent Completes Parent Section of DHS
Certificate of Child Health Certification Form –or
School Physical Form (required in k, 6, 9th grades)
Physician Reviews and Completes Form but may
not review parent section; may be “mass” health
screen event; even in ideal setting, docs are
rushed/have many forms to complete
Child/Parent submits completed School Physical
Form to child’s school
Nurse inputs School Physical Form information into
CPS’ IMPACT system (overextended, only certain
info may be input)
CPS Asthma Reporting
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CAC’s School Task Force
 Work with State to add asthma to physician section of School
Physical Form
 Lobby CPS or ISBE to adopt Asthma First Aid Poster as
generic asthma action plan for students without AAP on file at
school
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Additional Potential School Task Force Projects
 Lobby CPS to change policy on when asthma is entered into
IMPACT (at self-carry, 504, and/or some other point?)
 Streamline/consolidate forms that physicians are required to
complete
 Lobby CPS or IL State Board of Ed to make school physical
form electronic and linked with CPS IMPACT system
Section 504 Plan Request Letter
Pursuant to Section 504 of the Rehabilitation Act of 1973, I am writing to request an individualized evaluation on
behalf of _________________________________who is diagnosed with asthma,to determine what services,
accommodations, and modifications are necessary to include in a 504 Plan. I am requesting this assessment
and 504 Plan due to the following concerns:
□My child misses school frequently due to asthma.
□My child visits the school health office frequently due to asthma.
□My child has required emergency management of asthma (e.g. called 911, trips to E.R.).
□My child’s asthma is triggered by school/classroom conditions.
□My child’s asthma is affecting his/her learning.
□My child cannot participate fully in P.E. activities.
□The severity of my child’s asthma has changed.
□My child needs to self-administer asthma medication/inhaler/medical equipment during school
hours.
□My child needs help administering asthma medication/inhaler/medical equipment during school
hours.
□Other:
I have attached the following documents and am requesting that they be attached to the 504 Plan:
□ASTHMA ACTION PLAN
□Parent Request for Self-Administration of Medicationor
□Parent Request for Administration of Medication to Student
□The prescription label, including the name of the medication, the prescribed dosage, and the time or
circumstances under which the medication is to be administered
□Other___________________________________________
Childhood Asthma and SSI
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Supplemental Security Income (SSI) is a federal government program
that provides monthly payments to low-income families of blind or
disabled children in addition to adults and senior citizens. These benefits
can be very important to low-income families who have children with
asthma and have trouble affording rent and other basic needs.
 The SSI disability standard used for children whose only medical
problem is asthma (called the Asthma Listing by SSA) is very difficult to
satisfy. Generally, attorneys are successful in getting benefits for these
children in one of two circumstances:
 The child has been seen in the emergency room six times during a
12-month period where the PRIMARY diagnosis is asthma or, better
yet, asthma exacerbation. The number of admissions can be
reduced if the child is admitted for more than 24 hours – in that case,
such an admission counts as 2 visits.
 The child has persistent low-grade wheezing between acute attacks
and short courses of oral corticosteroids (e.g., Prednisone,
Predisolone, or Prelone) that average 6 or more days per month for
at least 3 months during a 12-month period.
Childhood Asthma and SSI: Role of
Providers
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It is very important for providers to keep this
information in mind when writing medical records.
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Better records will help claimants accurately describe whether
they meet the Social Security Administration’s (SSA) asthma
requirements.
The following actions would make it easier for
severely/chronically asthmatic children to be awarded benefits:
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Documenting wheezing on any examination in the office or
hospital
Documenting the number of days the doctor has prescribed oral
corticosteroids for the child to take as prescribed in the office,
hospital or by telephone
Understanding that SSA looks to the primary diagnosis for
determining that a visit counts as an asthma exacerbation
HHHC Findings
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The Community Health Educators encountered a large number of
environmental asthma stressors. Of the children participating in
the HHHC program:
 36.1% were exposed to pests
 23.2% had mold or moisture in their homes
 57.5% were living with a smoker and another 36.8% had a
primary caregiver who smokes
The MTO and CMLPC collaborations were generally well-received,
but many complex socioeconomic issues have been beyond the
scope of the project. Economic hardships create competing
priorities for families:
 43.2% of families had an annual income of less than $10,000
 62.0% of children had a primary caregiver who was
unemployed
 69.9% of children had a primary caregiver who was single,
divorced, widowed or separated
HHHC Results
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Preliminary outcomes through six months of
intervention and follow-up show great
improvements in the control and management
of children’s asthma (N=142) including:
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73% decrease in asthma attacks
75% decrease in wheezing episodes
74% decrease in asthma-related emergency room
visits
73% decrease in hospitalizations
45% less activity-limited days
30% less school days missed due to asthma