Student Breathing/Asthma Questionnaire (SBQ)
Instructions
F15
Purpose:
 The licensed school nurse uses the Student Breathing Questionnaire (SBQ) to:
 determine if the student’s asthma is under control.
 develop an appropriate plan of care (IHP) if appropriate.
 determine asthma severity level.
Instructions:
 The health service assistant (HSA), licensed practical nurse (LPN), and/or licensed school nurse (LSN) will administer
the SBQ to any student in Grades 6 – 12 with asthma:
 on initial visit to the Health Office during the school year.
 who frequently presents with asthma symptoms.
 who takes medication on a routine basis.
 who is reported to the Health Office staff as absent due to asthma  1 day.
 per request of the LSN.
 If the student’s asthma status appears to be changing, the LSN can repeat the SBQ if indicated (moderate to severe
asthma, out-of-control asthma).
 Assist student with SBQ if student cannot read at 3rd grade level or needs interpreter services.
Documentation:
 Document administration on daily log.
 Summarize findings in narrative notes of the Pupil Health Record (LSN).
 File in the Pupil Health Record (LSN).
 Document Severity Level on SHOAR and computerized health problem list (LSN).
Provided courtesy of the Healthy Learners Asthma Initiative / Minneapolis Public Schools, Health Related Services www.healthylearners.org or 612-668-0850