Five million children in the U.S. are living with asthma and the number is steadily increasing. Most live in cities, are poor, or are African American or Latino (Noble, 1999). Schools-especially those in urban areas with deteriorating physical plants and limited resources-can find it challenging to promote the good health, positive development, and educational achievement of children with asthma, although they are required to do so under the Individuals with Disabilities Education Act (IDEA) of 1990. Many schools, however, discover that maintaining a healthy physical environment and incorporating information about asthma into the curriculum benefits the entire school community.
This digest briefly describes asthma symptoms and "triggers." It also presents some suggestions for maintaining a school environment conducive to the attendance of children with asthma and for developing a curriculum conducive to their academic achievement.
Individuals can control asthma with oral medication taken regularly to prevent attacks and with medication inhaled at the onset of an attack. People with asthma carry a peak flow meter, a hand-held tool for measuring their air flow to determine whether an attack is imminent. With help from medical providers and caregivers, and age-appropriate printed materials (such as those available from the American Lung Association), children can learn to monitor their asthma and self-medicate. Taking such control of their illness not only decreases its symptoms but promotes children's feelings of self-confidence and accomplishment (Asthma, 1991).
Children in poor urban areas (especially those living in shelters) and children of color suffer disproportionally from asthma. There are several reasons why their risk is so high: (1) they get inferior medical care, often limited to emergency room visits, which includes no education about how to control the disease and no follow-up attention; (2) they live in homes and neighborhoods, and attend schools, that are overcrowded and laden with pollutants that irritate their lungs; and (3) they experience the high illness-inducing stress that accompanies poverty (Bernstein, 1999; Noble, 1999).
Schools may not be able to eliminate other pollutants, such as chalk dust. They can, however, find out which of them are triggers for particular students and try to limit the student's exposure to them. Further, sensitive scheduling can keep students with specific sensitivities away from certain art supplies and animals, which may enhance the education of some students but sicken students with asthma.
To ensure rapid treatment for an asthma attack, schools need a plan for such a medical emergency with components that range from delivery of medication on site to phoning for an ambulance. Despite the attractiveness of zero-tolerance policies for drug use, physicians usually recommend that students carry asthma medication, thus providing them with a quick and easy way to prevent or stop an attack, and enabling their participation in sports and field trips (Larkin, 1999).
2. Child Specific. The school nurse or another designated staff member should develop an individual asthma action plan with the family of each child with the condition and distribute it to the child's teachers. The plan should include all the information the family believes is important to provide, and, especially, information on medication and other strategies for stopping an attack, normal peak flow meter levels, known asthma triggers, and the names of several caregivers and a health care provider to contact in an emergency. The staff member and the family should also communicate throughout the school year to report attacks and update information in the plan. Parents should be assured that medical records will be kept confidential and that their children will be protected from teasing about their illness (Frieman & Settel, 1994). Most important, the school should maintain a supply of medicine for each child with asthma, located in a secure place that the designated staff member can easily access in an emergency (NHLBI, 1995).
Some families may not recognize their children's asthma, may maintain a home environment that inadvertently exacerbates it, may be unable to secure appropriate asthma treatment, or may be unable to manage the treatment. School personnel, particularly the nurse, can help these parents understand the problem and secure medical services. Considering families' attitudes, beliefs, reading skills, and extent of English comprehension when approaching them improves communication (Asthma, 1998; NHLBI, 1991).
3. Staff Training. The school nurse, a local hospital, or an organization (i.e., Mothers of Asthmatics) can provide staff members with inservice training and printed materials on asthma. Trainers can teach staff how to: (1) recognize the signs of an asthma attack (wheezing, shortness of breath, excessive coughing, a pale sweaty face, low peak flow readings); (2) help a child stop an attack by encouraging relaxation and deep breathing (possibly by modeling the technique), and providing warm water to drink; and (3) determine whether professional medical help is needed and get it rapidly. Training can also cover how asthma medication may affect a student's performance, and suggest ways to support students with asthma by helping them deal with their feelings of being different, their fatigue, their anxieties over medication, and their embarrassment at having an attack. Finally, trainers can help staff understand the pressures on families of students with asthma and communicate effectively with them (Frieman & Settel, 1994; NHLBI, 1991).
2. Sports. Students whose asthma is under control can play most sports, and, indeed, exercise helps develop muscles around the lung and increases stamina. Because some physical exertion may provoke an attack, however, teachers need to remind students to take preventive medication and to carry their inhaler, and to know how to help stop an attack. Schools and families together can develop an exercise program appropriate for their children (Asthma, 1991; NHLBI, 1991).
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