ERIC Identifier: ED438339
Publication Date: 1999-12-00
Author: Schwartz, Wendy
Source: ERIC Clearinghouse on
Urban Education New York NY.
Supporting Students with Asthma. ERIC/CUE Digest, Number 151.
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.
THE NATURE AND PREVALENCE OF ASTHMA IN CHILDREN
Asthma is a
non-contagious chronic lung condition caused by a tightening of the airways of
the lungs and production of extra mucus. An asthma attack, which may last a few
minutes or several days, results in breathing problems such as coughing,
wheezing, chest tightness, and shortness of breath. One or more factors, called "triggers," can provoke an attack. Triggers include: infections, physical
over-exertion, and emotional factors; and exposure to allergens (i.e., pollen,
mold, animal dander), irritants (i.e., chalk dust, smoke, pesticides), and
strong odors (i.e., some personal care products) (Awareness, 1995; Majer & Joy, 1993).
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 can take many measures to
ensure the health, safety, and emotional comfort of students with asthma. The
most effective school asthma management program is a cooperative effort
involving health providers, school staff, parents, and students, although
coordinated by one staff member (National Heart, Lung, and Blood Institute,
NHLBI, 1991). There are several effective interdisciplinary programs for
creating a healthy school environment, such as the Healthy Schools Networks in
Boston and New York, that can serve as models (Goldberg, 1996). Several Federal
programs, including those funded by IDEA, provide aid for cleaning up schools.
Most improvements in environmental
quality benefit everyone in the school building because pollutants have a
universally negative effect. For example, schools should undertake extensive
building repairs, painting, cleaning, and extermination during long vacations.
They should replace plastic furniture and carpeting, which often emit noxious
gases. They should limit use of cleaning supplies and equipment that emit toxic
fumes and strong odors and require good ventilation when they are used. They
should have the entire building (particularly the heating and ventilation
system) cleaned regularly to eliminate dust mites, mold, mildew, animal dander,
feathers, cockroaches, and other possible asthma and allergy triggers, and make
sure that leaks of water and plaster dust are stopped and quickly cleaned up.
They should regularly monitor the air quality of schools, especially those in
sealed buildings and try to increase the ventilation so that pollutants can
escape (Goldberg, 1997a; NHLBI, 1991).
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
MEDICAL POLICIES AND SERVICES
1. Overall. Schools with a
health clinic provide the best services for students with asthma because clinic
staff can monitor the children's condition, adjust their medication, and work
with families to provide effective management at home. In poor areas, where
health care is inferior and fragmented, school clinics can be vital to
children's well-being. However, most urban schools do not have the resources for
operating a clinic, and, in fact, even the presence of a full-time school nurse
is becoming increasingly rare. It is important, however, for a health care
provider to be available regularly to provide guidance on service delivery and
to help update school health policies (Goldberg, 1997b; Kronenfeld, 2000).
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,
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).
STUDENT EDUCATION AND ACTIVITIES
1. Curriculum. Asthma as a
topic across the curriculum draws on knowledge in several subject areas and has
a practical use. All the students can use the peak flow meter of a child with
asthma to learn about the respiratory system (and, by extension, about anatomy
in general),and about basic mathematical concepts as they record and analyze
data collected through periodic measuring of lung activity. Use of the many
available stories, poems, and audiovisuals with asthma as a theme can help
develop students' reading and critical thinking skills. Asthma can also be a
topic for students' personal writing, script writing, and role playing. Learning
about the illness itself helps develop all students' empathy for those living
with chronic illnesses and increases the self-esteem of children with asthma who
may feel stigmatized (Asthma, 1998).
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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