Procedures for Students with Asthma
Students with Asthma may require special accommodations while attending school. Florida Statute 1002.20 permits students with asthma, whose parent and physician provide their approval to the school principal, to carry a metered dose inhaler on their person while in school.
Bronchial asthma is a chronic airway disorder with narrowing of the large and small airways in the lungs from bronchial muscle spasm, edema (excessive accumulation of fluids in the lungs), and inflammation in the bronchial wall. The result is the production of thick mucus which decreases air exchange, causes breathing difficulties, and if untreated can cause respiratory distress and death.
Asthma is a chronic airway disorder, which causes a student to have trouble breathing. This trouble may occur frequently throughout the school year in the form of an asthmatic episode or “attack.” Episodes range from mild to severe. Most often, with mild episodes, the airways will open in a few minutes. However, some episodes last much longer and the student needs immediate assistance to prevent more severe episodes from happening. Episodes can usually be managed and brought under control if basic procedures, including immediate medications, are followed.
Asthma is not contagious. It is characterized by excessive sensitivity of the lungs to various stimuli. Each student reacts differently to these stimuli which include: respiratory infections and colds; allergic reactions to pollen, mold, animal dander, feathers, dust and food; vigorous exercise; exposure to cold air or sudden temperature changes; air pollution; fumes or strong odors; cigarette smoke; excitement, stress and strong emotions. In many situations these stimuli can be reduced, removed or controlled.
Asthma is a leading cause of school absenteeism in the United States, and accounts for over 13 million lost school days. It causes approximately 8,000 deaths per year, and appears most severe after a student is 8 years old.
Asthma cannot be cured, but it can almost always be controlled. It is important that school personnel recognize signs and symptoms and understand how to properly assist a student with asthma.
Signs and Symptoms
- non-productive coughing
- shortness of breath
- rapid breathing
- tightness in the chest
- inability to speak and a feeling of suffocation
- pneumonia, bronchitis, and chronic respiratory infections
Breathing difficulty is caused by three types of reactions in the air passages of the lungs: muscles inside the walls of the airways tighten and constrict; the inside walls of the airways swell up; and the swollen walls give off mucus which clogs the airways causing the student to struggle to breathe in or out.
Meeting of Principals Team
The principal/designee arranges a joint meeting with the student’s teacher(s), the assigned school nurse/ the health care designee, and the student’s parent/guardian at the beginning of each school year. The prevention, health care and emergency needs for each student with asthma will be documented in individualized action plans; which are developed in consultation with the student’s parents/guardians, primary health care provider, and school health personnel. The principal and the assigned school nurse/health care designee should develop a plan on how the health information will be conveyed. Special care should be emphasized to ensure the student’s right to privacy and that his/her confidentiality be maintained.
The purpose of the meeting is to discuss any change in the student’s health status, current medications and their side effects, health history, triggers, apparent times/seasons of episodes, emergency care needed, any health related information necessary to assist the student, how school staff will handle emergencies, and in-service education.
The registrar should make sure that asthma is noted on the student’s health frame information. Get several different phone numbers to call in emergencies, i.e. mother, father, doctor, aunt, uncle, grandparents, etc.
Develop the student’s Individual Health Plan with the assigned school nurse/on-call nurse/healthcare designee. The Principal, and the health care designee may contact Coordinated Student Health Services for assistance with this process. School staff will be educated about asthma, and trained to follow the student’s individual action plan.
Asthma education and training should be provided to all school personnel who will have contact with the student. The DVD “Dealing with Asthma, Diabetes, and Epilepsy in Schools” is available at each school in the Health Room/Clinic, and should be viewed by school personnel. Education and training will be provided to include but will not be limited to teachers, paraprofessionals, substitute teachers, school bus drivers/aids, and cafeteria staff. The asthma education and training should include the student’s rights to privacy according to the HIPAA and FERPA guidelines; particularly in the exchange of his/her health information.
Parents are responsible for providing all supplies, medication and equipment needed. The assigned school nurse/health care designee should have access to extra supplies and prescribed medication to be kept at school in case of emergency, and other unforeseen circumstances. For example, as when persons are not allowed to leave or enter the school such as in the case of a “school lockdown” or sudden severe weather, where there could be restrictions on movement for several hours at a time. All extra medication kept by the school must be in pharmacy labeled containers, and kept in a locked medicine cabinet.
Parents need to openly communicate any changes in the student’s health status with the school. Students with chronic health conditions, such as asthma, are assigned a specific health code for emergency purposes. In the event that the diagnosis of asthma is to be removed from the health database, at the request of the parent, the parent is to provide this request to the school in writing so that the school is authorized to remove the diagnosis code for asthma from the student’s health panel.
Common triggers are: allergens, cleaning products, dusts, weather, air pollution, exercise, infections, nighttime, intense emotions (laughing or crying hard), tobacco smoke, colognes, perfumes, and hair sprays. Diesel exhaust can be a trigger, so for students who are transported by school buses, care should be used to avoid overexposure to idling vehicles. Have school bus drivers turn off buses as soon as they arrive at schools. A student may also have additional unique triggers.
Parents should list the student’s asthma triggers. School personnel should make every possible effort to remove or reduce triggers from the student’s school environment. This may include, but not be limited to, frequent changing of the air conditioner filters, restricting pest control spraying to after school hours or on weekends, assisting students to follow dietary restrictions or eliminating pets in a specific classroom.
Schools have a no smoking policy, including all student events on campus.
Whenever possible, minimize the use of carpets and rugs, stuffed animals, dressing/play areas, odorous colored markers, art and science supplies, dust making chalk, fuzzy cotton or wool blankets, scented soaps, odorous wall paints, and strong smelling cleaning agents such as chlorine bleach.
Medication Authorization for Students
Effective school year 2010-2011 BCPS initiated the use of the School Asthma Action Plan as the form that physicians and parents are to complete if asthma medications are to be administered at school. The parent is to be given a copy of the School Asthma Action Plan to take to their healthcare provider in place of the District’s Authorization for Medication/Treatment form.
Should a physician prescribe the use of a metered dose inhaler, he/she needs to complete the School Asthma Action Plan and state that the student has been trained in the proper use and administration of the inhaler. The student should be allowed to keep the inhaler in his/her possession if the student’s physician requests this, or else it should be kept in a locked medicine cabinet in the health room clinic.
Should a physician prescribe the use of a nebulizer for breathing treatments, he/she needs to complete the School Asthma Action Plan and state that the student has been trained in the proper use of the nebulizer. If the student has not been trained, school staff will need to be trained to assist the student with the nebulizer treatment.
Exercise keeps the heart and breathing muscles strong. So most students with well-controlled asthma can participate in regular physical activities and exercise programs with minimal difficulties.
Each student with asthma will have different levels of tolerance to exercise. Running can trigger an episode in over 80% of students with asthma. Swimming seems to be the least asthma producing sport. Warm up exercises often help prevent asthmatic episodes caused by activity, and use of bronchodilator medications before exercise can help prevent most episodes.Students should be taught to pace themselves along with recognizing early symptoms, and to respond appropriately. Most asthmatic students can participate fully in physical activities. In fact, a student’s exercise tolerance is a good indicator of whether or not their asthma is well controlled.
Have the student’s physician state on the School Asthma Action Plan if the student should administer a medication prior to Physical Education or recess. The physician should also state any of the student’s limitations, such as avoiding prolonged running, or avoiding sports in cold or extremely hot weather.
Students wishing to participate on a field trip must have a School Asthma Action Plan for any medication needed during a scheduled field trip. If the student needs a nebulizer treatment during a field trip the School Asthma Action Plan should indicate that the student is trained to do the procedure. Otherwise, trained school personnel will need to assist the student with the nebulizer treatment. Emergency contact information should be current and accurate.
If a student is incapable of self-administering his/her asthma medication/treatment, a plan of action should be developed by the assigned school nurse/health designee to assist in meeting the needs of the student on the field trip. The plan of action will specify emergency care and identify trained school personnel.
The best practice of school personnel for an asthmatic student is to assign the student a buddy who can serve as a runner in times of an emergency. This can be particularly helpful for lunch, physical education, or outdoor activities. Teachers may wish to rotate buddies. Asthmatic students in distress may not be sent to the clinic with a buddy.
Emergency Care Plan/Crisis Management/Health Concerns
The student’s healthcare provider should indicate on the School Asthma Action Plan any emergency care that may be needed by the student. Parents and the school’s health care professional/healthcare designee should communicate significant changes in the student’s needs or health status promptly to school staff.
Staff should be alerted as to what symptoms to look for in order to prevent upper respiratory distress. Early detection of symptoms and an appropriate response can prevent the need of a 9-1-1 experience. Whenever there is an emergency situation, the student should not be left alone with other students, but rather in the company of school personnel.
Authorization should be provided by parents for appropriate exchange of information between the assigned school nurse/healthcare professional/healthcare designee, school administrators, and the student’s physician/health care team. Emergency contact information should be current and accurate.
Some students are on different medications, or miss sleep due to nighttime asthma that their personalities may have severe mood swings or their energy levels may vary drastically. Teachers should be made aware of possible side effects and to whom these observations should be reported.
Upon notification of school staff, identify and respond to concerns regarding ineffective coping mechanisms demonstrated by the student and/or family. Consult with the School Social Worker/Counselor/Psychologist in order to assist the student and/or the family with community resources and available services.
Hospital Homebound/Dual Enrollment
If a student has a history of frequent absences, then the school should have the parent consider filling out an application for dual enrollment in the hospital homebound program. Most parents will know the season when their child has the greatest number of asthmatic episodes. By planning for dual enrollment at the beginning of the year, a parent can be reassured that the student will be assisted in keeping up with his/her core courses.
A plan of action should be discussed regarding education and training on asthma for the appropriate school staff and the specific information needed to assist the specific student. The assigned school nurse/on call nurse should plan to provide scheduled in-service education to school personnel including teachers, paraprofessionals, clerical staff, bus drivers/aids, and food service personnel.
BCPS Coordinated Student Health Services Department, through a grant from the CDC DASH program, offers a variety of asthma education for students, of all ages, and staff. The asthma education programs help children, teachers, and parents become more knowledgeable about asthma and learn ways to better control it. The principal or school health personnel (on-site or on-call) can arrange for this in-service by contacting Coordinated Student Health Services at (754) 321-2272. Asthma education information may also be accessed via the Coordinated Student Health Services website by going to www.browardschools.com. Choose Departments, Health Education and then Asthma.