1. Controlling Asthma: Preventing Episodes Before They Occur

2. Is There A Cure For Asthma?
Asthma cannot be cured, but it can be Controlled
“We should expect nothing less”!

3. Goals Of Asthma Control
Prevent Symptoms
No coughing or wheezing
No shortness of breath or rapid breathing
No waking up at night
Maintain normal or near “normal” pulmonary function
Maintain normal activity levels (including exercise and other physical activities
Prevent exacerbations of asthma and minimize ER/UC and hospital visits
Minimal or no adverse effects from medications
Meet patients/family’s expectations and satisfaction with asthma care
Exerts from NAEPP EPR2 Guidelines for Diagnosis and Management of Asthma 1997

4. Asthma Control Do Most Students Have It?

5. Unfortunately NO! Many students who have asthma:
Have poor asthma control
Use “quick relief” medicine (e.g. albuterol) on a regular basis
Cough, experience chest tightness, wheezing, or shortness of breath regularly
Assume suffering from symptoms are “normal”
Remain indoors and cannot fully participate in sports, PE or recess
Miss school due to asthma

6. Examples Of Students Whose Asthma Is NOT Optimally Controlled
A 10th grader, says he feels fine except when he runs in PE class, then his chest hurts. He coughs most mornings and whenever he gets a cold or virus. He often can’t keep up with the other kids and needs to stop and rest
A 12th grader, carries an OTC Primatine Mist inhaler & uses it a few times every day. He says he “grew out” of his asthma

7. Examples Of Students Whose Asthma IS Optimally Controlled
A 6th grader, doesn’t need his “reliever”(albuterol) since consistently using his controller medications twice daily. He now plays soccer without developing symptoms or having to take pre-exercise albuterol
A kindergartener, no longer coughs or wheezes and easily keeps up with the other kids at recess. Her dad bought special dust mite proof covers for her mattresses and pillow. She now takes her controllers daily, uses her Asthma Action Plan, and sees her health care provider every 6 months for a well asthma check-up

8. Asthma Severity Level vs Asthma Control
Asthma Severity Levels (Mild Intermittent, Mild Persistent, Moderate Persistent, and Severe Persistent)
Based on signs and symptoms before a student starts on controller medications
Levels can change over time
Asthma Control (or “Current Asthma Severity”)
Is the students current severity level-
regardless if they are on medications, experiencing symptoms (episodes) and/or able to be fully active

9. Asthma Control Proactive vs Reactive
Going from a reactive to a proactive approach
Instead of thinking-
“ How do I treat these symptoms?”
e.g. with albuterol after the fact
Think-
“ How could have the symptoms have been prevented in the first place?”
e.g. daily controller medications, pre-exercise meds, asthma action plan, environmental control

10. Controlling Asthma
Medical
&
Environmental
Management

11. Controlling Asthma Medical Management

12. How To Achieve Good Asthma Control
Have regular asthma check-ups with a primary healthcare provider, even when feeling well
At least every 6 months (more often if having symptoms)
Monitor symptoms and peak flow readings daily
Ask for and use a personalized Asthma Action Plan
Know personal green- yellow- red zones, what each zone feels like and what to do in each zone

13. Asthma Control Continued...
Get a flu shot every fall
Avoid asthma triggers
Asthma’s not in control? Check in regularly at school health office for:
Peak flow check /symptom evaluation
Lung sounds / respiratory rate check
Pre-exercise and/or controller meds
Asthma education
Care coordination

14. Asthma Action Plan
See MDH Asthma Action Plan F1

15. Written Asthma Action Plans
Developed by the health care provider for each individual child with asthma
Medications are determined by asthma severity level
Based on symptoms and peak flow rates
Lists daily & rescue medications
Symptom management and emergency plan
Copies to be shared by clinic, family and school

16. Asthma Action Plan Zones
Green Zone: All Clear/Breathing Good/Go
No asthma symptoms and/or
Peak flow % Predicted or Personal best
Yellow Zone: Caution/Slow Down
Some asthma symptoms and/or
Peak flow 50-80% Predicted or Personal best
Red Zone: Medical Alert/Stop
Severe asthma symptoms and/or
Peak flow < 50% Predicted or Personal best

17. What Can A Student Do To Stay In The Green Zone
What Can A Student Do To Stay In The Green Zone? Select The Incorrect Answer
A. Take their controller (anti-inflammatory) medication every day
B. Avoid cigarette smoke and other asthma triggers
C. Take their pre-exercise (usually reliever) medicine before P.E. or at recess
D. Wash their bathroom often with bleach to avoid mold and mildew build-up

18. What Can A Student Do To Stay In The Green one
What Can A Student Do To Stay In The Green one? Select The Incorrect Answer
A.Take their controller (anti-inflammatory) medication every day
B. Avoid cigarette smoke and other asthma triggers
C. Take their pre-exercise (usually reliever) medicine before P.E. or at recess
D. Wash their bathroom often with bleach to avoid mold and mildew build-up

19. If A Student Is In The Yellow Zone, They Should:
A.Be cautious. Breathing isn’t their best. Take action
B.Eat a lot of yellow foods such as bananas, which are high in potassium
C.Automatically stay home from school
D.Call their doctor or nurse practitioner immediately

20. If A Student Is In The Yellow Zone, They Should:
A. Be cautious. Breathing isn’t their best. Take action
B. Eat a lot of yellow foods such as bananas, which are high in potassium
C. Automatically stay home from school
D. Call their doctor or nurse practitioner immediately (correct answer: call if they aren’t fully back into the green zone within hours). R1
R1 Animals in Schools guidelines

21. Which Is One Symptom/ Clinical Indicator Is NOT Associated With The Red Zone?
A. Mild coughing
B. Peak Flow reading < 50% of personal best
C. Significant breathing problems
D. Persistent wheezing or no wheezing at all indicating severely limited aeration

22. Which Is One Symptom/ Clinical Indicator Is Not Associated With the Red Zone?
A. Mild coughing
B. Peak Flow reading < 50% of personal best
C. Significant breathing problems
D. Persistent wheezing or no wheezing at all indicating severely limited aeration

23. Activity Group Case Discussion
The first month of school, your called to an elementary school by a substitute teacher. She sent a 3rd grader to the nurse’s office alone, and told her to lay down.
When you arrive, child has neck vein distension, accessory muscle retractions, dark/dusky color. No inhaler available
Mom is 45 min. away. Grandma is in town
WHAT DO YOU DO?

24. Controlling Asthma - Environmental Management

25. Common Environmental Triggers At Schools
Indoor Triggers
Animals with fur
Dust mites
Mold
Pests
Secondhand smoke
Chemicals (e.g. strong smelling cleaning supplies, perfume, air fresheners)
Outdoor Triggers
Ozone
Particulate matter
Diesel exhaust
Chemicals (e.g. re-surfacing the playground or roof, etc.)
This slide lists the environmental triggers commonly associated with schools – both inside and outside of school buildings. The US Environmental Protection Agency focuses on the 5 most common indoor environmental triggers of asthma. These triggers are not listed in order of importance. The Institute of Medicine report from 2000, Clearing the Air: Asthma and Indoor Air Exposures, provides a detailed review of indoor air triggers. While other outdoor air pollutants may trigger asthma, these 4 are highlighted because they are either a problem in some parts of Minnesota or are commonly associated with school buildings.

26. Animals Dander, urine & saliva are triggers
Triggers remain months after animal pet removed
Actions:
Prohibit/remove animals from schools if able
If removal is not possible:
Keep animals in cages or localized areas
Clean cages often
Keep animals away from fabric furniture, carpet & ventilation system
Locate sensitive students away from animals
Pre-notify parents if animals with fur/feathers visit
Sample Animals in School Guidelines in manual R1

27. Dust Mites
Both cause & trigger asthma; live in pillows, carpet, fabric-covered furniture, curtains
Actions:
Keep classrooms clutter-free
Make informed decision: presence of carpet
Vacuum often when people with asthma/allergies are gone (HEPA filter vacuum cleaners may help)
Pillows/mattress/box spring in dust-mite proof zipped covers
Wash bedding and stuffed toys weekly in HOT water (>130 degrees F)
Keep room humidity < 50% if possible

28. Mold Moisture control is key Actions:
Report leaks and wet/moist areas right away
Wash mold off hard surfaces
Replace moldy porous items such as ceiling tiles & carpet
Avoid carpet in areas with regular moisture such as drinking fountains & sinks E9

29. Pests Droppings or body parts can trigger asthma Actions:
Use integrated pest management (IPM) methods
Don’t leave food, water or garbage exposed
Don’t eat or drink in classroom
Seal entry points for pests
Use pesticides only as needed
Parent Right to Know Act: must notify parents & employees when using specific pesticides
F32, F33, F34

30. Secondhand Smoke
Causes asthma in young children & triggers asthma in children & adults
Contains over 4,000 substances
State law prohibits tobacco use in K-12 public schools
Actions:
Enforce smoking bans (for anyone on school property)
Include anti-smoking message in curriculum
Encourage parents/guardians to quit smoking or to not smoke inside their home

31. Outdoor Air Ozone & fine particles are concerns in MN
Staff have little control over outdoor air
Actions:
Sign up for Air Quality Index notice
Pollution Control Agency sends alerts when they expect poor air quality (regional)
Avoid being outside at high pollen count times, especially if students are allergic to particular pollen/s

32. Sept. 14, 2000/June 28, 2001

33. The AQI
We almost never see a maroon in the U.S. anymore. Purple is uncommon but might occur in cities that have serious pollution problems (not in MN).

34. Average Number Of Alerts
6-12 alerts per year in last few years
Most due to PM2.5
Not violation of federal air quality standards thus far
Health issues still valid

35. 2003 – Air Pollution Health Alerts
Expanded AQI to Duluth, St. Cloud, Rochester
Detroit Lakes, Marshall coming soon
Expanded media coverage (Pioneer Press, TV meteorologists, health reporters, others)
Expanded web & alert signup

36. MPCA’s AQI web page 1

37. MPCA’s AQI web page 2

38. School Buses State law requires:
Reduce unneeded idling in front of schools
Reroute bus parking zones away from air intakes, if possible
Actions:
Post “no idling” signs
Maintain bus fleet
Invest in cleaner fuels
Purchase newer, cleaner buses over long-term
R2, R3, R4
Minnesota low requires schools to take steps to reduce exposure to diesel exhaust from school buses. Action steps include reducing bus idling in front of schools, locating bus parking areas away from the fresh air intakes, maintain the fleet and the use of cleaner fuels.
R2 MN Bus idling statute
R3 MN School Bus school board policy Sierra Club- Bus idling
R4 MN School Bus idling Policy notification - news article

39. Other Environmental Issues
Indoor Air Quality Management Plan
Cleaning & cleaning products
Flooring
Air cleaners R7
Minnesota law requires all school districts to develop an Indoor Air Quality Management Plan. The Minnesota Department of Health Indoor Air Program web site includes information on the status of each school district’s progress in meeting these requirements including the name of the district’s Indoor Air Quality Coordinator.
Cleaning products may contain chemicals that are irritants and could trigger an asthma attack. Also avoid products with strong odors. Using walk-off mats at all entrances will reduce the amount of dirt tracked into buildings. This in turn minimizes dust inside of buildings and reduces the quantity of cleaning products used.
There is a continuing debate on the “best” type of flooring for use inside schools. No one floor cover works for every situation. Maintenance is the key to minimizing problems. If purchasing new carpeting, look for a product that is high density (10 stitches per inch), has a short pile (1/10 inch), and has a short level loop. Carpeting that meets these specifications is less likely to retain dirt and is often easier to clean.
The general rule of thumb in achieving good indoor air, is to eliminate exposure. For example, ban smoking, clean up mold, or remove animals from classrooms. Consider these options before using air cleaners. It is also important to select the proper size and type of air cleaner. A high efficiency air cleaner is not very good at removing gases. The Minnesota Department of Health does not recommend the use of ozone air cleaners to remove indoor air pollutants. Ozone is a strong irritant and can trigger asthma attacks.
R7 MN IAQ Management Plan

40. Home Environment Resources
US Environmental Protection Agency
Asthma Home Environment Checklist
8 page checklist of common asthma triggers
Questions to identify triggers & action steps
Clear Your Home of Asthma Triggers fact sheet
EPA website
The environmental triggers mentioned earlier are also found inside homes. Since people spend about 65 percent of their time in their homes, it may be important to identify and minimize residential sources of environmental triggers. Here are two US Environmental Protection Agency publications that focus on asthma triggers in the home.

41. Communication & Care Coordination

42. Key Communication Triad
Parent/
Guardian
Child
School Health
Health Care
Office
Providers

43. Care Coordination / Communication
Care Coordination / Communication Health Assistant / Paraprofessional / LPN Role
Health Assistants / Paraprofessionals / LPNs must alert LSN/PHN/RNs of students who come in frequently with asthma type symptoms
Monitor students with asthma as directed by LSN/PHN/RN
Perform delegated responsibilities once skills have been validated per district/school policies
OTHER (> 2 x a week visits to office)

44. Care Coordination /Communication (LSN/RN/PHN)
Examples of asthma care coordination activities
Request AAPs on students
Review AAP and/or IHP and develop/modify plan for care coordination
Determine medical insurance status and connect to appropriate provider(s)
Arrange for special transportation (in rare cases) prn
Connect to community resources

45. Care Coordination/ Communication
Communicating with Students
Educate them to:
Follow an individualized Asthma Action Plan
Avoid or control exposure to their triggers
Use medication appropriately
Long-term-control medicine
Quick-relief medicine
Monitor symptoms and response to treatment
Understand symptoms and peak flow levels
Seek a health care providers help when needed

46. Communicating w/ Students Continued..
Get regular follow-up care
Be able to exercise/ play at optimal levels
Be responsible for carrying and using their asthma medications per school policies
Ask for help when they need it!

47. Care Coordination/ Communication
Communicating with parents/guardians
Review parent/guardian and student questionnaires
Determine current asthma severity levels
Provide education to family/student as needed
Encourage questions and give feedback
Contact parent/guardian every time a student has asthma symptoms and or if having poor asthma control
Obtain a signed consent to release/ share information
F11, F14, F3, E1, F7
F11 Asthma Parent Questionnaire
F14 Student Breathing Questionnaire
F3 Asthma Severity Tool
E1 Asthma Awareness handout
F7 Asthma Visit Notification

48. Care Coordination / Communication
Communicating with health care providers
Report status changes and re-evaluation needs
Advocate for pre-exercise and /or controller medications as appropriate
Arrange for asthma education
Complete IHP and/or ECP if needed
Document as appropriate in Pupil Health Record
Evaluate symptoms, lung sounds and peak flow regularly on poorly controlled students
F17, F18
F17 Individualized Health Plan for Asthma
F18 Emergency Health Plan for Asthma

49. Communicating With School Staff
Share information with staff on a need to know basis only
Maintain student confidentiality
Provide general asthma education to staff proactively
Provide asthma first aid training to staff
Act as a resource to school staff for questions and concerns
A list of students with asthma is available from the school nurse - if you don’t receive one, please ask.
his also gives the nurse an opportunity to review inhaler/spacer technique.
Inform teachers, coaches, etc. re: what to do/how to care for breathing distress with any student (often students are not diagnosed or haven’t told anyone they have asthma), as well as specific students with unusual asthma related issues / needs

50. Health Office Scenario
A 4th grade student who you have not seen in the health office this year for asthma symptoms, has a diagnosis of asthma in her record, and has albuterol MDI / orders in the health office at school, but no Asthma Action Plan. She comes into the health office with a persistent cough.
What would you do for her?

51. Health Office Scenario Continued...
Actions
Physical Assessment (respiratory rate, breath sounds, severity of symptoms)
Ask what she was doing before coming into the health office / what may have precipitated symptoms
Ask frequency of day / nighttime symptoms
Check height/PF chart for predicted PF and initiate Asthma Record F5

52. Health Office Scenario Continued...
Check her Peak Flow reading and document in SHOAR F4
Instruct the child how to do a PF reading
Give albuterol (observe inhaler technique)
Teach/reinforce proper inhaler technique, use of spacer or holding chamber with inhaler
Monitor her for response to medication
Send note home with the child using the AVN F8 and a PAQ F11
F4 “SHOAR” Student Health Office Asthma Record
F8 AVN” Asthma Visit Notification
F11 Parent Asthma Questionnaire

53. Health Office Scenario Continued...
Two days later, she returns to the health office, with cough and shortness of breath
What would you do for this 4th grader first?
What would be the next steps or what else should you do at this point?

54. Health Office Scenario Continued…
What else should you do now?
Re-evaluate her respiratory status and treat as appropriate
Call her parent / guardian to notify, ask for parent questionnaire/more info.
Suggest she see her health care provider
Ask the child to come see you the next day for a follow up check
If you have consent, fax Asthma Medical Referral/Request to health care provider F9

55. Asthma Management In The School Health Office

56. Sample Forms For Optimal School Asthma Management

57. Key Asthma Tools
Components of Asthma Management in the Health Office E2, E3
Asthma Action Plan w/ imbedded consents, parent letter F1, F2
Asthma Visit Notification form F7,F8
Asthma Medical Request/Referral F9, F10
Pathway for Acute School Asthma Care E6, E7
Emergency Care Plan - Asthma F18
Individualized Health Plan - Asthma F17

58. Key Asthma Tools
Parent/Guardian Breathing/Asthma Questionnaire F11, F12, F13
Student Breathing/Asthma Questionnaire F14, F15, F16
School Health Office Asthma Record F4, F5, F6
Self-administration Asthma Medication Authorization F19, F20
First Aid for Asthma poster / pocket cards E4, E5
Asthma Green/Yellow Zone Update F23, F24
Permanent Health Office Pass F25

59. Components Of Asthma Management In School Health Office
Two Models Provided in School Asthma Manual
LSN + Health Assistant (Mpls. Public Schools model) E2
LSN + Secretary (St. Paul Public Schools model) E3
Purpose: Provides job specific instructions for providing quality asthma care in the school health office
Licensed School Nurse, Public Health Nurse, Registered Nurse
Licensed Practical Nurse
Health Aid/Service Assistant / Paraprofessional
Secretary / Administrative Assistant
Contents include:
Case Finding
Delegated Nursing Care / Procedures
Care Coordination
Emergency Care
Student Counseling / Education

60. Asthma Screening Questions
Include these 3 questions into your existing student health questionnaire
1. Does your child have asthma or other breathing problems?
2. Has your child ever been diagnosed by a doctor as having asthma?
3. Has your child had episode(s) of wheezing (whistling in the chest) in the last 12 months?

61. Asthma Action Plan (AAP)
Purpose
Provides a plan to guide the asthma management of individual students
Includes imbedded consents:
Allow parents/guardians and providers to give permission for medications to be given at school
Allow for sharing/release of information between school, clinic, hospital, child care provider and home care
Available in English and Spanish

62. Asthma Visit Notification Form (AVN)
Purpose
Increases communication between the school health office, parents/guardians, and primary care/asthma care providers
Fill out and send home whenever the student is in the health office with asthma symptoms
Or when delegated by the LSN/PHN/RN
F7,F8
Helpful to also send home some sort of brief asthma education handout to parents/guardians along with the AVN.

63. Asthma Medical Request (AMR)
Purpose
To facilitate communication and care coordination between the health care provider and the school nurse about the student’s asthma status/management
Fill out and fax, mail to health care providers
You must have the parents written consent to collect medical information first
F9, F10
In (Mpls) pilot, has resulted in increased # of AAPs at school, improved medical management and increased follow-up for students with out-of-control asthma

64. Pathway for Acute School Asthma Care
Purpose
Assists school nurses in making decisions regarding the provision of acute asthma care in the school health office or other school setting
Designed to be used for students experiencing mild, moderate or severe asthma symptoms
E6, E7

65. Asthma Emergency Care Plan (ECP)
Purpose
Provides special instructions to selected school staff on how to respond to an asthma emergency
Used with students with severe or labile asthma
Individualized for each student with asthma
F18
Note: An Emergency Booklet which contains “asthma first aid” is posted in all classrooms, health offices and public areas in the school building for school staff

66. Asthma Individualized Health Plan (IHP)
Purpose
Provides a Nursing Plan of Care and promotes care coordination and communication between the school nurse and health office staff regarding students whose asthma is not in good control
Also used to document special education nursing services
F17
(esp. students with moderate to severe persistent asthma)

67. Parent / Guardian Asthma Questionnaire (PQ)
Purpose
Used To:
Gather baseline information about the child’s asthma symptoms
Determine the child’s asthma severity level
Determine if the child’s asthma is under control
Develop an appropriate plan of care
Typically used for students in 5th grade or lower
F11, F12, F13
(Individualized Health Plan and/or Emergency Health Plan)

68. Student Breathing Questionnaire (SBQ)
Purpose
Used to:
Determine the student’s asthma severity level
Determine if the student’s asthma is under control
Develop an appropriate plan of care
Determine student’s familiarity of their meds, triggers, symptoms etc.
Used with students in grades 6th grade or higher
F14, F15
(Individualized Health Plan and/or Emergency Health Plan)

69. School Health Office Asthma Record (SHOAR)
Purpose
Provides a user-friendly document on which to record many aspects of a student’s asthma care
Allows health office staff to:
Record Asthma Medication
Record Peak Flow Readings
Document Asthma Symptoms
Document Education
F4, F5
Allows the health assistant or licensed school nurse to:
Record Asthma Medication
Record Peak Flow Readings
Document Asthma Symptoms
Document Education

70. Self-Administration Of Asthma Medication Authorization / Agreement
Purpose
To systematize practice regarding self-carrying of asthma medications between schools
Promotes strong asthma self care skills in students
Agreement between student and school nurse
Used in conjunction with an Asthma Action Plan or may stand alone
F19, F20

71. First Aid For Asthma Poster / Pocket Cards
Purpose
Provides basic first aid care for asthma and asthma symptoms with directions when to call 911
Place posters in locations in the school where students and staff are usually present
Pocket cards may be given to physical education teachers or coaches or other staff as needed E4, E5

72. Prioritizing In A Busy School Health Office

73. There’s Never Enough Time, What Can I Do?
It isn’t possible for school health office staff to get deeply involved with every student who has asthma so -
Prioritization is essential!
Determine which students seem to be having the most difficulty, and focus on them first

74. How Do I Prioritize?
Prioritize by “current asthma control / severity level”
Focus first on students with the poorest asthma control regardless of severity level
Start working with students whose asthma is poorly controlled in the moderate to severe persistent asthma levels
Use daytime & nighttime symptom frequency
To easily determine “current severity level” (may use the student and/or parent asthma questionnaires to help determine “current severity levels”
To get an idea if the student’s asthma is under control or not

75. Which Of These Students With Asthma Would You Focus On First?
A boy with diagnosed moderate persistent asthma who can run, play, attend school without symptoms and rarely uses his albuterol
A girl with current mild persistent asthma who is unable to fully participate in PE class
A girl who’s original severity level was severe persistent but whose “current asthma severity level” (control) is moderate persistent. She can play outside better than originally, but still needs albuterol for symptoms 3-4 times a week at school

76. Which Of These Students With Asthma Would You Focus On First?
3. A boy with diagnosed moderate persistent asthma who can run, play, attend school without symptoms and rarely uses his albuterol.
2. A girl with current mild persistent asthma who is unable to fully participate in PE class.
1. A girl who’s original severity level was severe persistent but whose “current asthma severity level” (control) is moderate persistent. She can play outside better than originally, but still needs albuterol for symptoms 3-4 times a week at school.
Child #3 - Her asthma control is improved from her original severity level diagnosis, but she still is not well controlled (moderate persistent symptoms).
Child #2 - Well controlled asthma includes the ability to fully participate in PE w/o coughing, wheezing etc. Though only mild persistent symptoms, she still is not fully under good control.
Child #1 - He’s in good control but still should be encouraged to be evaluated by his health care provider on a regular basis (every 6 months for a well asthma check-up), and check in with the school nurse.

77. Education In The School Health Office

78. Components Of Student & Family Education
Concept of asthma control
Pathophysiology of asthma
Environmental control and triggers
Controller vs. reliever medications and refilling medications
Use of Asthma Action Plan and treatment of episodes
Peak flow meter use

79. Components Of Student & Family Education Cont…
Signs and symptoms of respiratory distress and when to seek help
MDI with spacer / DPI technique
Nebulizer use and technique (prn)
Importance of relationship with provider and well-asthma check-ups
Flu shot every fall
Self-care, especially for students as they get older

80. Strategies To Educate When Time Is Limited
Give short asthma education messages when meeting with with students
Use innovative / interactive asthma education tools (computerized asthma games, internet-based asthma control tools, videos) with students / families
*Rather than scheduling one long education session.
*Game Examples: Quest for the Code, Merck’s Airtopia, Bronkie, etc.
Video examples: A is for Asthma, Buster’s Breathless, Roxie to he Rescue, Relieve the Squeeze, others

81. The Best Laid Plans..
You can increase the likelihood of asthma management success (compliance) by:
Reviewing Asthma Action Plan and making sure student understands how to use it
Ask how controller medications fit into the student’s daily routine (can they handle it?)
Identify obstacles or barriers to the student/family carrying out the plan as prescribed
Increasing likelihood of adherence to therapy or plan

82. “I Can’t Manage This By Myself. Who Else Should Be Involved”?

83. Referring To Community Resources For Education And Case Management
LSN/PHN/RNs can utilize case managers, home visiting professionals, and asthma educators from health plans, hospitals, clinics, public health, to help educate and/or case manage students whose asthma is poorly controlled
Connect students/family to community education, asthma camp, other community resources
Connect students to these resources

84. Coordinated School Health: Partnering For Optimal Asthma Management In Schools

85. CDC’s Strategies For Addressing Asthma Within A Coordinated School Health Program
Six Strategies
Establish management and support systems for asthma-friendly schools
Provide appropriate school health and mental health services for students with asthma
Provide asthma education and awareness programs for students and school staff

86. Strategies Continued…
4. Provide a safe and healthy school environment to reduce asthma triggers
Provide safe, enjoyable physical education and activity opportunities for students with asthma
Coordinate school, family, and community efforts to better manage asthma symptoms and reduce school absences among students with asthma

87. Asthma Goals For School Health
Healthy school environment
Health services in school
Asthma education
Supportive policies
Sound communication
1997 National Asthma Education and Prevention Program (NAEPP)

88. Spearheading School-wide Asthma Best Practices At Your School
See Checklist in manual for suggestions
Create a multi-disciplinary plan for improving asthma management in your health office, school and/or district
Improve own practice
Educate other school staff
Involve all disciplines within the school setting

89. Community Involvement
Get involved with the Minnesota Asthma Coalition, and/or the regional Asthma Coalition in your area
Contact your legislators and insist on legislation to support asthma-friendly policies
Anti-smoking laws
Healthy housing initiatives
Supporting Clean Indoor act
Support stricter pollution control measures

90. Conclusion Asthma is a big challenge for Minnesota
Working together with parents and health care providers, we have the ability to positively and dramatically impact the health of children who have asthma!
(that is what we are, really, all about, and we don’t want to lose focus of that.)