Presentation on theme: "Controlling Asthma: Preventing Episodes Before They Occur"— Presentation transcript:
1Controlling Asthma: Preventing Episodes Before They Occur
2Is There A Cure For Asthma? Asthma cannot be cured, but it can be Controlled“We should expect nothing less”!
3Goals Of Asthma Control Prevent SymptomsNo coughing or wheezingNo shortness of breath or rapid breathingNo waking up at nightMaintain normal or near “normal” pulmonary functionMaintain normal activity levels (including exercise and other physical activitiesPrevent exacerbations of asthma and minimize ER/UC and hospital visitsMinimal or no adverse effects from medicationsMeet patients/family’s expectations and satisfaction with asthma careExerts from NAEPP EPR2 Guidelines for Diagnosis and Management of Asthma 1997
5Unfortunately NO! Many students who have asthma: Have poor asthma controlUse “quick relief” medicine (e.g. albuterol) on a regular basisCough, experience chest tightness, wheezing, or shortness of breath regularlyAssume suffering from symptoms are “normal”Remain indoors and cannot fully participate in sports, PE or recessMiss school due to asthma
6Examples 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 restA 12th grader, carries an OTC Primatine Mist inhaler & uses it a few times every day. He says he “grew out” of his asthma
7Examples 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 albuterolA 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
8Asthma 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 medicationsLevels can change over timeAsthma 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
9Asthma Control Proactive vs Reactive Going from a reactive to a proactive approachInstead of thinking-“ How do I treat these symptoms?”e.g. with albuterol after the factThink-“ 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
12How To Achieve Good Asthma Control Have regular asthma check-ups with a primary healthcare provider, even when feeling wellAt least every 6 months (more often if having symptoms)Monitor symptoms and peak flow readings dailyAsk for and use a personalized Asthma Action PlanKnow personal green- yellow- red zones, what each zone feels like and what to do in each zone
13Asthma Control Continued... Get a flu shot every fallAvoid asthma triggersAsthma’s not in control? Check in regularly at school health office for:Peak flow check /symptom evaluationLung sounds / respiratory rate checkPre-exercise and/or controller medsAsthma educationCare coordination
15Written Asthma Action Plans Developed by the health care provider for each individual child with asthmaMedications are determined by asthma severity levelBased on symptoms and peak flow ratesLists daily & rescue medicationsSymptom management and emergency planCopies to be shared by clinic, family and school
16Asthma Action Plan Zones Green Zone: All Clear/Breathing Good/GoNo asthma symptoms and/orPeak flow % Predicted or Personal bestYellow Zone: Caution/Slow DownSome asthma symptoms and/orPeak flow 50-80% Predicted or Personal bestRed Zone: Medical Alert/StopSevere asthma symptoms and/orPeak flow < 50% Predicted or Personal best
17What Can A Student Do To Stay In The Green Zone What Can A Student Do To Stay In The Green Zone? Select The Incorrect AnswerA. Take their controller (anti-inflammatory) medication every dayB. Avoid cigarette smoke and other asthma triggersC. Take their pre-exercise (usually reliever) medicine before P.E. or at recessD. Wash their bathroom often with bleach to avoid mold and mildew build-up
18What Can A Student Do To Stay In The Green one What Can A Student Do To Stay In The Green one? Select The Incorrect AnswerA.Take their controller (anti-inflammatory) medication every dayB. Avoid cigarette smoke and other asthma triggersC. Take their pre-exercise (usually reliever) medicine before P.E. or at recessD. Wash their bathroom often with bleach to avoid mold and mildew build-up
19If A Student Is In The Yellow Zone, They Should: A.Be cautious. Breathing isn’t their best. Take actionB.Eat a lot of yellow foods such as bananas, which are high in potassiumC.Automatically stay home from schoolD.Call their doctor or nurse practitioner immediately
20If A Student Is In The Yellow Zone, They Should: A. Be cautious. Breathing isn’t their best. Take actionB. Eat a lot of yellow foods such as bananas, which are high in potassiumC. Automatically stay home from schoolD. Call their doctor or nurse practitioner immediately (correct answer: call if they aren’t fully back into the green zone within hours).R1R1 Animals in Schools guidelines
21Which Is One Symptom/ Clinical Indicator Is NOT Associated With The Red Zone? A. Mild coughingB. Peak Flow reading < 50% of personal bestC. Significant breathing problemsD. Persistent wheezing or no wheezing at all indicating severely limited aeration
22Which Is One Symptom/ Clinical Indicator Is Not Associated With the Red Zone? A. Mild coughingB. Peak Flow reading < 50% of personal bestC. Significant breathing problemsD. Persistent wheezing or no wheezing at all indicating severely limited aeration
23Activity 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 availableMom is 45 min. away. Grandma is in townWHAT DO YOU DO?
25Common Environmental Triggers At Schools Indoor TriggersAnimals with furDust mitesMoldPestsSecondhand smokeChemicals (e.g. strong smelling cleaning supplies, perfume, air fresheners)Outdoor TriggersOzoneParticulate matterDiesel exhaustChemicals (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.
26Animals Dander, urine & saliva are triggers Triggers remain months after animal pet removedActions:Prohibit/remove animals from schools if ableIf removal is not possible:Keep animals in cages or localized areasClean cages oftenKeep animals away from fabric furniture, carpet & ventilation systemLocate sensitive students away from animalsPre-notify parents if animals with fur/feathers visitSample Animals in School Guidelines in manualR1
27Dust MitesBoth cause & trigger asthma; live in pillows, carpet, fabric-covered furniture, curtainsActions:Keep classrooms clutter-freeMake informed decision: presence of carpetVacuum often when people with asthma/allergies are gone (HEPA filter vacuum cleaners may help)Pillows/mattress/box spring in dust-mite proof zipped coversWash bedding and stuffed toys weekly in HOT water (>130 degrees F)Keep room humidity < 50% if possible
28Mold Moisture control is key Actions: Report leaks and wet/moist areas right awayWash mold off hard surfacesReplace moldy porous items such as ceiling tiles & carpetAvoid carpet in areas with regular moisture such as drinking fountains & sinksE9
29Pests Droppings or body parts can trigger asthma Actions: Use integrated pest management (IPM) methodsDon’t leave food, water or garbage exposedDon’t eat or drink in classroomSeal entry points for pestsUse pesticides only as neededParent Right to Know Act: must notify parents & employees when using specific pesticidesF32, F33, F34
30Secondhand SmokeCauses asthma in young children & triggers asthma in children & adultsContains over 4,000 substancesState law prohibits tobacco use in K-12 public schoolsActions:Enforce smoking bans (for anyone on school property)Include anti-smoking message in curriculumEncourage parents/guardians to quit smoking or to not smoke inside their home
31Outdoor Air Ozone & fine particles are concerns in MN Staff have little control over outdoor airActions:Sign up for Air Quality Index noticePollution 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
33The AQIWe 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).
34Average Number Of Alerts 6-12 alerts per year in last few yearsMost due to PM2.5Not violation of federal air quality standards thus farHealth issues still valid
352003 – Air Pollution Health Alerts Expanded AQI to Duluth, St. Cloud, RochesterDetroit Lakes, Marshall coming soonExpanded media coverage (Pioneer Press, TV meteorologists, health reporters, others)Expanded web & alert signup
38School Buses State law requires: Reduce unneeded idling in front of schoolsReroute bus parking zones away from air intakes, if possibleActions:Post “no idling” signsMaintain bus fleetInvest in cleaner fuelsPurchase newer, cleaner buses over long-termR2, R3, R4Minnesota 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 statuteR3 MN School Bus school board policy Sierra Club- Bus idlingR4 MN School Bus idling Policy notification - news article
39Other Environmental Issues Indoor Air Quality Management PlanCleaning & cleaning productsFlooringAir cleanersR7Minnesota 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
40Home Environment Resources US Environmental Protection AgencyAsthma Home Environment Checklist8 page checklist of common asthma triggersQuestions to identify triggers & action stepsClear Your Home of Asthma Triggers fact sheetEPA websiteThe 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.
42Key Communication Triad Parent/GuardianChildSchool HealthHealth CareOfficeProviders
43Care Coordination / Communication Care Coordination / Communication Health Assistant / Paraprofessional / LPN RoleHealth Assistants / Paraprofessionals / LPNs must alert LSN/PHN/RNs of students who come in frequently with asthma type symptomsMonitor students with asthma as directed by LSN/PHN/RNPerform delegated responsibilities once skills have been validated per district/school policiesOTHER (> 2 x a week visits to office)
44Care Coordination /Communication (LSN/RN/PHN) Examples of asthma care coordination activitiesRequest AAPs on studentsReview AAP and/or IHP and develop/modify plan for care coordinationDetermine medical insurance status and connect to appropriate provider(s)Arrange for special transportation (in rare cases) prnConnect to community resources
45Care Coordination/ Communication Communicating with StudentsEducate them to:Follow an individualized Asthma Action PlanAvoid or control exposure to their triggersUse medication appropriatelyLong-term-control medicineQuick-relief medicineMonitor symptoms and response to treatmentUnderstand symptoms and peak flow levelsSeek a health care providers help when needed
46Communicating w/ Students Continued.. Get regular follow-up careBe able to exercise/ play at optimal levelsBe responsible for carrying and using their asthma medications per school policiesAsk for help when they need it!
47Care Coordination/ Communication Communicating with parents/guardiansReview parent/guardian and student questionnairesDetermine current asthma severity levelsProvide education to family/student as neededEncourage questions and give feedbackContact parent/guardian every time a student has asthma symptoms and or if having poor asthma controlObtain a signed consent to release/ share informationF11, F14, F3, E1, F7F11 Asthma Parent QuestionnaireF14 Student Breathing QuestionnaireF3 Asthma Severity ToolE1 Asthma Awareness handoutF7 Asthma Visit Notification
48Care Coordination / Communication Communicating with health care providersReport status changes and re-evaluation needsAdvocate for pre-exercise and /or controller medications as appropriateArrange for asthma educationComplete IHP and/or ECP if neededDocument as appropriate in Pupil Health RecordEvaluate symptoms, lung sounds and peak flow regularly on poorly controlled studentsF17, F18F17 Individualized Health Plan for AsthmaF18 Emergency Health Plan for Asthma
49Communicating With School Staff Share information with staff on a need to know basis onlyMaintain student confidentialityProvide general asthma education to staff proactivelyProvide asthma first aid training to staffAct as a resource to school staff for questions and concernsA 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
50Health 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?
51Health Office Scenario Continued... ActionsPhysical Assessment (respiratory rate, breath sounds, severity of symptoms)Ask what she was doing before coming into the health office / what may have precipitated symptomsAsk frequency of day / nighttime symptomsCheck height/PF chart for predicted PF and initiate Asthma RecordF5
52Health Office Scenario Continued... Check her Peak Flow reading and document in SHOAR F4Instruct the child how to do a PF readingGive albuterol (observe inhaler technique)Teach/reinforce proper inhaler technique, use of spacer or holding chamber with inhalerMonitor her for response to medicationSend note home with the child using the AVN F8 and a PAQ F11F4 “SHOAR” Student Health Office Asthma RecordF8 AVN” Asthma Visit NotificationF11 Parent Asthma Questionnaire
53Health Office Scenario Continued... Two days later, she returns to the health office, with cough and shortness of breathWhat would you do for this 4th grader first?What would be the next steps or what else should you do at this point?
54Health Office Scenario Continued… What else should you do now?Re-evaluate her respiratory status and treat as appropriateCall her parent / guardian to notify, ask for parent questionnaire/more info.Suggest she see her health care providerAsk the child to come see you the next day for a follow up checkIf you have consent, fax Asthma Medical Referral/Request to health care providerF9
56Sample Forms For Optimal School Asthma Management
57Key Asthma ToolsComponents of Asthma Management in the Health Office E2, E3Asthma Action Plan w/ imbedded consents, parent letter F1, F2Asthma Visit Notification form F7,F8Asthma Medical Request/Referral F9, F10Pathway for Acute School Asthma Care E6, E7Emergency Care Plan - Asthma F18Individualized Health Plan - Asthma F17
58Key Asthma ToolsParent/Guardian Breathing/Asthma Questionnaire F11, F12, F13Student Breathing/Asthma Questionnaire F14, F15, F16School Health Office Asthma Record F4, F5, F6Self-administration Asthma Medication Authorization F19, F20First Aid for Asthma poster / pocket cards E4, E5Asthma Green/Yellow Zone Update F23, F24Permanent Health Office Pass F25
59Components Of Asthma Management In School Health Office Two Models Provided in School Asthma ManualLSN + Health Assistant (Mpls. Public Schools model) E2LSN + Secretary (St. Paul Public Schools model) E3Purpose: Provides job specific instructions for providing quality asthma care in the school health officeLicensed School Nurse, Public Health Nurse, Registered NurseLicensed Practical NurseHealth Aid/Service Assistant / ParaprofessionalSecretary / Administrative AssistantContents include:Case FindingDelegated Nursing Care / ProceduresCare CoordinationEmergency CareStudent Counseling / Education
60Asthma Screening Questions Include these 3 questions into your existing student health questionnaire1. 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?
61Asthma Action Plan (AAP) PurposeProvides a plan to guide the asthma management of individual studentsIncludes imbedded consents:Allow parents/guardians and providers to give permission for medications to be given at schoolAllow for sharing/release of information between school, clinic, hospital, child care provider and home careAvailable in English and Spanish
62Asthma Visit Notification Form (AVN) PurposeIncreases communication between the school health office, parents/guardians, and primary care/asthma care providersFill out and send home whenever the student is in the health office with asthma symptomsOr when delegated by the LSN/PHN/RNF7,F8Helpful to also send home some sort of brief asthma education handout to parents/guardians along with the AVN.
63Asthma Medical Request (AMR) PurposeTo facilitate communication and care coordination between the health care provider and the school nurse about the student’s asthma status/managementFill out and fax, mail to health care providersYou must have the parents written consent to collect medical information firstF9, F10In (Mpls) pilot, has resulted in increased # of AAPs at school, improved medical management and increased follow-up for students with out-of-control asthma
64Pathway for Acute School Asthma Care PurposeAssists school nurses in making decisions regarding the provision of acute asthma care in the school health office or other school settingDesigned to be used for students experiencing mild, moderate or severe asthma symptomsE6, E7
65Asthma Emergency Care Plan (ECP) PurposeProvides special instructions to selected school staff on how to respond to an asthma emergencyUsed with students with severe or labile asthmaIndividualized for each student with asthmaF18Note: 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
66Asthma Individualized Health Plan (IHP) PurposeProvides 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 controlAlso used to document special education nursing servicesF17(esp. students with moderate to severe persistent asthma)
67Parent / Guardian Asthma Questionnaire (PQ) PurposeUsed To:Gather baseline information about the child’s asthma symptomsDetermine the child’s asthma severity levelDetermine if the child’s asthma is under controlDevelop an appropriate plan of careTypically used for students in 5th grade or lowerF11, F12, F13(Individualized Health Plan and/or Emergency Health Plan)
68Student Breathing Questionnaire (SBQ) PurposeUsed to:Determine the student’s asthma severity levelDetermine if the student’s asthma is under controlDevelop an appropriate plan of careDetermine student’s familiarity of their meds, triggers, symptoms etc.Used with students in grades 6th grade or higherF14, F15(Individualized Health Plan and/or Emergency Health Plan)
69School Health Office Asthma Record (SHOAR) PurposeProvides a user-friendly document on which to record many aspects of a student’s asthma careAllows health office staff to:Record Asthma MedicationRecord Peak Flow ReadingsDocument Asthma SymptomsDocument EducationF4, F5Allows the health assistant or licensed school nurse to:Record Asthma MedicationRecord Peak Flow ReadingsDocument Asthma SymptomsDocument Education
70Self-Administration Of Asthma Medication Authorization / Agreement PurposeTo systematize practice regarding self-carrying of asthma medications between schoolsPromotes strong asthma self care skills in studentsAgreement between student and school nurseUsed in conjunction with an Asthma Action Plan or may stand aloneF19, F20
71First Aid For Asthma Poster / Pocket Cards PurposeProvides basic first aid care for asthma and asthma symptoms with directions when to call 911Place posters in locations in the school where students and staff are usually presentPocket cards may be given to physical education teachers or coaches or other staff as needed E4, E5
73There’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
74How Do I Prioritize?Prioritize by “current asthma control / severity level”Focus first on students with the poorest asthma control regardless of severity levelStart working with students whose asthma is poorly controlled in the moderate to severe persistent asthma levelsUse daytime & nighttime symptom frequencyTo 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
75Which 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 albuterolA girl with current mild persistent asthma who is unable to fully participate in PE classA 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
76Which 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.
78Components Of Student & Family Education Concept of asthma controlPathophysiology of asthmaEnvironmental control and triggersController vs. reliever medications and refilling medicationsUse of Asthma Action Plan and treatment of episodesPeak flow meter use
79Components Of Student & Family Education Cont… Signs and symptoms of respiratory distress and when to seek helpMDI with spacer / DPI techniqueNebulizer use and technique (prn)Importance of relationship with provider and well-asthma check-upsFlu shot every fallSelf-care, especially for students as they get older
80Strategies To Educate When Time Is Limited Give short asthma education messages when meeting with with studentsUse 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
81The 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 itAsk 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 prescribedIncreasing likelihood of adherence to therapy or plan
82“I Can’t Manage This By Myself. Who Else Should Be Involved”?
83Referring 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 controlledConnect students/family to community education, asthma camp, other community resourcesConnect students to these resources
84Coordinated School Health: Partnering For Optimal Asthma Management In Schools
85CDC’s Strategies For Addressing Asthma Within A Coordinated School Health Program Six StrategiesEstablish management and support systems for asthma-friendly schoolsProvide appropriate school health and mental health services for students with asthmaProvide asthma education and awareness programs for students and school staff
86Strategies Continued… 4. Provide a safe and healthy school environment to reduce asthma triggersProvide safe, enjoyable physical education and activity opportunities for students with asthmaCoordinate school, family, and community efforts to better manage asthma symptoms and reduce school absences among students with asthma
87Asthma Goals For School Health Healthy school environmentHealth services in schoolAsthma educationSupportive policiesSound communication1997 National Asthma Education and Prevention Program (NAEPP)
88Spearheading School-wide Asthma Best Practices At Your School See Checklist in manual for suggestionsCreate a multi-disciplinary plan for improving asthma management in your health office, school and/or districtImprove own practiceEducate other school staffInvolve all disciplines within the school setting
89Community Involvement Get involved with the Minnesota Asthma Coalition, and/or the regional Asthma Coalition in your areaContact your legislators and insist on legislation to support asthma-friendly policiesAnti-smoking lawsHealthy housing initiativesSupporting Clean Indoor actSupport stricter pollution control measures
90Conclusion 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.)