1. Asthma Action Plan

2. Trigger avoidance Viral illnesses: hygiene and flu shots! Allergens Irritants: especially secondhand smoke! Internal triggers: GERD/rhinitis/sinusitis Medications:  blockers, ASA/NSAID, sulfites Advocate for environmentally friendly schools (including infection control!)

3. Ways schools can help Asthma education for all students Monitor adherence Implement action plans Facilitate communication Reduce triggers Counseling Prevent EIB Encourage physical activity Dietary instruction Teach respect of differences among children Monitor asthma in staff members

4. Communication with schools Acknowledge operational definition of “health” that may differ from yours Adapt language, avoid acronyms Make no assumptions about a program or staffing for healthcare in schools Be aware that staff morale may be low Realize that funding is decreasing while demand for healthcare programs is increasing Consider unified chronic disease approach to policymaking

5. Inner-city asthma interventions Home interventions to reduce allergen exposure result in fewer days with asthma symptoms; effect similar in magnitude to that reported from trials of ICS (Morgan et al, NEJM 2004;351:1068-80) School-based health center improves access to optimal asthma care, improves self management practices, decreases hospitalizations (Lurie et al, J Sch Health 2001;71:9-16) –Similar findings with Breathmobiles TM (Jones et al, Dis Management 2005;8:205-22)

6. Inner-city asthma interventions Computer-assisted instruction improves asthma self-management, reduces symptoms and hosps, improves functional status (Bartholomew et al, Patient Educ Couns 2000;39:269-80) MSW intervention reduces asthma symptoms, hospitalizations (Evans et al, J Pediatr 1999;135:332-8)

7. Inner-city asthma interventions Harlem Children’s Zone Asthma Initiative (interdisciplinary team providing medical, educational, environmental, social, legal services): decreased school absences and ED visits (MMWR 2005;54:11-14) Inhaled steroids at school: improved QOL, reduced absence, fewer symptoms in those not smoke-exposed (Halterman, et al, Arch Pediatr Adolesc Med 2004;158:460-7)

8. Schools Schools are children’s workplaces Children may spend up to 40 hours a week in a school building School buildings are generally more densely occupied than commercial offices Our school buildings in the US are growing older –Mean age = 40-50 yrs

9. Employees have occupational health and safety laws designed to protect an environmentally safe and healthy workplace –These standards are set for healthy adults No ‘occupational’ health and safety standards have been set to protect children in schools

10. Air-borne pollutants in schools: Dirt Dust Lead Asbestos fibers Chemical fumes Tar fumes Diesel fumes People Carbon monoxide Other gases Pesticides Bacteria Mold Contaminants from photocopiers & computers Pest droppings

11. Health Issues for You & Children in Schools Irritation of eyes, nose, throat Dry mucous membranes and skin Fatigue, headache, sleepiness Airway infections, cough Hoarseness, wheezing Sinus problems Nausea, dizziness Asthma attacks

12. Children are among the most vulnerable groups to environmental threats They may be exposed to higher levels of contaminants Organs are still developing & growing –Brain growth –Lung growth

13. Immune defenses not fully developed Relative to the size of adults: –Eat more food, drink more water –Breathe more air

14. Sources of Environmental Health Hazards for Children Sensitizers and/or Triggers for Asthma Secondhand smoke exposure Lead Asbestos Pesticides and other Chemicals Radon

15. Sensitizers and/or Triggers for Asthma Ambient Ozone Indoor Allergens Indoor Combustion Products

16. Combustion Products Sources –Unvented Space Heaters –Smoking—Secondhand smoke –Fire Places –Internal Combustion Engines Combustion Products –Particulate Material, including PM 2.5 –Sulfur and Nitrogen Oxides –Carbon Monoxide –Formaldehyde

17. Pesticides and Other Chemicals Home use of chemicals School use of chemicals (exposure & use) Chemicals from the ambient environment –Industrial Wastes –Accidental Releases

18. School Use of Chemicals Adhesives Cleaning Products Disinfectants Pesticides Waxes Air Fresheners Cosmetics Strippers Caulking Degreasers Paints Varnishes

19. Imagine, What If: Several classrooms are closed at your school after a mold aggravates allergies, sparks illnesses, and a leaky roof spreads the problem You notice strong odors in a classroom after a science experiment You notice poor air exchange in one room, but good air exchange in most of the rooms in one hall, children in the classroom with poor air exchange have more complaints of allergy and asthma symptoms A student becomes ill after being exposed to chemical fumes after a floor is cleaned in a classroom Teachers and students in your school start to complain of fatigue, asthma attacks, problems with allergies, sinus problems and headaches

20. Why School Environments? Indoor air pollution can be found in all types of buildings, even schools Approximately 55 million people spend their days inside of schools Indoor Air Quality has been reported as unsatisfactory in about 1/4 of public schools