1. Asthma The purpose of this presentation is to educate teachers & school staff about management of asthma in the school setting. Please consult with your school nurse for individual care plans for each of your students with asthma. This takes about 10 minutes.

2. What is Asthma? Asthma is the Greek word for panting. It is a condition in which an asthma episode or attack can be triggered which causes the person to have symptoms of difficulty breathing, coughing, and wheezing. The episode can be mild or potentially life-threatening, and should be treated immediately.

3. How Common is Asthma? Asthma is the most common childhood health condition in the school setting. Asthma affects about 10 to 12 % of the population. It affects about 2 to 3 students in the average classroom. Asthma can cause excessive absences, which can be a barrier to academic progress.

4. What can be done? Asthma can not be cured, but it can be well controlled so that it does not become a barrier to learning or participating in physical activity at school. Treatment focuses on controlling inflammation and broncho constriction with medications and avoiding triggers.

5. Normal Lungs, Bronchi & Alveoli Bronchus (airway) Smooth Muscle Alveoli

6. The Normal Airway Normally the airway is open and clear, allowing for quiet and relaxed breathing. Air effortlessly goes in & out.

7. An Asthma Episode Air can not move smoothly, and can get trapped causing symptoms of coughing, wheezing, shortness of breath, and difficulty talking.

8. Three things happen during an asthma episode Inflammation:The bronchi are inflamed or swollen causing the airway to become narrow. Broncho-constriction: Smooth Muscle around the bronchi tightens constricting the airway. Mucus forms, further obstructing the airway.

9. Common Asthma Symptoms Coughing Shortness of breath Wheezing Feelings of panic Painless tightening in the chest Difficulty exhaling

10. Advanced Asthma Symptoms ! Inability to complete a sentence due to shortness of breath. Wheezing becomes inaudible because so little air flows through the airways. Blue lips, tongue, fingers, and toes due to lack of oxygen, & in a hunched over position. Increasing tiredness, exhaustion, difficulty walking or doing normal activity. Visible retraction of chest & neck muscles.

11. Rescue Medication Asthma episode or asthma symptoms are treated with a rescue medication, also known as a bronchodialator medication. The rescue medication quickly treats the asthma symptoms by relaxing the muscle that is constricting the bronchi.

12. Treatment with Rescue Medication The medication (such as Albuterol) is in the form of an inhaler or a nebulizer delivery system. This medication is used as needed for symptoms at school.

13. Prevention It is thought that a person with asthma has chronically inflamed airways. Therefore, the person is more sensitive and it does not take much to trigger an asthma episode. Prevention focuses on avoidance of triggers, and using daily controller medication.

14. Treatment with a Controller Medication Controller medication is taken daily to reduce the inflammation, which decreases asthma symptoms, and in turn decreases the need for rescue medication. Controller medication is not effective for quick relief from an asthma episode, like a rescue medication.

15. Controller Medication Controller medication is usually taken daily at home. Controller medication includes inhaled steroids, allergy, and other medication.

16. Triggers The next group of slides are about common asthma triggers and possible solutions to minimize asthma symptoms.

17. Asthma Triggers Cold, flu, or respiratory infection

18. Take care of yourself when sick Get rest. Eat healthy. Take medication as ordered by the doctor. Practice good hand washing.

19. Asthma Triggers Cold Weather Change in temperature

20. Dress warm in cold weather

21. Asthma Triggers Strong Odors, Fumes, Aerosols, Smoke & Air Pollution

23. Asthma Triggers

24. Get asthma friendly pets

25. Asthma Triggers Carpet Dust

26. Keep floors & carpets clean Also keep dust to a minimum

27. Asthma Trigger Smoking

28. Don’t smoke or be around smoke Smoking

29. Asthma Triggers Allergies, Food

30. Stay away from things you are allergic to. Have an emergency plan if your allergies are severe.

31. Asthma Trigger exercise

32. Take your inhaler before exercise

33. Asthma Triggers Stress & Emotions

34. Calm down and relax

35. Asthma Action Plan Children with asthma should be seen at least annually (twice a year is recommended) by their doctor to evaluate the child’s condition, review & renew medication, and develop a new Asthma Action Plan (AAP). The AAP becomes the emergency care plan (ECP) in the school setting. If the student does not have an AAP, the school nurse (LSN) can develop an Asthma Care Plan (ACP). A new plan is written each school year.

36. Field Trips The inhaler and health plan should always go on the field trip with the student. The occurrence of an asthma episode is not always predictable, and because asthma symptoms can develop quickly, and could potentially be life threatening, the student should have ready access to his or her inhaler at school or on field trips.

37. Field Trips & the LSN If the student does not self-carry his or her own inhaler, or the parent/guardian is not able to go on the field trip, the school nurse will delegate this responsibility to the student’s teacher. The teacher is responsible for carrying the medication and observing/supervising the student using his or her inhaler. The next 2 slides show general interventions for managing asthma symptoms/episode, and what to observe when the students uses an inhaler.

38. General Interventions for managing asthma symptoms/episode Be calm and stay with the student. Administer medication as ordered and as needed. See the AAP or ACP. Call the parent if medication is not effective in controlling the asthma symptoms. Call 911 if: medication is not effective, and the student continues in respiratory distress. (See slide #10 for advanced asthma symptoms).

39. 1.Shake the inhaler. Use a spacer. 2.Exhale. Then administer one puff as inhaling. 3.Hold breath for 10 seconds. 4.Wait 1-2 minutes, and then give the 2 nd puff in the same way.

40. The LSN & Delegation Because of the “Nurse Practice Act”, only a nurse can delegate and instruct health treatments to non-health staff. A health assistant, or non-health staff can not delegate this responsibility.

41. Self Carry Inhaler Before a student can self-carry, the LSN must assess the student’s ability to safely and responsibly administer their own inhaler medication. (MN statute 121a). Middle and high school students usually self-carry their inhalers. Elementary students usually go to the health office for assessment and administration of their inhaler.

42. In Conclusion: Asthma, a common childhood condition, can be a barrier to learning, and potentially life threatening. Refer to the AAP or ACP for an individual student’s asthma management plan. Please consult your school nurse for any questions or concerns.

43. The Robbinsdale District 281 Licensed School Nurses