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Asthma Management in School A presentation in honor of World Asthma Day 2013 thru a collaboration with Children’s Healthcare of Atlanta and the Department of Education. Jodie Rodriguez, RN, MS, CPNP, AE-C Children’s Asthma Center of Excellence. Asthma in Georgia’s Children.

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Jodie rodriguez rn ms cpnp ae c children s asthma center of excellence

Asthma Management in SchoolA presentation in honor of World Asthma Day 2013 thru a collaboration with Children’s Healthcare of Atlanta and the Department of Education.

Jodie Rodriguez, RN, MS, CPNP, AE-C

Children’s Asthma Center of Excellence

Asthma in georgia s children
Asthma in Georgia’s Children

  • Approximately 10% have asthma, an estimated 226,000 children (approx 2-3 per class)*

  • #1 reason for inpatient admissions and emergency room visit to Children’s Healthcare of Atlanta

  • Higher morbidity and mortality rates among minority children from lower income households

  • 65% do not have a written asthma management plan

    (Georgia Asthma Surveillance Report 2007, DHR, Georgia)

Impact of uncontrolled asthma on student learning
Impact of Uncontrolled Asthma on Student Learning

  • 470,000 missed school days annually due to asthma

  • Missed class time due to frequent visits to the school clinic

  • Student fatigue due to night time symptoms


  • A disease of the lungs where:

  • Airway becomes swollen and inflamed in response to a trigger

  • Variable among students, seasons, and a person’s lifetime

  • Asthma episodes (attacks) can be mild, moderate or life-threatening

  • Asthma cannot be cured but it can be controlled

  • A chronic disease

Asthma triggers
Asthma Triggers

  • Allergens

    • Dust mites, pollens, cockroaches, molds, animals

  • Irritants

    • Smoke

    • Poor air quality

    • Aerosols/fumes

  • Upper Respiratory Infections, illness

  • Emotion (laughing or crying)

  • Weather or Temperature Changes

  • Exercise

What are the symptoms of asthma early signs
What Are the Symptoms of Asthma?(early signs)

  • Coughing

  • Wheezing or whistling in the chest

  • Feeling short of breath

  • Tightness in the chest

  • Waking at night with symptoms*

    *A key indicator of uncontrolled asthma

Signs of distress late signs

Can’t stop coughing or wheezing

Blue/gray color

Increased WOB/Tachypnea


Tripod breathing

Difficulty completing a sentence without

pausing for breath

**May not hear wheeze on Auscultation in late phase due to decreased air flow through bronchioles**

If in distress…. ACT QUICKLY

Signs of Distress(late signs)

Reducing triggers in school
Reducing Triggers in School

  • Avoid exposure to tobacco smoke and other smoke

  • Avoid exposure to strong smells and odors

  • Keep temperature and humidity at appropriate settings

  • Dry up damp and wet areas immediately

  • Consider removing furred or feathered animals from the classroom

  • Use pest management techniques to control pests

  • Adjust schedule for high smog, high pollen,

    low temps

  • Allow student to pre-medicate before exercise, if needed

  • Encourage good hand washing and flu shots

Components of an asthma action plan
Components of an Asthma Action Plan

  • Prescribed daily controller and quick-relief medicines

  • Treatment guidelines for handling asthma episodes

  • Guidelines for pre-treatment before activity

  • Emergency contacts

  • List of Triggers

  • Should be on file with the school with copies for student’s teachers, PE teachers , and coaches and easily available for all on and off-site activities before, during, and after school

  • Updated annually and as needed

Asthma medication
Asthma Medication

Two Main types of inhalers:

Quick Relievers ( yellow/red zone medication)

  • Used to treat or relieve asthma symptoms

  • Should ALways have it with them (ALbuterol)

  • Open airways by relaxing the muscles that surround the airway

  • Works very quickly, but for a short period of time (3-4 hours)

  • Used every 4 hours during a flare up to prevent further exacerbation

  • This medication is used to SAVE LIVES

    (e.g., Albuterol, ProAir, Proventil, Ventolin, Xopenex)

    Long-term Controllers(green zone medication)

  • Used for daily control and prevention

  • Reduce inflammation on the inside of the airway and helps to prevent future episodes

  • Will NOT work for quick relief of symptoms

    (e.g. Flovent, Pulmicort, Qvar, Asmanex, Advair, Dulera, Symbicort)


Managing an exacerbation yellow zone
Managing an Exacerbation – Yellow Zone

  • Early recognition of symptoms and/or triggers critical

    • Pre-treatment before exercise/exposure to known trigger

    • Don’t have to hear a wheeze to be asthma (cough, early signs URI, increased allergic symptoms)

  • Proper use of Albuterol; one vial nebulized or FOUR puffs every 3-4 hours for 24-48 hours or until 24 hours after symptoms subside

  • Student may come to school in yellow zone; every four hour Albuterol is crucial to managing exacerbation and/or decreasing severity even if symptoms not present.

Managing an attack red zone
Managing an Attack – Red Zone

  • Evaluate breathing: increased breathing rate, short of breath, color, signs of distress

  • Immediately administer 4-6 Puffs MDI Albuterol or Albuterol nebulizer. Evaluate response.

  • Implement your school’s emergency protocol (EMS, parents, administrator) if needed

  • Continue 4-6 Puffs MDI Albuterol or Albuterol nebulizer every 20 minutes x3 if needed

Exercise induced asthma eia
Exercise Induced Asthma (EIA)

  • 10-15% of General Population

  • 90% of all Asthmatics have some component

    Watch for:

  • Cough after exercise

  • Shortness of Breath

  • Wheezing/ Chest tightness

  • “Out of shape”

  • Tend to avoid play/Cannot keep up

  • May need pre-treatment before exercise or strenuous activity

  • Beware of dizziness- reflects cardiac issue

Signs of poor control
Signs of Poor Control

  • A persistent cough

  • Coughing, wheezing, chest tightness, or shortness of breath after vigorous physical activity on a recurring basis

  • Low level of stamina during physical activity or reluctance to participate

  • Frequent use of quick relief medication

    *may be using an empty inhaler

    (Source: Asthma & physical activity in the school, NHLBI, 2006)

Senate bill 472 sb 472
Senate Bill 472 (SB 472)

Self-administration of Asthma Medication by Minor Children at School

  • Effective on July 1, 2002

  • Also known as the “Kellen Bolden Act”

    Any student who is authorized for self-administration

    of asthma medication:

    1. while in school

    2. at a school sponsored activity

    3. while under supervision of school personnel

    4. while in before-school or after-school care on school property

School asthma management
School Asthma Management

Key components:

  • Identify students with asthma

  • Obtain asthma management/emergency plans

  • Educate staff and students on asthma

  • Implement policies to promote asthma control

  • Teamwork is essential to create a healthy school environment


  • Asthma Awareness Month: Event Planning Kit


  • Georgia School Health Resource Manual 2013



  • The American Academy of Allergy, Asthma & Immunology (2007). Pediatric Asthma: Promoting Best Practice, Guide for Managing Asthma in Children.

  • The National Institutes of Health, National Heart, Lung and Blood Institute, National Asthma Education and Prevention Program (2007). Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.

  • The National Institutes of Health, (2007). Practical Guide for the Diagnosis and Management of Asthma.

  • Plaut, T. (2005). One Minute Asthma: What You Need to Know, Seventh Edition. Amherst: Pediapress, Inc.

  • Fanta C.H., Carter, E.L., Stieb, E.S., Haver, K.E. (2007). The Asthma Educator’s Handbook, McGraw - Hill.

  • Centers for Disease Control (CDC), 2008.

  • CDC, EPA: (2009). Help Your Child Gain Control Over Asthma.

  • Georgia Asthma Surveillance Report 2007