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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