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Keep asthma under control at school

Contemporary PEDS Journal, August 2022,

Help your patients have a safe and healthy academic year.

Back-to-school time brings a mixture of emotions for students and parents alike. For parents and caregivers, sending a child to school for the first time can feel overwhelming. It’s even more stressful when the child has a chronic condition such as asthma. As a mother of a teenager with asthma, I remember my concerns when my daughter first went to preschool. As pediatricians, however, we know the importance of school attendance for academic and social growth, and we can help families prepare for a fruitful school year.

Review asthma triggers

Parents and caregivers need to know the triggers in a school environment that may worsen a child’s baseline condition and how to respond if the child has an asthma exacerbation. Practitioners should review triggers with the family before the school year begins. When children first attend school, they may have frequent upper respiratory infections (URIs) if they were not previously exposed to these infections in daycare or from older siblings. In my practice, I explain that the immune system is naïve until the child has been exposed to the viral infections and can create antibodies to protect them from future exposure. Since URIs and viral infections are some of the most frequent causes of asthma exacerbations, take the time to provide this anticipatory guidance and then have a plan in place for when it occurs.

Recommend that parents talk to the child’s teachers or school nurse about unnecessary exposure to possible asthma triggers such as dust, mold, animal dander, or cockroaches. For instance, a child with asthma may be allergic to pets, and some students in the classroom likely come from a family with a dog, cat, or other animals. Pet hair and dander can linger on a child’s clothes, backpack, etc, so it would be best for the child with asthma to not sit next to that child with a pet. Another child may have asthma or an allergy to mold that is important to note if the school has a leak in the classroom roof or in an air conditioning unit.

Deploy an asthma action plan

Ensuring that the student has an asthma action plan in place is vital. If the child is old enough to discuss this plan, remind them that they need to tell their teacher or school nurse if they are not feeling well. Reviewing signs and symptoms of an asthma exacerbation is important. It also is essential to review proper administration of rescue inhalers. I tell the child that if they are running around at recess or physical education and feel short of breath or start to cough after a short period of exercise, they should tell their teacher and then rest. Rescue inhalers should be immediately available, whether the child carries it with them or a teacher has it available in the classroom. The medication should be kept in an environment without large temperature changes, so an outdoor locker in a hot climate is not an ideal location. For a younger child who may not be able to express how they feel, it is important for the teacher to know ahead of time about their asthma diagnosis so that they can identify the start of an asthma exacerbation during school hours. The rescue inhalers should be readily available; the teacher can keep it in their desk or carry it for the student during physical education. Asking the teachers to notify the school nurse or parents when an exacerbation occurs also is essential to ensure proper and prompt treatment.

Educate families about resources

Study results have shown that school nurses have a positive impact on the management of asthma in children.1 Approximately 20% of schools in the United States don’t have a school nurse,2 but at schools where nurses are not available, teachers and school administrators should advocate for the students and become educated on common chronic illnesses. The Centers for Disease Control and Prevention published a report addressing asthma in schools that included information on asthma education, linking children to medical care in school, and improving school air quality.3 SAMPRO is a comprehensive program that provides educational materials regarding asthma.4 This school-based asthma management program was developed by key stakeholders to improve asthma care in school communities. It has 4 essential components: a circle of support to facilitate communication among child, family, clinicians, school nurses, and community; asthma management plans, including the Asthma Action Plan, which is available online5 ; an education plan for all school personnel; and a plan to assess the child’s environment and remediation of school-based asthma triggers. The ultimate goal is to ensure children stay healthy, and if they do have an exacerbation and go to a hospital setting that it will not lead to a readmission.6

School programs to improve the health of children with asthma are an integral part of the medical care many children receive, and resources for schools help provide a better environment for students with asthma. Starting the school year off healthy and with a plan of action in case of an asthma exacerbation is vital to a child’s success. As pediatricians and pediatric subspecialists seeing patients in preparation for back to school, we should ensure all prescriptions for rescue and maintenance medications are updated and address any questions or concerns the families may have. Looking forward to another successful school year!

Vivian P. Hernandez-Trujillo is a board-certified allergist/immunologist in Miami, Florida, and a member of the Contemporary Pediatrics® Editorial Advisory Board.

References:

1. Trivedi M, Patel J, Lessard D, et al. School nurse asthma program reduces healthcare utilization in children with persistent asthma. J Asthma. 2018;55(10):1131-1137. doi:10.1080/02770903.2017.1396473

2. Centers for Disease Control and Prevention. School Health Services and Practices Study. Accessed June 22, 2022. https://www.cdc.gov/healthyyouth/ data/shpps/pdf/2014factsheets/health_services_ shpps2014.pdf

3. Centers for Disease Control and Prevention. Strategies for addressing asthma in schools. Accessed June 22, 2022. https://www.cdc.gov/ asthma/pdfs/strategies_for_addressing_asthma_ in_schools_508.pdf

4. Lemanske RF Jr, Kakumanu S, Shanovich K, et al. Creation and implementation of SAMPRO: a school-based asthma management system. J Allergy Clin Immunol. 2016;138(3):711-723. doi:10.1016/j. jaci.2016.06.015

5. Elsevier. Asthma and asthma action plan. Accessed June 22,2022. https://www.elsevier. com/_ _data/assets/pdf_file/0007/164662/ FormAsthmaandAsthmaActionPlanPediatric.pdf

6. Krupp NL, Fiscus C, Webb R, et al. Multifaceted quality improvement initiative to decrease pediatric asthma readmissions. J Asthma. 2017;54(9):911-918. doi:10.1080/02770903.2017.1281294