Asthma in the Classroom: What do teachers need to know?

1. Pioneer Valley Asthma Coalition Pulmonary Rehabilitation Asthma in the Classroom: What do teachers need to know?

2. Asthma Impact Asthma… affects over twenty five million people nationwide causes 10.5 million lost school days annually third-ranking cause of hospitalization among those younger than 15 years of age Estimated cost of asthma in the U.S. is $56 billion per year (direct and indirect costs) Source: EPA Asthma Facts 2013, http://www.epa.gov/asthma/pdfs/asthma_fact_sheet_en.pdf

3. Asthma is Common • Nationally, 9.5% of children have asthma • Rates are twice as high for schoolchildren in some cities in MA • Holyoke- 18.7% • Springfield- 17.2% • High rates of uncontrolled asthma • asthma hospitalizations are more than double the state rate in both Holyoke and Springfield Sources: National Health Interview Survey Data, 2011, http://www.cdc.gov/asthma/nhis/2011/table4-1.htm, Baystate Health Community Health Needs Assessment 2013 CDC. Asthma’s Impact on the Nation, http://www.cdc.gov/asthma/impacts_nation/infographic.htm

4. Asthma ImpactSchool • Asthma can affect… • School attendance • Ability to concentrate • Overall academic performance • Overall quality of life

5. What is asthma? Overview

6. What is Asthma? Chronic lung disease that can affect a person’s breathing Asthma can range from mild to severe Image from www.mitchellzhomes.com/AZAPAA/azapaa_asthma.htm

7. What is Asthma? In asthma, two main things happen: 1. Muscles tighten around the airways (bronchoconstriction) 2. The insides of the airways swell (inflammation)and make mucus *Modified from GSK Programs to Go “What do you really know about asthma?”

8. Cough Wheezing/whistling with breathing Hard to breathe Chest tightness Tired or fatigued Common Asthma Symptoms

9. Asthma Triggers • What is an “asthma trigger”? • Things in the environment that can cause a person with asthma to have asthma symptoms (commonly called “attacks”, “flare-ups” or “exacerbations”) • Types of asthma triggers • Allergens – things that trigger allergies • Irritants – substances that irritate respiratory passages • Other – infections, exercise, cold air • Asthma triggers are different for everyone

10. Environmental Asthma TriggersHow does the environment impact asthma? Environment can affect • who can get asthma • when someone gets asthma • how bad the asthma is

11. Asthma Medications Two main types of asthma medication: • Rescue/quick-relief medications • Controller medications

12. Quick Relief Medications Provide quick treatment to reduce airway blockage when having asthma symptoms Stops tightening of muscles around airway (bronchospasm) Example: Albuterol *modified from Arizona Asthma Coalition’s “Asthma in the School Setting” http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf

13. Controller Medications Taken DAILY to control persistent asthma Used to stop chronic inflammation Examples: Flovent, Advair, Pulmicort, Symbicort *modified from Arizona Asthma Coalition’s “Asthma in the School Setting” http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf

14. Asthma in the Classroom Asthma Triggers

15. Triggers in the ClassroomAllergens: Pets and Pests • Examples: • Dust mites Example - found in classroom carpets and clutter • Animal dander – Pets and Pests Example - from class pets or pet hair on student clothes • Cockroach droppings

16. Triggers in the ClassroomAllergens • Examples: • Pollen Example - from plants in classroom or outdoors • Molds Examples – from wet drywall, rug or saturated plants Near intake vent or window

17. Create an Asthma Friendly Classroom Keep classroom allergen free! No dust mites here! • Make sure classroom is clean • Dust with damp rag (microfiber if possible) • Wash blankets, furry costumes and stuffed animals weekly in hot water • Use throw rugs, whenever possible, that can be machine washed periodically or replaced • Furry pets may be a trigger and should be avoided in classroom per protocol *modified from Arizona Asthma Coalition’s “Asthma in the School Setting” http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf

18. Create an Asthma Friendly Classroom Keep classroom allergen free! No dust mites here! • Make sure classroom is cleanable • Remove clutter to prevent accumulation of dust • Clear areas for custodians to dust, mop and vacuum

19. Create an Asthma Friendly Classroom Keep classroom allergen free! • Prevent allergens from entering or multiplying • Stay inside/close windows on high pollen days • Keep pet and people food tightly covered to prevent attracting pests and having food spoil • Avoid hissing cockroaches as pets if they are a trigger for students or staff *modified from Arizona Asthma Coalition’s “Asthma in the School Setting” http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf

20. Create an Asthma Friendly Classroom Keep classroom allergen free! Identify possible sources of mold

21. Create an Asthma Friendly Classroom Keep classroom allergen free! • Prevent allergens from multiplying • Keep plants well drained • Locate items that leak away from carpet • Locate plants away from air vents to prevent circulation of allergens (mold & pollen) • Identify sources of water leaks and report to maintenance

22. Create an Asthma Friendly Classroom Keep classroom allergen free! • Prevent exposure to allergens • Make sure ventilation system is working and report to custodian if it is not • Locate children’s clothes with smoke and pet allergens away from occupied areas and ventilation system

23. Triggers in the Classroom Irritants - Chemical • Products with fragrance or odor • Personal Care Products - perfume, scented lotions • Curriculum Products – permanent markers, scented markers • Cleaning and maintenance products • air fresheners • solvent-based cleaning products • disinfectants and sanitizers – i.e. bleach

24. Triggers in the Classroom Irritants - Particulate • Airborne particles in the building - chalk dust, from buffing waxed floors • High air pollution days Note: Though it should not be found in the classroom, it is important to be aware that second-hand smoke is a strong asthma trigger as many children have family members that smoke *modified from Arizona Asthma Coalition’s “Asthma in the School Setting” http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf

25. Triggers in the Classroom Irritants - Particulate • Exhaust (indoor/outdoor) • Vehicle - school bus, delivery and car idling • Landscaping equipment - snow blower, lawn mower, leaf blower

26. Triggers in the Classroom Irritants - Particulate • Exhaust - Office Equipment • Copier • Laminating machine • Laser printer

27. Create an Asthma Friendly ClassroomKeep classroom free of chemical irritants! No fragrances here! *modified from Arizona Asthma Coalition’s “Asthma in the School Setting” http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf • Create a fragrance free classroom • Avoid use of perfumes, powders, lotions, air fresheners, scented markers, etc. • Use safe products • Check with your school district about using green cleaning products • Springfield Public School District has a list of approved cleaning products for use– and teachers should not bring in products from home. • Use microfiber whenever possible • Do not dust or clean while children are present • Only use cleaning products when children are absent • Only trained custodians using approved products should disinfect after hours

28. Create an Asthma Friendly ClassroomKeep classroom irritant free! *modified from Arizona Asthma Coalition’s “Asthma in the School Setting” http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf Stay inside/close windows on poor air quality/high ozone days Make sure ventilation system is working properly Promote anti-idling policies at your school

29. Indoor Air Quality (IAQ) Reporting • If you find a ventilation or odor problem OR • If you suspect that staff or students have a reaction or symptoms due to conditions in the building • Report it to your principal who has the authority to have it investigated. • Ask your principal to report back on any action based on the investigation. • Check with your district to see if there is a specific protocol for investigating IAQ problems.

30. Asthma Triggers at SchoolExercise Asthma can be controlled and children with asthma can lead active, healthy lives! • Exercise and asthma • Exercise can trigger asthma • Some children with asthma take quick-relief medication before they exercise • Children with asthma should warm-up before exercise • If a child with asthma is wheezing during exercise, it is a sign of uncontrolled asthma • They should talk to their doctor to see if they need to adjust their medications • Children with asthma should not be excluded from exercise or recess unless they have written physician’s instructions to do so *modified from Arizona Asthma Coalition’s “Asthma in the School Setting” http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf

31. Asthma Triggers at SchoolWeather & Outdoor Air • Check the weather and outdoor air forecast • Cold air can make asthma worse • High air pollution/ozone days can trigger asthma • Pollen can trigger asthma • On cold days, wearing a scarf over nose and mouth warms and humidifies air • Close windows and limit exposure to outdoor air on high pollution, ozone and pollen days *modified from Arizona Asthma Coalition’s “Asthma in the School Setting” http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf

32. Asthma Triggers at SchoolOther Some other asthma triggers • Respiratory infections • Food Additives • Some food additives such as sulfites can trigger asthma flare-ups • Emotional Stress • Stress during an asthma flare-up can produce rapid breathing or hyperventilation which can make the episode worse *modified from Arizona Asthma Coalition’s “Asthma in the School Setting” http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf

33. Asthma in the Classroom What to be aware of

34. Asthma in the ClassroomKnow Early Warning Signs of Asthma Episode • stomach ache • poor appetite • itchy throat or chin • glassy eyes • feeling tired • coughing or waking at night *modified from ALA Asthma Education Certification Course and “Developing an Effective Asthma Action Plan” by Dr. Matthew Sadof cough wheeze chest tightness shortness of breath runny or stuffy nose sneeze headache funny feeling in chest

35. Asthma in the ClassroomAsthma Episodes *modified from Arizona Asthma Coalition’s “Asthma in the School Setting” http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf What to do during an asthma episode • Stay calm • Keep child calm • Have the child try to stay relaxed and focus on breathing • Contact the school nurse • Always make sure the nurse is available before sending a child to the nurse’s office • Never send a child experiencing asthma symptoms alone to the nurse’s office

36. Asthma in the ClassroomDanger Signs of Asthma Episode Know danger signs of an asthma episode Difficulty speaking Lips or fingernails turn gray or blue Heart rate is very fast Noisy breathing (may not be present if severe airway constriction) Visible drawing in or sinking of chest (retractions) when student inhales Quick-relief medicine does not improve the signs listed above Contact school nurse immediately!

37. Asthma in the ClassroomPotential Medication Side Effects Be Aware of Potential Medication Side Effects • Anxiety • Restlessness • Hyperactivity • Rapid heartbeat • Thrush • Sore throat *modified from Arizona Asthma Coalition’s “Asthma in the School Setting” http://www.azasthma.org/Common/Files/AAC%20Asthma%20School%20Presentation%202007.pdf

38. AsthmaMedication Devices Be Aware of Types of Medication Devices • Metered dose inhalers • Nebulizer • Dry powder inhalers • Spacers

39. Asthma at SchoolAsthma Action Plans • All children with asthma should have a written Asthma Action Plan at school, home and physician’s office • Asthma action plans provide information on • How to assess and monitor asthma symptoms and lung function (green, yellow and red zones) • Medications to take and when to take them • What to do during an asthma flare-up when things get worse • Triggers to avoid *modified from ALA Asthma Education Certification Course and “Developing an Effective Asthma Action Plan” by Dr. Matthew Sadof

40. Asthma Action Plan- Example

41. Classroom Asthma ManagementSummary • Create a healthy classroom by reducing exposure to triggers! • Encourage policies in your school to reduce triggers • Be aware of asthma symptoms • Know warning signs of an asthma episode and what to do • Encourage all children with asthma to have an Asthma Action Plan on file with the school nurse Together we can help children in our schools control asthma so that they can lead active, healthy lives!

42. Questions?

43. Thank you! If you have any questions about asthma or would like more information, visit: Pioneer Valley Asthma Coalition, www.pvasthmacoalition.org American Lung Association, www.lung.org/lung-disease/asthma Pioneer Valley Asthma Coalition Brought to you by: Pulmonary Rehabilitation Presentation developed by: Michele Hart, RN, BSN, AE-C, Baystate Pulmonary Rehab; Ann Ottalagana, American Lung Association; Kathleen Szegda, and Sarita Hudson, Pioneer Valley Asthma Coalition