Departments: Health
Clearing the Air on Asthma

How can schools help kids with asthma breathe easier? Michele Hodak of the NEA Health Information Network spoke to Susan Drake, Pennsylvania director to the National Association of School Nurses, and Lani Wheeler, Anne Arundel County Health Department, Maryland.

How many school-age children have asthma?
According to the Centers for Disease Control and Prevention, about five million children--that's one in 13 in the United States--have been diagnosed with asthma. Pediatric asthma has increased significantly in both numbers and severity over the past 15 years, making it the most common chronic childhood illness and the leading cause of childhood hospitalization. And while asthma affects children of all backgrounds, minority groups are disproportionately represented.

Why the increase?
We don't know all the answers, but there seems to be a combination of factors: better recognition and diagnosis at younger ages; more time spent indoors in tightly sealed buildings; decreased physical activity; and increased prevalence of allergies and other risk factors such as obesity, poverty, and being a racial minority or a child in a single-parent family.

Is there a connection to school air quality?
Yes. Some of the most common asthma triggers found in school buildings include dander from animals in the classroom, chalk dust, cockroaches and other pests, and mold from excess moisture in the building. Secondhand smoke and dust mites are also school-based asthma triggers, as well as respiratory infections, cold air exposure, food allergies, pollens, and outdoor air pollution.

Reducing exposure to indoor environmental asthma triggers is an important step in controlling asthma.

Does asthma affect school performance?
More than ten million missed school days per year are attributed to asthma, making it the leading cause of school absenteeism due to a chronic illness.

Children who have had interrupted sleep due to nighttime asthma symptoms come to school tired, often fall asleep in the classroom, or are irritable. Students who experience difficulty in breathing while in the classroom are not concentrating on schoolwork, and those who need breathing treatments during school hours miss class time or may not take their treatments because it is too bothersome to go to the health office. When a student has a severe asthma episode, that child also misses time from class. And the side effects from some medications used to control and manage asthma can interfere with performance and concentration.

Can schools help control and manage asthma?
Yes. Educating staff is important, and thinking about asthma in the context of a coordinated school health program helps, too.

Ask the school nurse or a representative from the American Lung Association to provide staff with an in-service on asthma that includes the early warning signs, how to follow a student's asthma action plan, the common side effects of asthma medication and the effect on student learning, and how to help students manage their condition.

It's important to implement and enforce school policies such as:

• Making sure the school--including bathrooms, stairwells, and school buses--is smoke free all the time.

• Providing appropriate access to medications for all students. This includes allowing students to self-carry and self-administer reliever or rescue medications when authorized by the parents, the physician, and the school nurse.

• Developing and implementing asthma action plans for all students with asthma.

• Involving families in asthma education and management efforts.

• Providing sufficient staff, including school nurses, to safely implement every student's asthma action plan.

What is an asthma action plan?
Since school is the child's home away from home, all students with asthma should have an asthma action card--an individualized management plan that contains the student's medical information (physician's name and maintenance medications), identified asthma triggers, peak flow information, emergency procedures, and phone numbers.

How can staff create an asthma-friendly school?
Everyone can help by being well informed. Teachers should know which students have asthma and what their individual triggers are. In particular, physical education teachers should learn about asthma; allow students to take pre-exercise medications, if indicated; and modify activity levels if indicated. Teachers can help maintain trigger-free classrooms and encourage students to follow their asthma management plans. All staff can learn what to do when asthma flares up, whether it's referring the student to the school nurse or calling 911.

The school nurse can help track students with an asthma card and make sure that those who don't self-carry medications have immediate access. The nurse should know standard emergency protocols for respiratory distress and can provide intensive case management for students who are absent ten or more days per year. The school nurse can also help educate other staff and document suspected relationships between asthma and poor air quality in the school.

What steps can improve air quality?
Facilities and maintenance staff can learn about indoor air quality and its relationship to asthma and help make good air quality a high priority. Specifically, they can help identify common sources of indoor allergens and act to remove them using environmentally friendly cleaning products and pest control methods. They can also report on progress in the school's environment.

When it comes to clearing the air on asthma, there's a role for every member of the school community.

Resources

• IAQ Tools for Schools: Managing Asthma in the School Environment, produced by the U.S. Environmental Protection Agency's Indoor Environments Division, provides practical guidance on how to manage asthma in schools. For a free copy, call the Indoor Air Quality Information Clearinghouse at 800/438-4318. The IAQ Tools for Schools Action Kit can also be downloaded from EPA's Web site at www.epa.gov/iaq.

• The Asthma and Allergy Foundation of America has an extensive list of school-based asthma education materials, including a sample asthma action card. Call 800/7-ASTHMA or visit www.aafa.org.

• Open Airways for Schools is a school-based asthma education program for children that teaches them that asthma can be controlled and what steps they can take. Produced by the American Lung Association. Call 800/LUNG-USA or visit www.lungusa.org.

• The National Asthma Education and Prevention Program, coordinated by the National Heart, Lung, and Blood Institute, provides a variety of materials on asthma and schools, including "How Asthma-Friendly Is Your School?" (English or Spanish versions). Visit www.nhlbi.nih.gov/about/naepp/index.htm and click on "Schools/Child Care."

• AsthmaMoms is an interactive, online asthma community resource for families managing asthma. Information is available in Spanish and English. Visit www.asthmamoms.com.

• For information on coordinated school health programs, go to www.ashaweb.org.

Feeling Fit at 50

Weights are great for relieving stress, staying trim, and reducing her arthritis, says Jane Howland.

Having spent the first 50 years of her life taking care of others, Jane Howland is making no more excuses when it comes to taking care of herself.

In 1998, Jane Howland's life changed.

"My daughter went away to college, and both of my parents had passed away within the past year," says the school counselor at Eastern Middle School in Riverside, Connecticut. "I kept wondering how I was going to fill my time."

An unexpected back surgery and diagnosis of arthritis in her hip--also that year--left Howland frustrated.

"I thought, 'I'm 50 years old, and my body is a wreck.' It's time to do something for me," she recalls. So, Howland did what thousands do every month: She joined a gym.

"Like many women my age, I spent the first 50 years of life using excuses to put off taking care of me," she says. "I hid behind my child, my job, and my parents. With no one to hide behind anymore, I bravely stepped into that gym and did something good for me."

Howland started walking on a treadmill. A year later, when a nearby gym offered new patrons free lessons with a personal trainer, she decided to try weight training. Today, Howland combines weight training with 20 minutes of aerobic exercise two days per week. She also walks on the treadmill for 40 minutes at least three days a week. She credits the routine for keeping her overall weight down and significantly reducing her arthritis.

"When I started weight training, my arms looked like they belonged on a small child," she adds. "Now, I have shoulder definition and arm muscle, and I feel so much better about myself. Weights also help me escape the stresses of work. On a treadmill, you replay the day in your head. Working out with weights, you're thinking about the weights."

Howland is fascinated with her recent attitude shift about exercise. "I would have never guessed I would be into fitness," she says. "Women my age were raised to believe that girls shouldn't sweat. My husband is a marathon runner and still, I spent all those years being too tired or too busy to enjoy working out."

Many her age want to get in shape, says Howland, but have no idea where to start. It's especially hard for women who have never made exercise a priority.

"I know women who say they have to lose 20 pounds before they will start working out in a gym," she says. "But that's just another excuse. The hardest part is starting. Once you get a routine down, then it becomes something you can't live without."

With retirement just a few years away, the 30-year veteran sees exercise as a key to healthy, older living.

"We have to think about the kind of life we want to lead in our 60s and beyond," she says. "I don't want to motor along and go into a holding pattern. I want to hike and walk in the outdoors. I want to see the country. And I want people to look at me and question in disbelief, 'You're how old?'" She adds, "By staying fit, I have no doubt they will."

--Dina S. Gómez

Making A Start

Never made exercise a priority? Here's how to start:

Find a Role Model--Enlist the support of someone who does exercise frequently to help you start and keep going.

Break the Cycle--Educators have this vicious cycle of life--we're too tired to exercise, but know it makes us feel better. Focus on that end feeling you get after exercise to motivate you.

Join a Gym Close By--If you have to drive 30 minutes just to work out, you'll never go. But if you can find one close to home or school, you won't use distance as an excuse.

Schedule Exercise--Educators live by schedules. So sit down with your calendar and schedule exercise into your week. Don't make it a haphazard event.

Get Professional Assistance--If your gym offers personal training, take advantage of it. Usually gyms will give you at least one free sesion with a trainer to get you acclimated to the weight machines. If they don't offer it for free, pay for one or two sessions. I learn so much from my trainer, and he helps me vary my routine so I don't get bored.

--Jane Howland

Quick Tip

By Valerie Washeck

Get into the swing of things with these warm weather tips:

• Start slowly--Injuries and soreness result when you push too hard too soon.

• Stretch before and after--Muscle injuries occur when they haven't been properly warmed up and cooled down.

• Increase your water intake--While hot summer weather and humidity can take a lot out of you, this is a good suggestion year-round.

• Consume more potassium-rich foods--Foods like bananas, dates, tomatoes, broccoli, potatoes, and fish help curb muscle aches and pains.

• Try a new sport--Take a few lessons from a professional at first, and you'll have all summer to practice your new skills.

Valerie Washeck, is a junior English teacher at Rossford (Ohio) High School.

From the NEA Health Information Network

• Safe Schools Now Media Messages
  "Mind Over Media: Helping Kids Get the Message," the final episode of the Safe Schools Now network series, airs Thursday, May 24, 2001 from 2:00 to 2:45 p.m. ET. The program teaches students to analyze media messages to help them understand the potentially negative impact on their thinking and actions. For satellite coordinates or more information, visit www.safeschoolsnow.org.

• Helping Spanish-speaking Parents Talk About Drugs
  The National Institute on Drug Abuse has published Latina Juventud/Hable con Sus Hijos Sobre las Drogas y Sus Peligros (Latino Youth/Speak to Your Children about Drugs and Their Dangers), a new brochure on drug abuse and addiction. To order a free copy, call the National Clearinghouse for Drug Information at 800/729-6686 and request publication number PHD854S

• Online Substance Treatment Program
  EGetgoing, an online treatment facility, has launched an Internet-based group treatment program that uses advanced audio- and video-conferencing technology to combat drug and alcohol abuse. For more information, go to www.eGetgoing.com or call 866-HELP-999.

• Anti-Drug Media Kit
  The "Media Tool Kit for Anti-Drug Action" provides information on substance abuse prevention, strategies for reaching youth and parents, and info on promoting drug-free activities. Visit www.mediacampaign.org, E-mail ondcp@ncjrs.org, or call 800/666-3332. Reference number NCJ18213.

• Character Education Curriculum
  No Putdowns is a school-based, K-6 curriculum that addresses character education, social skill building, and violence prevention. For more, call 800/561-4571.