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Helping
Students Control their Asthma
Getting control of asthma means recognizing asthma triggers
(the factors that make asthma worse or cause an asthma
episode), avoiding or controlling these triggers, following
an asthma management plan, and having convenient access
to asthma medications. It also means modifying physical
activities to match the students' current asthma status.
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1. Asthma Triggers
- Exercise--running
or playing hard--especially in cold weather
- Upper
respiratory infections--colds or flu
- Laughing
or crying hard
- Allergens
- Pollens--from
trees, plants and grasses, including freshly
cut grass
- Animal
dander from pets with fur or feathers
- Dust
and dust mites--in carpeting, pillows and
upholstery
- Cockroach
droppings
- Molds
- Irritants
- Cold
air
- Strong
smells and chemical sprays, including perfumes,
paint and cleaning solutions, chalk dust,
lawn and turf treatments
- Weather
changes
- Cigarette
and other tobacco smoke
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Recognize
Asthma Triggers
Each student with asthma has a list of triggers that can
make his or her condition worse--that is, that increase
airway inflammation and/or make the airways constrict,
which makes breathing difficult. Table 1
lists the most common triggers.
Avoid
Or Control Asthma Triggers
Some asthma triggers--like pets with fur or feathers--
can be avoided. Others--like physical exercise--are important
for good health and should be controlled rather than avoided.
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Actions
To Consider
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- Identify
students' known asthma triggers and eliminate
as many as possible. For example, keep animals
with fur out of the classroom. Consult the students'
asthma management plans for guidance (see the
next section).
- Use
wood, tile or vinyl floor coverings instead
of carpeting.
- Schedule
maintenance or pest control that involves strong
irritants and odors for times when students
are not in the area and the area can be well
ventilated.
- Adjust
schedules for students whose asthma is worsened
by pollen or cold air. A midday or indoor physical
education class may allow more active participation.
- Help
students follow their asthma management plans.
These plans are designed to keep asthma under
control.
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Follow
the Asthma Management Plan
A student's
asthma management plan is developed by the student, parent/guardian,
and health care provider. Depending on the student's needs,
the plan (see Appendix 1 for
a sample) may be a brief information card or a more extensive
individualized health plan (IHP). Table
2 lists what asthma plans typically contain. A copy
of the plan should be on file in the school office or
health services office, with additional copies for the
student's teachers and coaches. The plan--as well as the
student's asthma medications--should be easily available
for all on- and off-site activities before, during and
after school.
Table
2. Asthma Management Plan Contents
- Brief
history of the student's asthma
- Asthma
symptoms
- Information
on how to contact the student's health care
provider, parent/guardian
- Physician
and parent/guardian signature
- List
of factors that make the student's asthma worse
- The
student's personal best peak flow reading if
the student uses peak flow monitoring. (see
Appendix 2.
- List
of the student's asthma medications
- A
description of the student's treatment plan,
based on symptoms or peak flow readings, including
recommended actions for school personnel to
help handle asthma episodes.
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Winners
With Exercise-Induced Asthma
What do Nancy
Hogshead, Jackie Joyner-Kersee, Bill Koch, Greg Louganis,
Dominique Wilkins, and Jim Ryun all have in common?
Each is a
famous athlete who has asthma. They come from diverse
fields: swimming, track and field, cross-country skiing,
diving, basketball, and long-distance running.
Following
their asthma management plans helped these athletes become
winners.
Supporting
and encouraging each student's efforts to follow his or
her asthma management plan is essential for the student's
active participation in physical activities. Students
with asthma need understanding from both teachers and
students in dealing with their asthma. If students with
asthma are teased about their condition, they may be embarrassed,
avoid using their medication, or cut class. If students
with asthma are encouraged to "tough it out," they may
risk health problems or just give up.
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Actions
To Consider
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- Get
a copy of each student's asthma management plan.
Review the plan to identify the role of the
teacher and coach in the student's asthma management
plan.
- Teach
asthma awareness and peer sensitivity. For example,
use the activities in the Asthma Awareness curriculum
(see "NHLBI" in
Appendix 4) to teach K-6 students about
asthma. As students learn more about asthma,
they can more easily offer support instead of
barriers to their classmates with asthma.
- Consult
"Managing Asthma: A Guide for Schools" for suggested
activities for all grades. (see
"NHLBI" in Appendix 4)
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"The
role of physical education teachers is in some ways probably
the first line of recognition of children who have problems
with their asthma...They can really help these children."
-Dr.
David Evans
Columbia University
Ensure That
Students With Asthma Have Convenient Access to Their Medications
Many students
with asthma require two different medications: one for
daily control and prevention, the other to treat and relieve
symptoms. These medications are usually taken by metered-dose
inhaler (see Appendix 3). Preventive
asthma medications are taken daily and usually can be
scheduled for before and after school hours. However,
some students may need to take preventive daily medication
during school hours. All students with asthma need to
have their medication that relieves symptoms available
at school in case of unexpected exposure to asthma triggers,
or an asthma episode. In addition, students with asthma
often benefit from using their inhaled medication 5-10
minutes before exercise. If accessing the medication is
difficult, inconvenient, or embarrassing, the student
may be discouraged and fail to use the inhaler as needed.
The student's asthma may become unnecessarily worse and
his or her activities needlessly limited.
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Actions
To Consider
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Provide students with
asthma convenient access to their medications
for all on- and off-site activities before,
during and after school. These medications prevent
as well as treat symptoms and enable the student
to participate safely and vigorously in physical
activities.
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Enable students to carry and administer their
own medications if the parent/guardian, health
care provider, and school nurse so advise.
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Modify Physical Activities To Match Current Asthma
Status
Students who
follow their asthma management plans and keep their asthma
under control can usually participate vigorously in the
full range of sports and physical activities. Activities
that are more intense and sustained--such as long periods
of running, basketball, and soccer--are more likely to
provoke asthma symptoms or an asthma episode. However,
Olympic medalists with serious asthma have demonstrated
that these activities are possible with good asthma management.
When a student
experiences asthma symptoms, or is recovering from a recent
asthma episode, exercise should be temporarily modified
in type, length, and/or frequency to help reduce the risk
of further symptoms. The student also needs convenient
access to his or her medications.
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Actions
To Consider
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- Include
adequate warmup and cool-down periods. These
help prevent or lessen episodes of exercise-induced
asthma.
- Consult
the student's asthma management plan, parent/guardian,
or health care provider on the type and length
of any limitations. Assess the student and school
resources to determine how the student can participate
most fully.
- Remember
that a student who experiences symptoms or who
has just recovered from an asthma episode is
at even greater risk for additional asthma problems.
Take extra care. Observe for asthma symptoms,
and check the student's peak flow if he or she
uses a peak flow meter. Review the student's
asthma management plan if there are any questions.
- Monitor
the environment for potential allergens and
irritants, for example, a recently mowed field
or refinished gym floor. If an allergen or irritant
is present, consider a temporary change in location.
- Make exercise
modifications as necessary to get appropriate
levels of participation. For example, if running
is scheduled, the student could walk the whole
distance, run part of the distance, alternate
running and walking.
- Keep the
student involved when any temporary but major
modification is required. Ask the student to
act, for example, as a scorekeeper, timer, or
equipment handler until he or she can return
to full participation. Dressing for a physical
education class and participating at any level
is better than being left out or left behind.
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"Every
spring my asthma gets real bad. I couldn't even finish
the Presidential Physical Fitness Tests! But this year
my teacher let me do the run inside before the air got
so bad. I got a badge!"
-Student
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