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School nurses, teachers, administrators, and school staff play important roles in the safe and effective management of asthma at school. Over the last two decades the worldwide prevalence of asthma has increased dramatically, particularly among school-age children. Large numbers of students are experiencing poorly controlled, disabling asthma. Yet, this problem is growing worse at a time when very effective asthma medications have become available. Today, with appropriate education, clinical care, and support, children with asthma can lead normal lives. This section focuses on changes that occur in the airway due to asthma, signs and symptoms of an asthma flare-up (exacerbation), medications used in the treatment of asthma, and skills needed by health care staff to assist children who have asthma.
Train for key competencies and clinical knowledge
Step 1.
What are the key competencies for all school health professionals need?
Recommended action: Train school health professionals until they can demonstrate competency with asthma management skills, as noted on the Staff Procedure Performance Checklist (G-2). The skills are: MDI using spacer/aerochamber with mask, MDI using spacer/aerochamber, DPI, nebulizer, peak flow meter, electronic peak flow meter, EpiPen Autoinjector, and Twinject Autoinjector.
Recommended action: All school health professionals should be aware of the major components of an asthma-friendly school. Review the information contained in How Asthma-Friendly Is Your School? (F-9) and encourage all staff to contribute recommendations for make the school more asthma-friendly.
Step 2.
What is the most essential clinical knowledge needed by school health professionals?
Recommended action: Ensure all school health professionals have a solid understanding of the pathogenesis of asthma and national asthma care guidelines. Essential information is summarized in Pathogenesis of Asthma (G-3) and Expert Panel Report Highlights [EPR-3] (G-6).
What are the key competencies for all school health professionals need?
Recommended action: Train school health professionals until they can demonstrate competency with asthma management skills, as noted on the Staff Procedure Performance Checklist (G-2). The skills are: MDI using spacer/aerochamber with mask, MDI using spacer/aerochamber, DPI, nebulizer, peak flow meter, electronic peak flow meter, EpiPen Autoinjector, and Twinject Autoinjector.
Recommended action: All school health professionals should be aware of the major components of an asthma-friendly school. Review the information contained in How Asthma-Friendly Is Your School? (F-9) and encourage all staff to contribute recommendations for make the school more asthma-friendly.
Step 2.
What is the most essential clinical knowledge needed by school health professionals?
Recommended action: Ensure all school health professionals have a solid understanding of the pathogenesis of asthma and national asthma care guidelines. Essential information is summarized in Pathogenesis of Asthma (G-3) and Expert Panel Report Highlights [EPR-3] (G-6).
Prepare for an asthma episode
Step 3.
What are the warning signs of an asthma episode? Asthma episodes rarely occur without warning. Most people have warning signs (physical changes) that occur hours before symptoms of an asthma episode appear. Warning signs are not the same for everyone.
Recommended action: Ask parents/guardians to complete the Warning Signs of an Asthma Episode (F-3) to increase awareness about warning signs that occur hours before symptoms of an asthma episode appear.
Step 4.
What are the best ways to manage an asthma episode?
Recommended action: Ensure all school health personnel understand the Summary of Steps to Managing an Asthma Episode (F-5) and Steps to Follow for an Asthma Episode When a School Nurse is Not Available (G-25).
What are the warning signs of an asthma episode? Asthma episodes rarely occur without warning. Most people have warning signs (physical changes) that occur hours before symptoms of an asthma episode appear. Warning signs are not the same for everyone.
Recommended action: Ask parents/guardians to complete the Warning Signs of an Asthma Episode (F-3) to increase awareness about warning signs that occur hours before symptoms of an asthma episode appear.
Step 4.
What are the best ways to manage an asthma episode?
Recommended action: Ensure all school health personnel understand the Summary of Steps to Managing an Asthma Episode (F-5) and Steps to Follow for an Asthma Episode When a School Nurse is Not Available (G-25).
Use national clinical guidelines to support the care plan
Step 5.
What are the national standards for assessment and treatment of asthma?
Recommended action: Use key tables from the national guidelines to assess the control status of a student or compare his/her current treatment plan to the standard. The manual includes some of the most useful tables for school health professionals. Refer to EPR3 National Clinical Guidelines for Diagnosis and Treatment (G-7). Complete information about the EPR3 guidelines is available on the National Institute for Health website.
(This step is cross-listed -- Unit 7: Medication Management.)
What are the national standards for assessment and treatment of asthma?
Recommended action: Use key tables from the national guidelines to assess the control status of a student or compare his/her current treatment plan to the standard. The manual includes some of the most useful tables for school health professionals. Refer to EPR3 National Clinical Guidelines for Diagnosis and Treatment (G-7). Complete information about the EPR3 guidelines is available on the National Institute for Health website.
(This step is cross-listed -- Unit 7: Medication Management.)
Teach proper inhalation technique
Step 6.
Why is inhalation technique important?
An inhaler is a small, handheld device that delivers medication directly to the lungs. There are many inhalers on the market. Improper inhalation techniques results in a sub-optimal amount of medication being delivered to the lungs, which makes the medication less effective.
Recommended action: Obtain training on how to teach students to take an inhaled medications correctly. A checklist of tips is available in the manual -- Guidelines for Teaching Inhalation Technique (G-29).
Why is inhalation technique important?
An inhaler is a small, handheld device that delivers medication directly to the lungs. There are many inhalers on the market. Improper inhalation techniques results in a sub-optimal amount of medication being delivered to the lungs, which makes the medication less effective.
Recommended action: Obtain training on how to teach students to take an inhaled medications correctly. A checklist of tips is available in the manual -- Guidelines for Teaching Inhalation Technique (G-29).
Support peak flow monitoring
Step 7.
When and why should peak flow monitoring be used?
Peak expiratory flow (PEF) provides a simple way of measuring breathing ability. It is reproducible, demonstrating the severity of air flow obstruction (severity of asthma attack). PEF can be measured with hand-held devices called peak flow meters. Peak flow meters are designed to monitor, not diagnose asthma.
Recommended action: Talk with parents/guardians and student about how they are using peak flow monitoring as part of a care management plan. The one-page document Asthma Self Maintenance Peak Flow Monitoring Information for Parents (F-8) provides an overview of what PEF measurement is, why it is done, and how to use the results. A peak flow monitoring diary is available here.
When and why should peak flow monitoring be used?
Peak expiratory flow (PEF) provides a simple way of measuring breathing ability. It is reproducible, demonstrating the severity of air flow obstruction (severity of asthma attack). PEF can be measured with hand-held devices called peak flow meters. Peak flow meters are designed to monitor, not diagnose asthma.
Recommended action: Talk with parents/guardians and student about how they are using peak flow monitoring as part of a care management plan. The one-page document Asthma Self Maintenance Peak Flow Monitoring Information for Parents (F-8) provides an overview of what PEF measurement is, why it is done, and how to use the results. A peak flow monitoring diary is available here.
Be attentive to asthma triggers in the school environment
Step 8.
What are the asthma triggers the school?
Recommended action:. Common triggers in the school setting are described in three-page checklist Avoiding Asthma Triggers in the School Environment (G-26). Use this checklist to audit the school and remove as many triggers as possible.
What are the asthma triggers the school?
Recommended action:. Common triggers in the school setting are described in three-page checklist Avoiding Asthma Triggers in the School Environment (G-26). Use this checklist to audit the school and remove as many triggers as possible.
