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Asthma management is usually accomplished by a combination of long-term control medication (taken every day for maintenance) and quick relief medications (fast-acting bronchodilators) to reduce the troublesome symptoms of acute exacerbations. It is important to establish effective use of maintenance medications. Quick relief medications do not change airway pathology and or improve
the long-term course of asthma. Excessive use of quick relief medications is associated with lifethreatening asthma attacks.
This section includes general information on drug classes used in the treatment of asthma, as well as information specific to the individual medications commonly used within each class. Historically, asthma has been treated as a condition involving waxing and waning of symptoms, rather than a chronic illness. However, current clinical thinking recognizes underlying inflammatory mediators
as causative mechanisms in the pathogenesis of asthma. Asthma is a serious chronic condition, but it can be managed with appropriate pharmacological intervention and avoidance of triggers.
It is also important to acknowledge that medications alone cannot control asthma. The National Heart, Lung, and Blood Institute advocates a four component approach. Each component must be addressed if the best possible outcomes are to be achieved. School personnel have an important role in each component: 1) measures of assessment and monitoring, 2) education for a partnership in asthma care, 3) control of environmental factors & comorbid conditions that affect asthma, and 4) medications.
the long-term course of asthma. Excessive use of quick relief medications is associated with lifethreatening asthma attacks.
This section includes general information on drug classes used in the treatment of asthma, as well as information specific to the individual medications commonly used within each class. Historically, asthma has been treated as a condition involving waxing and waning of symptoms, rather than a chronic illness. However, current clinical thinking recognizes underlying inflammatory mediators
as causative mechanisms in the pathogenesis of asthma. Asthma is a serious chronic condition, but it can be managed with appropriate pharmacological intervention and avoidance of triggers.
It is also important to acknowledge that medications alone cannot control asthma. The National Heart, Lung, and Blood Institute advocates a four component approach. Each component must be addressed if the best possible outcomes are to be achieved. School personnel have an important role in each component: 1) measures of assessment and monitoring, 2) education for a partnership in asthma care, 3) control of environmental factors & comorbid conditions that affect asthma, and 4) medications.
Know the types of inhaled medications
Step 1.
What types of inhalation devices can deliver medications to the lungs?
Recommended action: Study the one-page summary Types of Inhalation Devices for Asthma Medications (H-3) to understand differences in the four types.
Step 2.
Which inhaled corticosteroid is part of the student's personalized treatment plan?
Inhaled corticosteroids (ICS) are the preferred treatment for all levels of persistent asthma. ICS work by binding to receptor sites on target cells in the epithelium. ICS decrease the amount of inflammation and mucus in the airway. ICS are very unlikely to cause the
systemic side effects that are associated with frequent use of oral corticosteroids, such as weight gain, risk of infection, and stunting. ICS are very different from the illegal anabolic steroids taken by some athletes. This is a highly effective class of medications that are capable of changing the underlying airway pathology of asthma leading to dramatically reduced morbidity and greatly improved quality of life. Relieving inflammation and swelling helps prevent the chain reaction that causes asthma symptoms. These Drugs should not be stopped without consulting a health care provider.
Recommended action: Become familiar with the names and dosages of ICS medications. Review Inhaled Corticosteroids (H-4).
What types of inhalation devices can deliver medications to the lungs?
Recommended action: Study the one-page summary Types of Inhalation Devices for Asthma Medications (H-3) to understand differences in the four types.
Step 2.
Which inhaled corticosteroid is part of the student's personalized treatment plan?
Inhaled corticosteroids (ICS) are the preferred treatment for all levels of persistent asthma. ICS work by binding to receptor sites on target cells in the epithelium. ICS decrease the amount of inflammation and mucus in the airway. ICS are very unlikely to cause the
systemic side effects that are associated with frequent use of oral corticosteroids, such as weight gain, risk of infection, and stunting. ICS are very different from the illegal anabolic steroids taken by some athletes. This is a highly effective class of medications that are capable of changing the underlying airway pathology of asthma leading to dramatically reduced morbidity and greatly improved quality of life. Relieving inflammation and swelling helps prevent the chain reaction that causes asthma symptoms. These Drugs should not be stopped without consulting a health care provider.
Recommended action: Become familiar with the names and dosages of ICS medications. Review Inhaled Corticosteroids (H-4).
Identify all medications in the asthma treatment plan
Step 3.
What other medications have been prescribed?
Recommended action: Review information about types and dosages of other medications prescribed by the student's healthcare provider. See Asthma Medications (H-6).
What other medications have been prescribed?
Recommended action: Review information about types and dosages of other medications prescribed by the student's healthcare provider. See Asthma Medications (H-6).
Get standing orders for managing respiratory distress
Step 4.
What should be included in standing orders?
Recommended action: Obtain standing orders from the school's medical director or collaborating physician to assess respiratory status and provide care to students with or without a prior history of asthma. Use the Standing Orders for Managing Respiratory Distress (H-14) template.
Recommended action: Given the possibility of anaphylaxis, get documentation of a standing order for epinephrine with the Standing Order for Epinephrine Autoinjector (H-15).
What should be included in standing orders?
Recommended action: Obtain standing orders from the school's medical director or collaborating physician to assess respiratory status and provide care to students with or without a prior history of asthma. Use the Standing Orders for Managing Respiratory Distress (H-14) template.
Recommended action: Given the possibility of anaphylaxis, get documentation of a standing order for epinephrine with the Standing Order for Epinephrine Autoinjector (H-15).
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 6: Health Staff Training.)
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 6: Health Staff Training.)
