Students With Asthma
What are asthma symptoms and "triggers?" Here are some
suggestions for maintaining a school environment conducive to
the attendance of children with asthma and for developing a curriculum
conducive to their academic achievement.
College, Columbia University
by Wendy Schwartz
children in the U.S. are living with asthma and the number is steadily
increasing. Most live in cities, are poor, or are African American
or Latino (Noble, 1999). Schoolsespecially
those in urban areas with deteriorating physical plants and limited
resourcescan find it challenging to promote the good health,
positive development, and educational achievement of children with
asthma, although they are required to do so under the Individuals
with Disabilities Education Act (IDEA) of 1990. Many schools, however,
discover that maintaining a healthy physical environment and incorporating
information about asthma into the curriculum benefits the entire
briefly describes asthma symptoms and "triggers." It also
presents some suggestions for maintaining a school environment conducive
to the attendance of children with asthma and for developing a curriculum
conducive to their academic achievement.
Nature and Prevalence of Asthma in Children
Asthma is a
non-contagious chronic lung condition caused by a tightening of
the airways of the lungs and production of extra mucus. An asthma
attack, which may last a few minutes or several days, results in
breathing problems such as coughing, wheezing, chest tightness,
and shortness of breath. One or more factors, called "triggers,"
can provoke an attack. Triggers include: infections, physical over-exertion,
and emotional factors; and exposure to allergens (i.e., pollen,
mold, animal dander), irritants (i.e., chalk dust, smoke, pesticides),
and strong odors (i.e., some personal care products) (Awareness,
1995; Majer & Joy, 1993).
can control asthma with oral medication taken regularly to prevent
attacks and with medication inhaled at the onset of an attack. People
with asthma carry a peak flow meter, a hand-held tool for measuring
their air flow to determine whether an attack is imminent. With
help from medical providers and caregivers, and age-appropriate
printed materials (such as those available from the American Lung
Association), children can learn to monitor their asthma and self-medicate.
Taking such control of their illness not only decreases its symptoms
but promotes childrens feelings of self-confidence and accomplishment
poor urban areas (especially those living in shelters) and children
of color suffer disproportionally from asthma. There are several
reasons why their risk is so high: (1) they get inferior medical
care, often limited to emergency room visits, which includes no
education about how to control the disease and no follow-up attention;
(2) they live in homes and neighborhoods, and attend schools, that
are overcrowded and laden with pollutants that irritate their lungs;
and (3) they experience the high illness-inducing stress that accompanies
poverty (Bernstein, 1999; Noble,
take many measures to ensure the health, safety, and emotional comfort
of students with asthma. The most effective school asthma management
program is a cooperative effort involving health providers, school
staff, parents, and students, although coordinated by one staff
member (National Heart, Lung, and Blood Institute,
NHLBI, 1991). There are several effective interdisciplinary
programs for creating a healthy school environment, such as the
Healthy Schools Networks in Boston and New York, that can serve
as models (Goldberg, 1996). Several
Federal programs, including those funded by IDEA, provide aid for
cleaning up schools.
Most improvements in environmental quality benefit everyone in the
school building because pollutants have a universally negative effect.
For example, schools should undertake extensive building repairs,
painting, cleaning, and extermination during long vacations. They
should replace plastic furniture and carpeting, which often emit
noxious gases. They should limit use of cleaning supplies and equipment
that emit toxic fumes and strong odors and require good ventilation
when they are used. They should have the entire building (particularly
the heating and ventilation system) cleaned regularly to eliminate
dust mites, mold, mildew, animal dander, feathers, cockroaches,
and other possible asthma and allergy triggers, and make sure that
leaks of water and plaster dust are stopped and quickly cleaned
up. They should regularly monitor the air quality of schools, especially
those in sealed buildings and try to increase the ventilation so
that pollutants can escape (Goldberg, 1997a;
Schools may not be able to eliminate other pollutants, such as chalk
dust. They can, however, find out which of them are triggers for
particular students and try to limit the students exposure
to them. Further, sensitive scheduling can keep students with specific
sensitivities away from certain art supplies and animals, which
may enhance the education of some students but sicken students with
Medical Policies and Services
Overall. Schools with a health clinic provide the best services
for students with asthma because clinic staff can monitor the childrens
condition, adjust their medication, and work with families to provide
effective management at home. In poor areas, where health care is
inferior and fragmented, school clinics can be vital to childrens
well-being. However, most urban schools do not have the resources
for operating a clinic, and, in fact, even the presence of a full-time
school nurse is becoming increasingly rare. It is important, however,
for a health care provider to be available regularly to provide
guidance on service delivery and to help update school health policies
(Goldberg, 1997b; Kronenfeld,
To ensure rapid
treatment for an asthma attack, schools need a plan for such a medical
emergency with components that range from delivery of medication
on site to phoning for an ambulance. Despite the attractiveness
of zero-tolerance policies for drug use, physicians usually recommend
that students carry asthma medication, thus providing them with
a quick and easy way to prevent or stop an attack, and enabling
their participation in sports and field trips (Larkin,
The school nurse or another designated staff member should develop
an individual asthma action plan with the family of each child with
the condition and distribute it to the childs teachers. The
plan should include all the information the family believes is important
to provide, and, especially, information on medication and other
strategies for stopping an attack, normal peak flow meter levels,
known asthma triggers, and the names of several caregivers and a
health care provider to contact in an emergency. The staff member
and the family should also communicate throughout the school year
to report attacks and update information in the plan. Parents should
be assured that medical records will be kept confidential and that
their children will be protected from teasing about their illness
(Frieman & Settel, 1994). Most important,
the school should maintain a supply of medicine for each child with
asthma, located in a secure place that the designated staff member
can easily access in an emergency (NHLBI,
may not recognize their childrens asthma, may maintain a home
environment that inadvertently exacerbates it, may be unable to
secure appropriate asthma treatment, or may be unable to manage
the treatment. School personnel, particularly the nurse, can help
these parents understand the problem and secure medical services.
Considering families attitudes, beliefs, reading skills, and
extent of English comprehension when approaching them improves communication
(Asthma, 1998; NHLBI,
Staff Training. The school nurse, a local hospital, or an organization
(i.e., Mothers of Asthmatics) can provide staff members with inservice
training and printed materials on asthma. Trainers can teach staff
how to: (1) recognize the signs of an asthma attack (wheezing, shortness
of breath, excessive coughing, a pale sweaty face, low peak flow
readings); (2) help a child stop an attack by encouraging relaxation
and deep breathing (possibly by modeling the technique), and providing
warm water to drink; and (3) determine whether professional medical
help is needed and get it rapidly. Training can also cover how asthma
medication may affect a students performance, and suggest
ways to support students with asthma by helping them deal with their
feelings of being different, their fatigue, their anxieties over
medication, and their embarrassment at having an attack. Finally,
trainers can help staff understand the pressures on families of
students with asthma and communicate effectively with them (Frieman
& Settel, 1994; NHLBI, 1991).
Education and Activities: Curriculum
Asthma as a topic across the curriculum draws on knowledge in
several subject areas and has a practical use. All the students
can use the peak flow meter of a child with asthma to learn
about the respiratory system (and, by extension, about anatomy
in general),and about basic mathematical concepts as they record
and analyze data collected through periodic measuring of lung
activity. Use of the many available stories, poems, and audiovisuals
with asthma as a theme can help develop students reading
and critical thinking skills. Asthma can also be a topic for
students personal writing, script writing, and role playing.
Learning about the illness itself helps develop all students
empathy for those living with chronic illnesses and increases
the self-esteem of children with asthma who may feel stigmatized
Students whose asthma is under control can play most sports,
and, indeed, exercise helps develop muscles around the lung
and increases stamina. Because some physical exertion may provoke
an attack, however, teachers need to remind students to take
preventive medication and to carry their inhaler, and to know
how to help stop an attack. Schools and families together can
develop an exercise program appropriate for their children (Asthma,
1991; NHLBI, 1991).
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was developed by the ERIC Clearinghouse on Urban Education, with
funding from the Office of Educational Research and Improvement,
U.S. Department of Education, under contract no. ED-99-CO-0035.
The opinions in this Digest do not necessarily reflect the position
or policies of OERI or the Department of Education.
on Urban Education, Institute for Urban and Minority Education,
Box 40, Teachers College, Columbia University, New York, NY 10027,
(800) 601-4868. Erwin Flaxman, Director. Wendy Schwartz, Managing