Asthma is a growing health problem, especially among school-aged children.  Asthma prevalence has increased from 7.3% of the population in 2001 to 8.4% in 2010 (CDC NCHS Data Brief no 94 May 2012).  In its 2011 Asthma & Children Fact Sheet, the American Lung Association reported that 7.1 million children under 18 had asthma.  The Association also reports that the annual direct health care cost of asthma is approximately $50.1 billion (Asthma in Adults Fact Sheet).  In 2008, there were more than 14.8 million asthma-related school absences (Meng et al. 2012).

A life-long disease once acquired, asthma causes wheezing, shortness of breath, chest tightening and coughing.  Susan Hoffmann, the Delaware director of the National Association of School Nurses and lead school nurse for the Caesar Rodney School District in Camden, Delaware, compares asthma episodes to the embers of a fire—“sometimes it’s just smoldering in the background but then you have flare-ups.”  Asthma symptoms are caused by three issues: inflamed airways, increased mucus production and tightening , called bronchoconstriction, of the smooth muscles that surround the airways.

According to Hoffmann, schools should “develop a multi-disciplinary team of administrators, teachers, parents, custodial staff and coaches to create asthma management policies and look at ways to reduce triggers throughout the school.”  Hoffmann recommends the following actions to deal with asthma at school.

1. Establish strong links with asthma-care clinicians to ensure appropriate and ongoing medical care.  Medical providers should develop an asthma action plan.  Plans should include actions for tiered symptom levels, such as green (no symptoms), yellow (moderate symptoms) and red (asthma crisis).  The school nurse should keep plans for each student on file and share them with teachers, physical education coaches and other staff.
2. Use a coordinated, multi-component and collaborative approach that includes school nursing services, asthma education for students and professional development for school staff.
3. Ensure that students have access to all medications.  Consult state laws to determine if children are allowed to carry their own quick relief medications.

Well-controlled asthma should not limit a child’s ability to participate in school activities.  However, uncontrolled asthma is the leading reason for school absences.  “Asthma symptoms can lead to a disruption in sleep because the child cannot rest due to coughing, which can result in decreased school performance, learning difficulties, restlessness or fatigue,” comments Hoffmann.  Additionally, the side effects of some asthma medications include irritability and sleeplessness.

IPM in schools and homes go hand-in-hand with asthma management.  Common triggers for asthma include mold, pet dander, and cockroach and pest allergens.  Sealing leaky pipes, promptly cleaning up spills, and sealing cracks and crevices can greatly reduce these triggers by denying pests water, food and shelter.  Reducing moisture is critical to eliminating mold.

According to the US EPA’s Asthma Triggers: Gain Control, “Droppings or body parts of cockroaches and other pests can trigger asthma.  Certain proteins are found in cockroach feces and saliva and can cause allergic reactions or trigger asthma symptoms in some individuals.”  Some IPM tips for reducing cockroach allergens include:

• Keep counters, sinks, tables and floors clean and clutter-free. Cluttered areas provide harborage for cockroaches and are difficult to clean.  (More information about cockroach habits can be found in our December 2011 newsletter.)
• Clean up any crumbs and spills right away. These are a great source of food and water for roaches.
• Store any food or food products (like pasta or rice used for art projects) in airtight containers, such as Tupperware® containers or Ziplock® bags.
• Seal cracks or openings around or inside cabinets.

Resources

The US EPA Indoor Air Quality (IAQ) Tools for Schools program has a number of free resources to help schools implement IAQ programs, including a set of lesson plans to teach children about asthma.  To manage IAQ in schools, EPA recommends six technical solutions, including providing quality HVAC systems, controlling moisture and mold, practicing IPM and using proper cleaning and maintenance techniques.  The American Lung Association’s Asthma-Friendly Schools Initiative also includes information and tools for school asthma management.  The National School IPM Working Group created a document, Reducing your Child’s Asthma using Integrated Pest Management: A Practical Home Guide for Parents, to educate schools and parents about the cost benefits and asthma reduction that can be achieved through IPM implementation.

Educators and others can gain access to best practices, tools and resources with AsthmaCommunityNetwork.org, a national network designed for community-based asthma programs.  EPA’s School IAQ Connector email discussion list is also available for members to ask questions about asthma management.  Join by sending a blank email message to schools_iaq_connector-subscribe@lists.epa.gov.