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Health Information for the Public

National Asthma Education and Prevention Program Resolution on Asthma Management at School

Updated November 2005

Asthma affects over 5 million school-aged children and youth in the United States--about one out of every 11 students1. This chronic lung disease often causes unnecessary restriction of activities and is a leading cause of school absenteeism. Asthma is controllable, however. With proper treatment and support, children and youth with asthma can develop healthy life long habits and lead fully active lives.

The National Asthma Education and Prevention Program (NAEPP) believes that schools should adopt policies for the management of asthma that ensure student safety, encourage the active participation of students in the self-management of their condition and allow for the most consistent, active participation in all school activities.2

Policies should address the following essential activities:

  • A smoke-free environment for all school activities.3
  • A written medication policy that allows safe, reliable and immediate access to medications. Policies are encouraged that allow students to carry and self-administer quick-relief medication whenever possible. 4,5
  • A school-wide emergency plan for handling asthma episodes.6,7
  • Professional development for all school personnel on school medication policies, emergency procedures, and procedures for communicating health concerns about students.

Policies that promote the following activities are also highly desirable:

  • Access to health services provided or supervised by a school nurse throughout the school day. The school nurse should provide the following activities, delegating activities consistent with state Nurse Practice Acts:
  • School health services should include:
    • Identifying, assessing and monitoring of students with asthma;8
    • Obtaining or constructing (with information from the student, family and health care clinician) a written asthma action plan for each student with asthma, updated at least annually;9
    • Ensuring emergency care including a quick-relief inhaler and spacer/holding chamber;10
    • Providing nurse supervision for the support of a trained adult, as appropriate, to document and report on the administration of medication to the parent/guardian and/or health care clinician; and
    • Providing appropriate additional services (e.g. care coordination) for students with significant morbidity due to asthma, such as those students with frequent episodes at school or absenteeism.11
  • Asthma education for students with asthma and asthma awareness education for all students.
  • Appropriate physical education options and physical activity for students with asthma that promote as much activity as possible and fulfill physical education requirements.12.13
  • Development of a supportive and healthy environment that respects the abilities and needs of each student with asthma including:
    • An indoor air quality management plan that includes preventing or reducing indoor air quality problems by reducing or eliminating allergens to which students are sensitive and irritants, including tobacco smoke; chalk dust; dust and debris from clutter, construction and remodeling; dust mites; molds; furred and feathered animals; cockroaches and other pests.14
    • Using integrated pest management techniques to control pests.15
    • Reducing students' exposure to diesel exhaust created by diesel school buses before, during and after the transportation of the students to and from school. ,

References

  1. American Lung Association, Epidemiology and Statistics Unit, Trends in Asthma Morbidity and Mortality, May 2005 based on the 2003 NHIS survey. Available at http://www.lungusa.org/atf/cf/%7b7A8D42C2-FCCA-4604-8ADE-7F5D5E762256%7d/ASTHMA1.PDF
  2. Centers for Disease Control and Prevention. Strategies for Addressing Asthma Within a Coordinated School Health Program. Atlanta, GA. 2002. Available at www.cdc.gov/HealthyYouth/asthma.
  3. Centers for Disease Control and Prevention. Guidelines for school health programs to prevent tobacco use and addiction. MMWR 1994;43(RR-4):1-10.
  4. National Asthma Education and Prevention Program. Guidance for Health Care Providers Who Prescribe Life Saving Medications for Students With Asthma or Allergies to Self-Carry and Administer at School. 2005. Available at http://www.nhlbi.nih.gov/health/prof/lung/asthma/emer_medi.htm.
  5. Summary of states with self-carry laws. Available at http://www.breatherville.org/cityhall/ch_childrights.htm
  6. National Association of School Nurses, Recognizing and Managing Acute Asthma Episodes at School: Actions for the School Nurse and Designated and Trained Asthma Care Staff. School Nurse Asthma Management Program Resource Manual, p 2-55, 2004.
  7. National Asthma Education and Prevention Program. Suggested Emergency Protocol for Students with Asthma Symptoms. 2005. Available at www.nhlbi.nih.gov/health-pro/resources/lung/.
  8. Wheeler L, Boss LP, Williams PV. Identifying Students with Asthma in Schools: What's Best for Your School? Journal of School Health 2004; 74(9):378-380.
  9. National Association of School Nurses, Tips for Obtaining and Disseminating Asthma Action Plans. School Nurse Asthma Management Program Resource Manual, p2-33, 2004.
  10. National Association of School Nurses, Preparing for School Emergencies, 2003. Available at: http://www.nasn.org/positions/2003pspreparing.pdf
  11. National Asthma Education and Prevention Program and National Association of School Nurses, Is the Asthma Action Plan Working?, 2004 Available at http://www.nhlbi.nih.gov/health/prof/lung/asthma/asth_act_plan_frm.htm.
  12. National Asthma Education and Prevention Program. Asthma and physical activity in the school. 2004 Available at www.nhlbi.nih.gov/health/resources/lung/asthma-physical-activity.htm
  13. National Asthma Education and Prevention Program. Breathing Difficulties Related to Physical Activity for Students With Asthma: Exercise-Induced Asthma Information for Physical Educators, Coaches and Trainers. 2005. Available at http://www.nhlbi.nih.gov/health/prof/lung/asthma/exer_induced.htm.
  14. U.S. Environmental Protection Agency. Managing asthma in the school environment. April 2000.. Available at www.epa.gov/iaq/schools/asthma/index.html.
  15. U.S. Environmental Protection Agency. Integrated pest management for schools: A how-to manual. June 1999. Available at www.epa.gov/region09/toxic/pest/school.
  16. U.S. Environmental Protection Agency. Clean School Bus USA Basic Information. Available at: www.epa.gov/otaq/schoolbus/basicinfo.htm.
  17. American Academy of Pediatrics. Committee on Environmental Health. Ambient Air Pollution: Health Hazard to Children. Pediatrics 2004; 114 (6): 1699-1707.

NAEPP Coordinating Committee Organizations

Agency for Health Care Policy and Research - Allergy and Asthma Network/Mothers of Asthmatics - American Academy of Allergy, Asthma, and Immunology - American Academy of Family Physicians - American Academy of Pediatrics - American Academy of Physician Assistants - American Association for Respiratory Care - American Association of Occupational Health Nurses - American College of Allergy, Asthma, and Immunology - American College of Chest Physicians - American College of Emergency Physicians - American Lung Association - American Medical Association - American Nurses Association - American Pharmaceutical Association - American Public Health Association - American School Health Association - American Society of Health-System Pharmacists - American Thoracic Society - Association of State and Territorial Directors of Public Health Education - Asthma and Allergy Foundation of America - Centers for Disease Control and Prevention - National Association of School Nurses - National Black Nurses Association - National Center for Environmental Health - National Center for Health Statistics - National Heart, Lung, and Blood Institute - NHLBI Ad Hoc Committee on Minority Populations - National Institute for Occupational Safety and Health - National Institute of Allergy and Infectious Diseases - National Institute of Environmental Health Sciences - National Medical Association - Society for Public Health Education - U.S. Environmental Protection Agency - U.S. Public Health Service

Coordinated by the National Heart, Lung, and Blood Institute, National Institutes of Health

For additional information, contact the NAEPP at 301­592­8573 (phone) or 301­592­8563 (fax)

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