Asthma Kit for Canadian Schools

Your Resource Kit The purpose of this Kit is to provide classroom teachers, physical education teachers and principals with practical advice on how to recognize and manage asthma in the classroom, gym and school playground. There is no cure for asthma, but it can be controlled with proper medication and adequate environmental controls. Most children can participate in the same activities as their peers when their asthma is symptom free. Since you work with these children in your classroom and schools on a daily basis, you are in the ideal position to observe early signs and symptoms of asthma that may be out of control. You are also in an ideal position to communicate those observations to parents who can ensure that their child's asthma gets medical attention, if required. The information in this Resource Kit will: Increase awareness of asthma among teachers, parents and caregivers

Improve the ability of schools and teachers to fulfill your role in providing a safe learning environment for students with asthma After reading this Kit, you will be able to: Recognize the signs and symptoms of pending asthma episodes Make appropriate decisions to avert a pending asthma attack Understand and help students use their asthma medication appropriately Implement a child's Asthma Action Plan, as required Communicate clearly with parents by using the Symptom Alert included in this Kit, to ensure they are getting appropriate medical attention for their child Implement a school asthma policy Identify and access appropriate community resources

Increase participation of students with asthma in physical education

Note

School personnel play an instrumental role in reducing frequency of asthma attacks and school absenteeism due to uncontrolled symptoms

This information is not intended as a substitute for medical advice. Every child with asthma is unique and only a physician can determine the best course of action in treating that child.

Asthma Kit for Canadian Schools

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Resources Asthma Society of Canada

Asthma Education Centres

www.Asthma.ca

Certified Asthma Educators are healthcare professionals who are specifically trained in asthma. Visit Asthma Society of Canada at www.Asthma.ca or call 1-866-787-4050 to find out the location of the nearest asthma education centre.

www.Asthma-Kids.ca

1 866 787 4050

Health Canada The Asthma Society encourages healthy indoor air for the health of all students, especially for those with asthma. ‘Tools For Schools Action Kit‘ provides practical tips to keep the school air clean. To obtain copies of this publication: E-mail: [email protected]

www.Asthma-Kids.ca

Pilot Program This is a pilot program and we encourage your feedback. Please email your comments to Melva Bellefountaine, Director of Programs, Asthma Society of Canada at [email protected]

Asthma Overview

A Serious Health Problem Asthma, the most common chronic lung disease of childhood, affects 12% of Canadian children. It is also the major cause of school absenteeism. Asthma is a serious health problem that can be addressed with communication and collaboration. Of children with asthma, more that 60% do not have good control and are, at risk for a serious asthma attack. In a typical elementary school with 300 children, there could be 36 children with asthma, of which 21 are experiencing asthma symptoms that lead to activity limitations and poor quality of life.

miss an opportunity to avoid a serious, sometimes life-threatening asthma attack.

What is asthma? Asthma is a condition where inflammation of the airways causes cough, wheeze, chest tightness and shortness of breath. The major goal of asthma management is to reduce this inflammation and achieve symptomfree asthma. Most children with asthma can get excellent results from treatment and can control their symptoms so they can participate in the same activities as their peers — including exercise.

When parents and teachers fail to recognize the early warning signs and symptoms of asthma, they

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Normal airway = normal activity 5

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Emergency room visit. Absent from school.

If not treated

Viral infections and allergens trigger inflammation 4

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Inflammation of airway and mucous

Symptoms with exercise

Asthma Overview

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Common Signs and Symptoms Are any of your students displaying the following symptoms?

Signs: Poor quality sleep, so is tired in class

Many children may not be aware that their asthma symptoms are not normal. The presence of a chronic cough may be the teacher’s only clue that something is wrong.

School absenteeism, so academic performance may suffer

Symptoms:

Needs to use their inhaler more than two times a week to relieve symptoms

Persistent or troublesome cough Wheezing Shortness of breath Chest tightness or pain

Did You Know? Although hospital admissions occur throughout the year, there is a peak in September. Viral infections are a powerful and common inflammatory trigger for asthma symptoms and they are easily spread in the classroom setting.

Low exercise tolerance or reluctance to participate in gym class

Managing Asthma Signs and Symptoms in School

Early Warning Signs and Symptoms The majority of life-threatening asthma attacks can be prevented if you recognize the early signs of poor asthma control. By managing asthma appropriately, most children can achieve symptomfree asthma. As someone who sees the child almost daily, you are in a good position to observe, and the communicate to parents, if the child is showing early signs and symptoms of poor asthma control.

What should you be looking for? Asthma symptoms during or following exercise Reluctant or unable to participate in physical activities Persistent or troublesome cough that lasts more that a week Uses reliever (blue) inhaler more than twice a week at school Missing school because of allergies or asthma Tired in class Faster breathing Coughing Wheezing Sneezing Runny or stuffy nose Moodiness

Irritability Headache Complaints of throat or chin itchiness Dark circles under eyes

Take Action What should you do? Early warning signs can occur before the start of an asthma episode. By recognizing these clues, treatment can be started that will help the child achieve symptom-free asthma. Use the Symptom Alert, included in this Kit to inform parents of the signs and symptoms that you have observed.

Managing Asthma Signs and Symptoms in School

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Life-Threatening Signs and Symptoms What are the signs a child is experiencing serious breathing problems? Difficulty talking or concentrating Struggling to breathe Lips or fingernails are blue Pale or sweaty skin Quick relief medication fails to help Severe coughing Wheezing (may or may not be heard) Lethargy or loss of consciousness Fast breathing Hunched shoulders

Take Action STEP 1: Get Help Call 911 STEP 2: Treat Help student take 2 puffs of (blue) reliever inhaler This is a life-threatening situation. Repeat inhaler every 10 minutes until ambulance arrives and emergency personnel take over STEP 3: Communicate Record the name of medication, dose and time given Contact parents Reassure student

Asthma and Exercise

Exercise-Induced Asthma Exercise is a powerful trigger for asthma symptoms — 90% of asthmatics experience exercise-induced asthma. As a result, you should anticipate it in children who have asthma. Attacks triggered by exercise can be frightening and may lead to reluctance to participate in future activities. Young children may avoid vigorous activity with damaging consequences to their physical and social well-being. Parents may be reluctant to allow their children with asthma to participate in physical activity, and teachers may fear taking responsibility for a child’s asthma attack. Physical education teachers are in a position to notice early warning signs of worsening asthma control. If a child has any asthma symptoms, even mild ones, during or after exercise, or is reluctant to participate, it may be a sign of worsening asthma. Breathing difficulty usually occurs 15 minutes into the activity, or after stopping. For the child in the primary grades, the teacher may notice symptoms following recess.

How can children with exerciseinduced asthma participate in exercise? Students who are diagnosed with exercise-induced asthma may be instructed to take their reliever (blue inhaler) medication 10 to 15 minutes prior to strenuous exercise. This will allow the student to participate without symptoms. If however, the student needs to stop again to take more reliever, then the asthma is not under control. If a child is unable to participate in physical activity, use the Symptom Alert, included in this Kit, to inform parents of the signs and symptoms that you have observed.

Take Action What should you do? If the child is experiencing serious breathing problems, call 911 or the local emergency number.

With appropriate treatment, 90% of children with exercise-induced asthma can control their symptoms and should be able to participate in any vigorous activities.

Quick Tip A child with wellcontrolled asthma will be able to fully participate in gym class.

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Asthma and Exercise

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Prevention How can you help prevent exerciseinduced asthma? Here are some of the things you can do to the help prevent exercise-induced asthma in your school. Identify all students who have asthma. Review the student’s Asthma Action Plan. If a child does not have a plan, call the parents to get one. Ensure that asthma is under control prior to exercise. Exercising when the asthma is not controlled may lead to severe attacks. It is recommended that the student displaying symptoms withdraw from gym until their physician has indicated it is safe to return. A recent respiratory infection, such as a cold, will worsen asthma control. Restrict or modify any activity when the child is recovering from a recent respiratory infection. If prescribed, provide reliever inhaler 10 to 15 minutes prior to exercise. Restrict outdoor activities if the: Pollution or pollen index is very high Days are very cold Ensure adequate warm up and cool down Stop exercise if symptoms occur and refer to child’s Asthma Action Plan for next step

Next Steps If the child cannot fully participate in exercise, use the Symptom Alert, also included in the Kit, to inform parents of the signs and symptoms that you have observed.

What should you if you do think a child is using their asthma as an excuse not to participate in class? A physician or asthma specialist is the best person to determine the level of asthma control. If a child refuses to participate, use the Symptom Alert included in this Kit, to inform parents, so they can speak to their doctor about it. Do not insist that a child keep going as it may worsen their symptoms.

Does every child with asthma need to take their reliever (blue) inhaler before gym class? Children who have symptoms only with exercise may be prescribed to use a reliever inhaler 10 to 15 minutes before physical activity. Children who have symptoms during activity have poor asthma control.

Asthma Medications

Commonly Prescribed Medications Medication is important in the proper asthma management. Even with adequate classroom and home environmental controls in place to limit the triggers for asthma, medication is usually necessary to maintain symptom-free asthma. The type of medication a student is prescribed will depend on the level of asthma control. The amount of medication may depend on the time of the year. Students with allergies to pollen will likely be on more medication in the fall or spring. Every child who has asthma should have a reliever inhaler at school along with an Asthma Action Plan on when to use it. There are two basic groups of inhaled medications; bronchodilators and anti-inflammatory agents.

Relievers or Bronchodilators:

Controllers or Preventor Medications It is helpful to parents when they are notified that their child is having asthma symptoms at school so they can adjust the controller medication taken at home. Controller medications prevent or reduce the bronchial inflammation. These medications are likely to be taken at home on a regular basis. Depending on the level of asthma control, these medications may increase or decrease throughout the school year. Controller medications: Are used to reduce inflammation and mucus in the airways. That are inhaled are not the same as anabolic steroids that are in the sporting news. Are prescribed for use on a regular basis, thus are generally used before and after school hours.

Are used when the child is experiencing asthma symptoms.

Are not used for the treatment of sudden onset of breathing difficulty.

Relieve bronchospasm by opening up the twitchy, tight bronchial tubes.

Need to be taken for days or even weeks before they work to their full effectiveness

Do not reduce the airway inflammation Dilate the airway within 10-15 minutes of inhalation Are effective for about 4 hours Can be prescribed for prevention of exerciseinduced asthma. Monitor frequency of use. If a child needs to use it more than 2 times a week, their asthma is not under control. Use the Symptom Alert, also included in this Kit, to tell the parent. Side effects: Shaky hands (tremor), headache, nervousness and a fast heart beat. There have been some reports of excitability in children. Examples: Salbutamol (Ventolin®), Turbutaline Sulphate (Bricanyl®), Fenterol hydrobromide (Berotec®)

Side Effects of inhaled controllers are: Hoarse voice, sore throat and a mild throat infection called thrush. Examples of inhaled controllers: Beclomethasone (also sold as Vanceril® or Qvar®), Budesonide (Pulmicourt®), Fluticasone (Flovent®) Some children may be taking a tablet to control their asthma. Examples of controllers in tablet form: Montelukast sodium (Singular®), zafirlukast (Accolade®)

Quick Tip A child's inappropriate classroom behaviour may be due to either side effects from their asthma medication or asthma that is poorly controlled. Use the Symptom Alert to tell parents about the signs and symptoms you have observed.

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Asthma Medications

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Questions and Answers Where should the medications be stored?

To learn more about proper inhaler techniques visit www.Asthma.ca

Store the inhalers at room temperature in a safe place that is easily accessible to the child. All medications left at school should have the student’s name, the doctor’s name and phone number, expiry date and directions for use.

Spacers or holding chambers are devices that attach to the inhaler to increase the amount of medication that is delivered to the child's airways. It is recommended that all children use a spacer device with their inhalers.

Can a child use their own inhaler effectively? Most children can, with good instruction, learn how to self-administer their inhaler. Many, however, have not received the proper instruction. If you observe a child that has poor inhaler technique do not hesitate to tell the parent who can then discuss educational or therapeutic alternatives with their doctor.

Take Action Consider inviting a pharmacist or asthma educator to the school to teach the children how to use their devices properly. See the first insert, Asthma Kit for Canadian Schools, for a list of resources.

Asthma-Friendly School Policies

Establishing Policies The following elements are the cornerstone to a comprehensive policy in how to better manage asthma in your school. They will help those children with asthma achieve better asthma control — the kind of control that will enable them to fully participate in all academic and physical activities. Consider the following: 1

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Promote safe and full participation in all school activities Encourage student participation Allow pre-treatment and or warm-up before physical activity Allow access to quick relief medication Modify activity or substitute with less strenuous option

Identify students with asthma Review and update student health records Review criteria for asthma control and signs to watch for

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Establish emergency plan for asthma episodes

Send newsletters to parents regarding asthma and associated allergies

Develop school wide emergency plans/ procedures

Identify school resource staff

Include respiratory distress treatment protocols

Monitor students' asthma control

Include this protocol for children without an individual plan

Watch for early warning signs and symptoms of uncontrolled asthma, especially with exercise Monitor absenteeism due to asthma Communicate any changes in asthma control to parents Refer to an Asthma Education Centre for training as required 3

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Obtain a written asthma action plan for every student Highlight signs & symptoms of worsening asthma Specify medications required for emergencies and how to monitor response to them Indicate emergency contacts Include Asthma Action Plan in student's health record Review and update the plan Keep a copy in the classroom where you and a substitute teacher can find it. Make copies for off-site activities

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Provide quick, reliable access to medications Ensure reliable access to medication for all school activities Allow self-administration as appropriate Provide a spacer for effective inhaler delivery

Asthma-Friendly School Policies

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An Asthma Action Plan What is an Asthma Action Plan? An Asthma Action Plan is a strategy that can be used to manage asthma over the long term and when it gets out of control. Here is a sample action plan from the Family Physician Airways Group of Canada. Go to www. asthma.ca to download a sample Asthma Action Plan.

Plan an Asthma Awareness Information Night Parent's knowledge of asthma will vary between families. An asthma awareness evening can address many issues around asthma management. It can also create an excellent forum to alleviate the concern that parents might have around their child's asthma management when the child is in the school's care. Several organizations and health care professionals may wish to work together to conduct the event, and the partnerships that develop could evolve into an informal network of care and support for families.

The goal of the event, usually best held in the evening, is to teach parents and school staff how to: Identify signs and symptoms of asthma, and how to respond. Identify and reduce exposure to environmental triggers Use inhalers correctly Take steps to understand and improve asthma control for students with asthma

Take Action Call Asthma Society of Canada at 1-866-787-4050 if you are hosting an Asthma Awareness Event. We can provide free: ‘Asthma Basics’ Booklets Series that includes: Diagnosis Medications Triggers Kids Sample Asthma Action Plans Asthma Posters Referrals to qualified speakers Presentation overheads and speaker’s notes