The best way to make sure that your son’s school is in a position to handle his asthma is to continue to teach him about his asthma and the medicines he takes and to establish effective communication with all of his teachers and the school nurse. Your son’s ability to recognize and act on his asthma symptoms will, of course, evolve depending on his age and maturity.
Even though asthma is a common condition throughout childhood and adolescence, it is still a good idea to make sure that school staff knows about your son’s asthma. The adage, “Never assume” applies! You should meet with your son’s teacher and possibly the nurse (if there is one) early in the school year to discuss his medical history. It would be appropriate to have a list of the daily medications that he takes as well as those, such as quick-relief bronchodilator MDIs (albuterol) that should be administered to treat an acute symptom or exacerbation.
The updated 2007 NAEPP Expert Panel Report (EPR-3) recommends that physicians caring for children with asthma prepare an individualized written asthma action plan for each child that is specifically designed for school or the child care setting.
It further specifies that each school action plan contain instructions for handling exacerbations (including the doctor’s recommendation regarding student self-administration of medication); recommendations for daily use, long-term control medications and for the prevention of exercise-induced bronchospasm (EIB), if appropriate; and identification of those factors that make the student’s asthma worse, so the school may help the student avoid exposure. The NHLBI offers written resources for schools and school staff on its Web site addressing all aspects of asthma management in schools—see http://www.nhlbi.nih.gov/.
You can also view several sample asthma action plans online by typing “school asthma action plan” in your browser. The Asthma and Allergy Foundation of America has a sample student asthma card on its Web site. You can view it online (http://www.aafa.org). You should familiarize yourself with the school district’s policies (if any) regarding the use of asthma medication in the school setting.
Some schools allow students to carry their quick-relief bronchodilator inhaler with them at all times, whereas others require that it be left in the school nurse’s office. The former is obviously far more desirable than the latter.
I insist that my patients carry their inhaled bronchodilator with them through-out the school day. The NAEPP and other authorities advocate that students with asthma be allowed to carry their asthma medicine (especially an inhaled quick-relief bronchodilator or SABA) for self-administration as required during the school day, with prior parental and physician okay of course! Several states have enacted legislation to allow students to carry their asthma medicine at all times during the school day.
That policy is especially appropriate for student athletes with EIB who require pre-medication with bronchodilator medicine before exercise. Make sure to review any of your concerns with your son’s doctor in advance of the school year; a good time might be when the physician fills out the required pre-enrollment health forms.
The school should be given a written copy of the action plan, treatment plan, and your son’s medication list. Make sure that your son learns when and how to use his quick-relief inhaler. If he is old enough, he should also learn, just to be on the safe side, the correct technique for using an MDI without a valved holding chamber (VHC) even though he usually would use an MDI and VHC together.
Kerrin’s comment:
The day care where my son goes has many people who are familiar with how to work the nebulizer. Because allergies and asthma are so prevalent these days, it’s not dif-ficult to find people knowledgeable about the condition and treatment.
Whenever he has a cold, we send the nebulizer and vials of albuterol to school with him, and one of the teachers administers a treatment before he goes down for a nap and later in the afternoon before I pick him up. This way he is able to get the four treatments per day that his doctor recommends during the times when he is at the greatest risk for having his asthma symptoms triggered.