Asthma Action Plan

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Asthma Action Plan
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Trigger avoidance

• Viral illnesses hygiene and flu shots!
• Allergens
• Irritants especially secondhand smoke!
• Internal triggers GERD/rhinitis/sinusitis
• Medications b blockers, ASA/NSAID, sulfites
• Advocate for environmentally friendly schools
  (including infection control!)

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Ways schools can help

• Asthma education for all students
• Monitor adherence
• Implement action plans
• Facilitate communication
• Reduce triggers
• Counseling

• Prevent EIB
• Encourage physical activity
• Dietary instruction
• Teach respect of differences among children
• Monitor asthma in staff members

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Communication with schools

• Acknowledge operational definition of health
  that may differ from yours
• Adapt language, avoid acronyms
• Make no assumptions about a program or staffing
  for healthcare in schools
• Be aware that staff morale may be low
• Realize that funding is decreasing while demand
  for healthcare programs is increasing
• Consider unified chronic disease approach to
  policymaking

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Inner-city asthma interventions

• Home interventions to reduce allergen exposure
  result in fewer days with asthma symptoms effect
  similar in magnitude to that reported from trials
  of ICS (Morgan et al, NEJM 20043511068-80)
• School-based health center improves access to
  optimal asthma care, improves self management
  practices, decreases hospitalizations (Lurie et
  al, J Sch Health 2001719-16)
• Similar findings with BreathmobilesTM (Jones et
  al, Dis Management 20058205-22)

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Inner-city asthma interventions

• Computer-assisted instruction improves asthma
  self-management, reduces symptoms and hosps,
  improves functional status (Bartholomew et al,
  Patient Educ Couns 200039269-80)
• MSW intervention reduces asthma symptoms,
  hospitalizations (Evans et al, J Pediatr
  1999135332-8)

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Inner-city asthma interventions

• Harlem Childrens Zone Asthma Initiative
  (interdisciplinary team providing medical,
  educational, environmental, social, legal
  services) decreased school absences and ED
  visits (MMWR 20055411-14)
• Inhaled steroids at school improved QOL, reduced
  absence, fewer symptoms in those not
  smoke-exposed (Halterman, et al, Arch Pediatr
  Adolesc Med 2004158460-7)

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Schools

• Schools are childrens workplaces
• Children may spend up to 40 hours a week in a
  school building
• School buildings are generally more densely
  occupied than commercial offices
• Our school buildings in the US are growing older
• Mean age 40-50 yrs

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• Employees have occupational health and safety
  laws designed to protect an environmentally safe
  and healthy workplace
• These standards are set for healthy adults
• No occupational health and safety standards
  have been set to protect children in schools

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Air-borne pollutants in schools

• Dirt
• Dust
• Lead
• Asbestos fibers
• Chemical fumes
• Tar fumes
• Diesel fumes
• People

• Carbon monoxide
• Other gases
• Pesticides
• Bacteria
• Mold
• Contaminants from photocopiers computers
• Pest droppings

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Health Issues for You Children in Schools

• Irritation of eyes, nose, throat
• Dry mucous membranes and skin
• Fatigue, headache, sleepiness
• Airway infections, cough
• Hoarseness, wheezing
• Sinus problems
• Nausea, dizziness
• Asthma attacks

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• Children are among the most vulnerable groups to
  environmental threats
• They may be exposed to higher levels of
  contaminants
• Organs are still developing growing
• Brain growth
• Lung growth

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• Immune defenses not fully developed
• Relative to the size of adults
• Eat more food, drink more water
• Breathe more air

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Sources of Environmental Health Hazards for
Children

• Sensitizers and/or Triggers for Asthma
• Secondhand smoke exposure
• Lead
• Asbestos
• Pesticides and other Chemicals
• Radon

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Sensitizers and/or Triggers for Asthma

• Ambient Ozone
• Indoor Allergens
• Indoor Combustion Products

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Combustion Products

• Sources
• Unvented Space Heaters
• SmokingSecondhand smoke
• Fire Places
• Internal Combustion Engines
• Combustion Products
• Particulate Material, including PM 2.5
• Sulfur and Nitrogen Oxides
• Carbon Monoxide
• Formaldehyde

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Pesticides and Other Chemicals

• Home use of chemicals
• School use of chemicals (exposure use)
• Chemicals from the ambient environment
• Industrial Wastes
• Accidental Releases

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School Use of Chemicals

• Adhesives
• Cleaning Products
• Disinfectants
• Pesticides
• Waxes
• Air Fresheners

• Cosmetics
• Strippers
• Caulking
• Degreasers
• Paints
• Varnishes

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Imagine, What If

• Several classrooms are closed at your school
  after a mold aggravates allergies, sparks
  illnesses, and a leaky roof spreads the problem
• You notice strong odors in a classroom after a
  science experiment
• You notice poor air exchange in one room, but
  good air exchange in most of the rooms in one
  hall, children in the classroom with poor air
  exchange have more complaints of allergy and
  asthma symptoms
• A student becomes ill after being exposed to
  chemical fumes after a floor is cleaned in a
  classroom
• Teachers and students in your school start to
  complain of fatigue, asthma attacks, problems
  with allergies, sinus problems and headaches

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Why School Environments?

• Indoor air pollution can be found in all types of
  buildings, even schools
• Approximately 55 million people spend their days
  inside of schools
• Indoor Air Quality has been reported as
  unsatisfactory in about 1/4 of public schools