In the United States, more than 10 million children under age 18 (14 percent) have been diagnosed with asthma at some point in their lives and 6.8 million children currently have asthma (9 percent). Data from the National Health Interview Survey, 2012, shows there are gender, ethnic and economic disparities among children with asthma with boys (16 percent) more likely than girls (12 percent) to have ever been diagnosed with asthma, non-Hispanic black children more likely to have ever been diagnosed with asthma (22 percent) and to still have asthma (16 percent) and children in poor families more likely to have ever been diagnosed with asthma (19 percent) or to still have asthma (13 percent) than children in families that were not poor (12 percent and 8 percent).
Asthma is a chronic disease that affects airways; the walls of the airways become inflamed and sensitive intermittently to allergies or other triggers the lungs find irritating. When the airways react, they get narrow producing decreased air flow and bronchospasm or asthma attack. The asthma attack causes symptoms including wheezing (a whistling sound when you breathe), coughing, chest tightness, trouble breathing, fatigue, stomach cramps, headache, and decrease in exercise tolerance. Symptoms of asthma occur most frequently at night or in the early morning. The most common triggers of asthma attacks include upper respiratory infections, exercise, allergies, weather changes, strong odors, and stress. In some cases, uncontrolled asthma can lead to severe respiratory distress and death. Asthma cannot be cured, but most people with asthma can control it by taking oral and inhaled medications and avoiding situations that stimulate asthma. As indicated in Wis. Stat. sec. 118.291, students with asthma are allowed to carry their own inhalers in Wisconsin schools, with a medical provider and parent’s written permission provided to the building principal.
School personnel need to know how to recognize the onset of asthma, prevent exposure to the triggers, and provide basic and emergency care. When school personnel see a student with asthma symptoms, they should provide basic asthma care by remaining calm, stopping the student’s physical activity, removing any triggers, providing rescue medication and monitoring effectiveness of the response to medication. Emergency asthma care is provided when the student needs prompt action due to lack of improvement or worsening of symptoms after administration of rescue medication. The student may have increased respiratory rate and effort to breathe as evident by retraction, posturing and cyanosis. Emergency care requires administration of medication as prescribed, calling 911, and parent or guardian. Effective management of asthma can improve a student’s absentee rate, educational productivity, and well being.
Poor air quality can trigger asthma attacks and increase the severity of ongoing asthma symptoms. Students with asthma should be allowed to self-limit physical activity and may need shortened recess and physical education class periods when air quality is questionable. As a part of asthma management in the school setting, school personnel need to be knowledgeable about indoor and outdoor air quality.
Indoor air quality
Since the majority of class time occurs inside a school building, indoor air quality is an important aspect of health promotion. Children can be especially susceptible to poor air quality due to their size and rapidly changing bodies. Indoor air quality is managed by controlling airborne pollutants and by introducing and distributing outdoor air. Over the past several decades, our exposure to air contaminates has increased due to a variety of factors including air-tight construction techniques and use of synthetic materials in the building process. The quality of indoor air can be affected by mold, radon, pesticides, insecticides, cleaning agents, chemicals, and emissions from equipment. Failure to address the quality of the school’s indoor air quality can result in health problems, changes in performance, and increases in absenteeism of students and staff. The Environmental Protection Agency has an Indoor Air Quality Tools for Schools Kit available.
Outdoor air quality
Outdoor air quality is determined by the amount of small particles, ozone and other gases in the air. Small particle matter is of concern because the particles can lodge deep into lungs, causing serious damage. Some of the sources of small particle matter include dust, ash, and soot. Ozone comes from emissions of cars, power plants, industrial boilers, refineries, chemical plants, and other sources which react chemically in the presence of sunlight. Ozone at ground level is a harmful air pollutant. When inhaled, outdoor pollutants can aggravate the airways and can lead to chest pain, coughing, shortness of breath, and throat irritation. Outdoor air pollution may also worsen chronic respiratory diseases, such as asthma.
The Environmental Protection Agency offers a Healthy School Environments Assessment Tool (HealthySEAT).
To check on Wisconsin air quality, the Department of Natural Resources provides current Wisconsin statewide air quality notices on its website.
When the Department of Natural Resources deems the air quality to be unhealthy, school districts will want to provide accommodations to children who have asthma. Some of the accommodation strategies may include elimination or reduction of the offending substance, improved ventilation, and shortening or canceling outdoor recess and physical education classes.
DPI Medication Training Resources
- SAMPRO Asthma Action Plan for Home & School (English)
- SAMPRO Asthma Action Plan for Home & School (Spanish)
- National Heart Lung and Blood Institute Guidelines for the Diagnosis and Management of Asthma
- American Lung Association has many resources related to asthma in children that can be accessed from this page.
- Wisconsin Asthma Coalition is committed to improving asthma management for children and adults. Their web site provides access to tools and resources, videos and webinars.
- Green and Healthy Schools is a web-based program available to all Wisconsin schools. Through this program, schools can find support to get started or continue to move forward and receive recognition for green and healthy measures.
- Air Quality Activity Guidelines from Minnesota
- Wisconsin State Statute section 118.291 is the law that allows students to carry and self-administer asthma inhalers.
- Indoor Air Quality Tools for Schools Kit by the Environmental Protection Agency
- Wisconsin Department of Natural Resource’s website lists current air quality alerts and a link for individuals to sign up to receive air quality alerts for their area.