Strategy 1: Maximize School Health Services
Managing asthma in school starts with informed and prepared school health services staff. A school health office should provide students with help to manage their asthma, support to prevent asthma emergencies and the ability to handle a breathing emergency. Within this section are the recommended components to support health services that can properly address asthma management in school.
Identify and track all students with asthma
Schools must know which students have asthma in order to properly support them. The information collected provide the baseline data that can be used to measure progress moving forward. A school should focus on students diagnosed with asthma, specifically those that require medications (most children with asthma). It is important to note that the Centers for Disease Control and Prevention does not recommend conducting mass screenings at school with spirometry or symptom-based questionnaires, which can be costly and are not supported by research to make a difference for tracking purposes. The American Lung Association shares a similar position on population-based screenings for asthma.
The American Lung Association Asthma Incidence Reporter (AIR™) Database is a free downloadable tool to help school nurses track student with asthma, their absences, triggers and additional data. The AIR Database meets Family Educational Rights and Privacy Act standards.
Download and installation instructions
When prompted, choose to save the "air_database.exe" file to your desktop or another easily accessible location on your computer. After the database has finished downloading, double-click on the air_database.exe file to launch the self-extractor. Click on the "Unzip" button to decompress the air_database.exe file. Click on the "Close" button once the files have been successfully unzipped. A folder titled "AIR Database" will be created. Open the AIR Database folder and double-click on the "autostart" icon to launch the database menu.
Collecting and sharing adequate information will help to strengthen the asthma management plan. Make sure the school health inquiry forms include all necessary asthma-related items, including: (1) previous diagnosis, diagnosis of reactive airway disease, or repeat diagnosis of bronchitis, bronchiolitis and/or pneumonia; (2) prescribed medications; (3) high absenteeism for breathing issues. After the information is collected, compile the data, and share non-confidential information.
Use an asthma action plan for all students with asthma
The National Heart, Lung, and Blood Institute's National Asthma Education and Prevention Program (NAEPP) recommends an asthma action plan as part of the efforts to educate people with asthma in self-management. An asthma action plan, or asthma management plan, is an individualized form completed by a healthcare provider along with the patient. The form includes details about a patient’s medications, asthma triggers and emergency protocols.
- American Lung Association Asthma Action Plan (English & Spanish). There are also a number of asthma action plans available in other languages available through the CDC.
- Metered-Dose Inhaler (MDI) Technique Checklist for School Nurses
- Peak Flow Meter Techniques Checklist for School Nurses
Collecting asthma action plans can be difficult for school nurses. As with many elements of a comprehensive asthma plan for schools, a policy on asthma action plans can cement the importance of this self-management tool. Communication about asthma action plans is critical to share with school administrators as well as the parents or guardians of a student with asthma.
- Sample Asthma Action Plan Policy
- Sample Letter to Parents and Guardians
- Sample Flyer for Parents and Guardians [English] [Spanish]
Once asthma action plans are collected, make copies available to teachers, coaches and other staff members that work closely with the student who has asthma. Make sure the plan is effective and that adults understand the asthma action plan and how to use it. Use the National Asthma Education and Prevention Program's "Is the Asthma Action Plan Working?" checklist for school nurses.
Don’t forget field trips! Establish a policy or procedure to handle field trips, including a designated faculty or staff member with a copy of the asthma action plan. This person must understand the asthma action plan, know what to do in case of an emergency and be able to administer medications if needed.
Assure immediate access to medications as prescribed
All 50 states now allow students to self-carry and self-administer medications. While this is a positive step forward, many schools do not properly communicate the procedures or paperwork required to allow a student to self-carry their medications. A school must a have a clearly written policy that is properly shared with parents or guardians of a student with asthma.
- Asthma and Allergy Foundation Mothers of Asthmatics’ national map of self-carry laws for Medications at School
- Authorization for Administration of Inhaler Asthma Medication (English)
- Authorization for Administration of Inhaler Asthma Medication (Spanish)
- Self-Administration of Inhaler Asthma Medication Student Agreement
Use standard emergency protocols
Adopting standardized emergency procedures can benefit both diagnosed and undiagnosed students with asthma during unexpected respiratory distress. School nurses should be familiar with the National Asthma Education and Prevention Program's Management of Asthma Exacerbations: School Treatmentin case a student without an asthma action plan on file has an emergency.
Provide special services for students most affected by asthma
Students identified as having severe asthma or who miss a higher rate of school then students without asthma need specialized school health services support. Some of these students may need an Individualized Health Plan or intervention through case management. In these instances, staff education is crucial to make sure that all responsible adults in the school are well informed about asthma and asthma management. Asthma education will help staff to better support the student with asthma and be able to understand and use the established plan.
Facilitate linkages with the medical home and referrals to medical provider
School nurses and health center personnel should be responsible for providing medical referrals to students with undiagnosed asthma. While asthma self-management education can significantly improve asthma self-management, it does not take the place of proper medical care or medications.
Connect students to medical support by: (1) determining if all students with asthma have a medical home, (2) refer students and families to providers and/or state child health insurance, (3) work with insurance companies and determine local asthma case management resources, and (4) help find emergency services for students without a medical home.
- Sample Letter to Physician/Healthcare Provider for Students with Asthma
- Sample Letter to Physician/Healthcare Provider When Student’s Asthma Affects School Performance
Provide a Fulltime Registered School Nurse All Day, Every Day, for Each School
The American Academy of Pediatrics and the National Association of School Nurses (NASN) have specific recommendations regarding the need for school nurses. Find out about NASN’s recommended nurse to student ratios.
School nurse allocations are determined by policy makers, including school administrators and school boards, and can be influenced by leaders in education, school health and medicine. The following steps can support your efforts to get a full-time school nurse, all day, every day: (1) convince decision-makers of the need for full-time nursing, (2) develop a health advisory council at the district level, (3) develop support structures for school nurses, (3) explore school-based health centers, and (4) identify advocacy and legislative opportunities.
- Position Description: School Nurse
- School Health Advisory Councils: Charge and Operational Guidelines
Assure access to consulting physician or healthcare provider
A consulting physician can play many roles within a school district. This physician can review policies and procedures, prescribe standing medications, and help a school nurse communicate with a student's physician. When assuring access to healthcare provider, remember to: (1) educate decision makers about the need, (2) solicit community support, and (3) secure funding.