Diane is the Assistant Director of Asthma Education at the North East Independent School District in San Antonio, Texas, the eighth largest school district in the state (2nd largest in San Antonio). She was hired to launch the Asthma Awareness Education Program back in 2006 after the district realized that poorly controlled asthma among the student population was having a negative impact on academic performance. NEISD has over 8000 students with asthma- close to 12 percent of the student population. School funding was suffering as well, because in Texas funding is linked to average daily attendance levels and asthma was causing too many kids to miss school. The district received several awards over the years from the Environmental Protection Agency for their achievements in providing a healthy learning environment and multiple schools in the district received the American Lung Association Asthma-Friendly Schools Champion Gold Awards.

Asthma is one of the most common chronic disorders in childhood, currently affecting more than 6 million American children under the age of 18, with 4.1 million of these kids suffering from an asthma attack or asthma episode in 2011 alone. This highlights the urgency of proper asthma care, because if not properly managed, asthma can be a life-threatening disease.

As the Assistant Director of Asthma Education at the North East Independent School District (NEISD) in San Antonio, Texas, I am also acutely aware that asthma is one of the leading causes of school absenteeism. In 2008, asthma accounted for an estimated 14.4 million lost school days throughout the United States, which can lead to further set-backs in school and missed opportunities. In this way, asthma doesn't just affect our student's health, it affects their education as well. In addition to lost days, school district administrators, teachers and school nurses also realize the loss of valuable academic classroom time as a result of frequent school clinic visits. Additionally, the child who is experiencing symptoms in the classroom is not going to achieve their full academic potential. When you can't breathe, nothing else matters.

When looking at this issue through our school district, we were able to see that during the 2006-2007 school year we had 120 Emergency Medical Service (EMS) calls for students in respiratory distress which resulted in 80 students leaving campus in an emergency vehicle to a local emergency department. Further investigation revealed these EMS calls were predominately due students experiencing symptoms at school and not having access to their quick-relief albuterol medication. Given the information on asthma management available today (medications and trigger reduction), this was unacceptable.

Armed with this information, I was able to work with our NEISD superintendent, Medical Advisory Council and Health Services Department to create asthma-friendly policies for emergency albuterol. We drafted a policy that addressed the gaps in medication accessibility for many of our students as well as met the needs of school nurse licensing laws. We provided education and training to all nurses during school staff in-service training. Campus nurses were very appreciative of a policy that allowed them the ability to help a child who couldn't breathe versus just "waiting" for EMS/parent to arrive.

Did you know?The American Lung Association's Template Policy on Stock Bronchodilators can assist school districts with a framework for back-up emergency nebulizers and children to self-carry and administer their own medication.

In year one of this new program, we saw a decline in the number of asthma related emergencies and EMS transports. Eighty transports quickly reduced to 32. Instead of making that call, we were able to provide earlier medication intervention and fostered continuity of care; allowing students to follow-up with their primary care provider to assess lack of asthma control. The nurses also had an opportunity to engage and educate parents and students on asthma management. We heard the appreciation from families on addressing their child's immediate needs as well as the associated cost-savings to families they would have encountered otherwise with an emergency department visit.

By the 2008 – 2009 school year, two years into the program, we had 94 asthma related emergencies; 70 met our early intervention criteria (i.e., diagnosis of asthma on file) allowing us to administer medicine (albuterol).  Of those 70, only five students' asthma symptoms did not improve after nebulized albuterol and needed to be seen at an emergency department. Early intervention of albuterol by the school nurse may have saved these students lives.

We know that every child that is developmentally and physically capable of self-monitoring and administering their medication should be allowed to do so.  Allowing students to carry their quick-relief inhaler with them during the school day and properly using their quick-relief inhaler can prevent or reduce the severity of an asthma episode and keep children healthy, in school and ready to learn. Early intervention of albuterol is key.  To ensure students with asthma can have lifesaving medication, self-carry is essential and is done effectively when school districts incorporate asthma education, awareness, trigger reduction, and disease-management strategies as part of the culture.

By working with our school board, administration, school nurses, physical education teachers, classroom teachers, parents and students our school district is able to provide a healthy and safe learning environment for all of the children in our care.Healthy children learn better.

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