Supporting Children and Students With Prevalent Medical Conditions In Schools: Asthma Procedure

This procedure has been created to support Policy/Program Memorandum No.161 (PPM161): Supporting Children and Students with Prevalent Medical Conditions in Schools, Ryan’s Law, 2015, and Durham District School Board Policy.

The goals of this procedure are to support the creation of asthma friendly schools allowing students with asthma to:

• Maximize their potential for growth, development and achievement;
• Experience positive educational, social and health benefits; and 
• Develop lifelong skills for managing their asthma.

This procedure should assist school Principals, staff, parents/ guardians and students in preparing mutually acceptable plans to support children with asthma. Since parents/guardians, students (if age appropriate) and staff have responsibilities in this matter, consultation, on-going communication and regular training are essential for a successful plan.

1.1 According to the Ontario Lung Association, asthma is a very common chronic (long-term) lung disease that can make it hard to breathe

1.2 People with asthma have sensitive airways that react to triggers. There are many different types of triggers for example poor air quality, environmental allergies, viral infections, animals, smoke and cold air. Symptoms of asthma are variable and can include coughing, wheezing, difficulty breathing, shortness of breath and chest tightness.

1.3 The symptoms can range from mild to severe and sometimes could be life threatening.

SCHOOL PLAN FOR ASTHMA SAFETY

All school and individual asthma safety plans must adhere to DDSB Privacy Policy, Regulation, and Procedure.

2.1 The parents/guardians or students (if age appropriate) are responsible for:

2.1.1 informing the school Principal about their child’s asthma and use of asthma medications

2.1.2 completing the health information on the Student Registration Form

2.1.3 considering the merits of their child wearing medical identification such as MedicAlert ®

2.1.4 immediately informing the Principal if there is a change in medical conditions as they pertain to asthma

2.1.5 completing an Individual Student Asthma Management Plan form

2.1.6 ensuring the inhaler is current and not past its expiration date

2.2 The student is responsible for:

2.2.1 Ensuring they have easy access to their asthma medication

2.2.2 Wearing medical identification e.g. MedicAlert® (http://www.medicalert.ca/www.medicalert.ca), if available

2.3 The Principal shall be responsible for:

2.3.1 establishing a process to identify students with asthma at time of registration or following diagnosis and gather necessary asthma related information from the parents/guardians and student; 

2.3.2 developing an individual student asthma management plan for each student diagnosed with 
asthma, based on the recommendation of the student’s health care provider

2.3.3 ensuring easy access to asthma medication and identifying which students can carry and administer their asthma medication

2.3.3 a. permitting a pupil to carry his or her asthma medication if the pupil has his or her parent’s or guardian’s permission

b. permitting a pupil 16 years or older to carry his or her asthma medication without parental permission

2.3.4 maintaining a file for each student diagnosed with asthma (the file may contain personal medical information, treatment plans and other pertinent information about the student accessed with the appropriate consents). The file shall also include current emergency contact information.

2.3.5 creating a health board similar to that for students with severe allergies to ensure school staff are informed and aware of student needs.

2.3.6 informing school board personnel and others who are in direct contact on a regular basis with a student with asthma about the contents of the student’s asthma management plan

2.3.7 developing a process for notifying supply teachers (e.g. briefing the supply teacher, posting a sign on the classroom door and/or a note in the supply teacher binder) 

2.3.8 ensuring communication with parents when a student with asthma has an asthma attack or shows symptoms

2.3.9 following the Indoor Air Quality procedure to have additional air testing should there be air quality concerns

Asthma is a chronic inflammatory condition in the airways of the lungs.
Students with asthma have very sensitive airways that react to triggers in the environment. When students 
with asthma come in contact with one of their triggers, the airway narrows leading to symptoms such as:

• coughing
• wheezing
• difficulty breathing
• chest tightness

For some students with asthma, the most common (and perhaps only) symptom is coughing.

Triggers are things in the environment that cause, provoke or aggravate asthma symptoms (e.g., coughing, wheezing, difficulty breathing).

Common triggers include:

• viral infections (e.g., colds/flu), which cause up to 90 percent of asthma attacks in children;
• tobacco smoke;
• air pollution;
• physical activity;
• extremes in weather;
• allergies (e.g., animals, pollen, mould, dust, dust mites);
• strong odours (e.g. paints, permanent markers, perfumes, cleaning products, glue).

REGULAR TRAINING ON ASTHMA AWARENESS 

4.1 The Principal is responsible for ensuring that:

All employees and others who are in direct contact with students on a regular basis receive regular training on:

• Common asthma triggers
• Identify asthma signs and symptoms
• Medication and use
• Asthma emergency protocol

4.2 Employees and others include, but are not limited to: 

• Administration
• Department Heads
• Regular administrative staff
• Classroom staff
• Clerical staff
• Supply teachers
• Custodians
• Lunch supervisors
• Parent volunteers
• Bus drivers

4.3 Training includes information which may be presented by one or several of the following:

Professional Organizations:

The Allergy Asthma Information Association (AAIA) (www.aaia.ca) can provide speakers as well as a comprehensive package of training materials for schools 

Physician or health care provider Identified student's parent(s) or guardian(s)

4.4 Staff Meetings

Ensure time at a staff meeting is allocated early in the school year to review the asthma procedure and provide update information. 

4.5 Resources 

Provide all staff with appropriate resources such as pamphlets, documents and related websites. See Appendix C. 

It is difficult to predict when asthma will worsen. When a student experiences asthma symptoms such as difficulty breathing, coughing and/or wheezing, the use of reliever medication is needed. If a student experiences asthma symptoms, follow recommendations outlined in their completed Individual Student Asthma Management Plan. Calling 911 is recommended if there is any doubt or concern.

The Ontario Lung Association’s Managing Asthma Attacks guideline is included as Appendix B. It outlines how to determine the severity of the asthma attack/exacerbation and the steps to take. This guideline is to be reviewed annually by all school staff. 

6.1 The safety, health and well-being of students with a medical condition such as asthma are shared responsibilities of the Board, school, family, health care provider and community partners. Asthma is leading cause of hospital admissions, emergency room visits and school absenteeism. Asthma can cause disrupted learning through absenteeism and interrupted sleep, which affects the ability to concentrate. 

6.2 Students with asthma can lead healthy, happy, active lives by maintaining control of asthma through medications and management of their triggers. Schools are required to identify and reduce common asthma triggers within the school (e.g., dust, moulds, pests, fumes and fragrances), with special attention to two common asthma situations; asthma and physical activity, and, asthma and anaphylaxis.

6.3 Vigorous activity often triggers asthma symptoms. This is especially the case in extremes of weather and/or when a student's asthma is not well controlled, such as when recovering from a common cold or infection. Physical activity should not be started if the student is already experiencing asthma symptoms. Asthma symptoms can occur several minutes into the activity and/or up to 30 minutes after stopping the activity. If a recurring pattern of asthma symptoms with physical activity is seen, talk to the student (if age appropriate) and the parents/guardians and let them know what you are observing. Having asthma interrupt physical activity is a common sign that the asthma is not well controlled.

The following strategies can help students with asthma to participate in physical activity:

• The student should not participate in physical activity if he or she is already experiencing asthma symptoms.
• Ensure a gradual warm-up has occurred before activities requiring sustained exertion.
• Be aware of potential asthma triggers in the area and try to reduce exposure to them. 
• Encourage the student to wear a scarf or facemask in cold weather to help warm and humidify the air.
• Move planned outdoor activities to well-ventilated indoor sites if there are extreme weather conditions (cold, hot, humidity, wind), high pollen counts or poor air quality.
• Check pollen levels in your community at www.theweathernetwork.ca and air quality forecasts and smog alerts at www.airqualityontario.com and www.airhealth.ca. In general, consider modifying plans for outdoor physical activity if the Air Quality Health Index (AQHI) is between four and ten for students with asthma or between seven and ten for the general population. This is a general guideline for the use of the AQHI. Some students with asthma may experience triggering of their asthma at a lower level if they have poorly controlled or severe asthma, while others with asthma may have no problems in the upper range of the AQHI if their asthma is well controlled.
• Have parents/guardians inform staff of modifications or considerations for participating in physical activity.
• Notify parents/guardians if the student is not able to fully participate in physical activity because of asthma symptoms; this can be a sign of poorly controlled asthma that may require follow-up with their health care provider.

6.4 The risk of exercise-induced asthma symptoms is reduced by keeping asthma well controlled. Sometimes a reliever inhaler is prescribed to be taken 10 to 15 minutes before the activity is started to prevent symptoms for students with more difficult to control asthma. For the majority of students, preventive use of the reliever inhaler before activity will not be prescribed so if symptoms occur after the activity has started, the reliever inhaler should be taken. If the student used the reliever inhaler before the activity and symptoms are experienced after starting the activity, the reliever can be used again to relieve symptoms. The student should not continue the activity and should be monitored for worsening asthma. For students identified with exercise-induced asthma, the teacher/coach should review each student's Individual Student Asthma Management Plan form for specific information on managing asthma during physical activity and have a conversation with each student and/or the student's parent/guardian to learn more about the student's asthma

6.5 Students with asthma in conjunction with life-threatening allergies (ie. anaphylaxis) are at a much greater risk of having a severe and fatal reaction. Understanding the signs and symptoms of asthma and anaphylaxis are necessary to manage serious reactions. Refer to students' Individual Student Asthma Management Plan form which contains information about life-threatening allergies and asthma. Know what causes their anaphylaxis, the signs and symptoms of a reaction and how to manage the reaction. Refer to your school board's Anaphylaxis Policy for more information regarding the prevention and management of life-threatening allergies. If a life-threatening asthma event is happening to a student with anaphylaxis, an epinephrine auto-injector (e.g., an EpiPen) should be easily accessible and used.

7.1 The Individual Student Asthma Management Plan shall include:

• Details about informing employees and others who are in direct contact with the student on a regular basis of the monitoring and avoidance strategies and appropriate treatment
• A readily accessible emergency procedure for the student, including emergency contact information
• Details relating to the storage of the pupil’s asthma medication, including:
  
  1. if the pupil is under 16 years old, whether the pupil has his or her parent’s or guardian’s permission to carry his or her asthma medication, and
  2. whether any spare medication is kept in the school and, if so, where it is stored

7.2 Employees may be preauthorized to administer medication or supervise a pupil while he or she takes medication in response to an asthma exacerbation if the school has the consent of the parent, guardian or pupil as applicable

7.3 It is the obligation of the pupil’s parent or guardian and the pupil to ensure that the information in the pupil’s file is kept up to date with the medication that the pupil is taking

7.4 If an employee has reason to believe that a pupil is experiencing an asthma exacerbation, the employee may administer asthma medication to the pupil for the treatment of the exacerbation even if there is no preauthorization to do so

7.5 Employees must know where extra medication is stored for each child. For example, is there extra in the office as well as with the student?

8.1 Principal shall arrange for a debriefing session in order to:

• Review the incident in question
• Evaluate the response
• Formulate lessons learned

8.2 Debriefing session should involve (at a minimum)

• The Principal, parent(s)/guardian(s), the student (if age appropriate) and any relevant employee(s)

9.1 The Principal is responsible for:

• Creating and maintaining a record of all asthma events. 
• Reporting on the number of students with asthma, and all asthma events to the Operations Dept.