Counseling and Human Development Services

Children with Asthma Strategies for Educators

AUTHOR:       Yvette Q. Getch, Stacey Neuharth-Pritchett

TITLE:           Children with Asthma Strategies for Educators

SOURCE:    Teaching Exceptional Children 31 no3 30-6 Ja/F '99

The magazine publisher is the copyright holder of this article and it is reproduced with permission. Further reproduction of this article in violation of the copyright is prohibited.

Do you know the following astounding facts about asthma? Do you know what to do if your class includes a child with asthma? In this article, we provide an orientation to the chronic condition of asthma and suggest ways in which educators and caregivers may assist children with asthma to have more positive and healthy educational experiences. Here are the facts:

Children with asthma represent the largest group of children with chronic illness enrolled in U.S. day-care centers, preschools, and elementary schools. Asthma affects 5 million children nationwide (Feldman, 1996).
Educators and caregivers on average will have two children with an asthmatic condition enrolled in their classrooms at any given time (National Heart, Lung and Blood Institute, NHLBI, 1993; Newacheck & Taylor, 1992); (see box, "What Is Asthma?").
In an August 7, 1997, press release, the Centers for Disease Control noted that asthma is one of the most costly diseases in the United States--the death rate for youth under age 19 has increased 78% between 1980 and 1993.
Despite the need for adequate medical care and the rise in the number of cases of asthma in young children, there is a shortage of full-time nurses and medical personnel assigned to U.S. child care centers and schools.

What results is an ever-increasing need for educators and other personnel to assist with the management of a child's asthma (Vail, 1996). In addition, unlike other chronic childhood diseases, asthma is a condition that often necessitates immediate medical intervention because children who experience severe asthmatic episodes may require attention within a matter or seconds or minutes.

ASTHMA AT SCHOOL

Asthma is the leading cause of school absenteeism (Majer & Joy, 1993). Approximately two-thirds of children with asthma have mild conditions, but the other third experience moderate to severe conditions. Given the limited research on the connections between asthma and schooling, however, there is insufficient evidence to suggest that school absence rates are associated with the severity of the asthma condition (Celano & Geller, 1993).

EFFECT ON ACADEMIC PERFORMANCE

Many educators are concerned about the effect of this chronic illness on children's academic performance. Children with severe asthma do not significantly differ in their school performance from children without asthma, although they experience a greater degree of absenteeism than do their peers without asthma (Celano & Geller, 1993). Indeed, other areas of development are more likely to be affected than academic performance. Academic performance among children with severe asthma is more likely to be influenced by socioeconomic status and behavior problems (Bender, 1995; Celano & Geller). Children with asthma are more likely to have experiences with depression or withdrawal, lower self-esteem and levels of confidence, and feelings of inadequacy and helplessness (Hamlet, Pellegrini, & Katz, 1992; MacLean, Perrin, Gortmaker, & Pierre, 1992).

Children with asthma may also be at risk for decreased school performance because of the following:

Unexpected adverse effects of asthma medication.
Incorrect perceptions that the child is too vulnerable to participate in school activities.
Acute exacerbation of symptoms.
Stress (Celano & Geller, 1993).

PSYCHOSOCIAL EFFECTS

Teachers should also note sources of stress for children with asthma. Perceptions of the frequency and severity of stressors of children with asthma are more related to their gender-role development than to their illness (Walsh & Ryan-Wenger, 1992). In general, girls with asthma are more likely to rate stressors they experience as more severe than do boys with asthma. Girls are more likely to feel left out of activities than are boys.

Pless and Nolan (1991) noted that teachers should monitor these stressors because children who experience symptoms of chronic physical disorders are at greater risk for psychosocial maladjustment than are other children their age. Psychological factors of the disease are important to consider because they may contribute to the frequency of asthmatic episodes, as well as to their severity (Weiss, 1994). Teachers should model for their students’ self-control, consistency, and a straightforward approach to dealing with asthmatic symptoms.

NEED FOR COLLABORATION AND EDUCATION

Researchers have found that systematic, comprehensive education and collaboration among all concerned--children with asthma, their parents, educators, caregivers, and medical personnel--increase the chance that the children’s illness will be controlled (Wigal, Creer, Kotses, & Lewis, 1990). Such education programs contribute to the following:

Preventing and managing asthma attacks.
Reducing the costs of medical care for asthma.
Attenuating the effect of asthma on life functioning.
Enhancing children’s responsibility for the management of their asthma (Wigal et al., 1990).

Findings by the NHLBI (1991) suggested that health education programs designed for medical care or clinical settings may be successfully integrated into schools and early education centers.

Partnerships among the students, parents or guardians, physicians, and educators are required for the effective management of asthma.

COMMON TRIGGERS AND INDICATORS OF ASTHMATIC EPISODES

HEADS UP ON THE ENVIRONMENT

As educators and caregivers, we may create classroom environments that minimize the chance of asthma attacks. Because children with asthma often have accompanying allergies, teachers should exercise caution in introducing allergens into the classroom (see box, "Common Triggers"). Consider the following situations and conditions within the environment:

Keeping the classroom free of dust, plants that generate pollen, molds, strong smells or perfumes, and cleaning chemicals will assist the breathing patterns of children with asthma.
Often, construction projects in or near schools or day-care centers increase the likelihood that children may experience an asthmatic episode.
Cold or dry air serves as a potential trigger for attacks.
At times, children who either laugh or cry too hard may experience an attack.
Upper-respiratory infections often contribute to breathing problems; as well, excessive exercise (such as running or jumping) may trigger an attack if the child hasn't taken a preventive medication dosage.
Although a perfectly wonderful teaching tool, classroom pets (especially those with feathers or fur) may contribute to breathing difficulties for children with asthma.

STAY ALERT FOR SYMPTOMS

Although we may minimize the exposure t o triggers of asthmatic episodes, no educational environment may be completely free of such contaminants. Therefore, we need to be aware of common signs of breathing difficulties. The most commonly recognized indicators of a potential asthma attack include observable shortness of breath, persistent cough, clipped speech, breathing faster than normal, and sneezing.

Other indicators may suggest an impending, asthmatic episode. Children may become irritable and restless and make comments like: "I don't feel well" or "My neck feels funny." Younger children have difficulty articulating exactly what they are experiencing (see box, "Early Warning Signs").

WHAT EVERY TEACHER SHOULD KNOW ABOUT ASTHMA

Studies indicate that although many teachers have taught children with chronic health conditions at some time during their careers, most teachers do not believe that they have adequate information about chronic illnesses (Johnson, Lubker, & Fowler, 1988). Because it is likely that every classroom teacher, at some time, will have a child with asthma in the classroom, we all must learn about asthma and how it can affect the child in the classroom setting. Here are nine important considerations for teachers:

Obtain a basic understanding of asthma to effectively meet the needs of children with asthma in the classroom. Be informed about asthma and the potential effect it may have on the child.
Familiarize yourself with the school's policies regarding administration of medications and emergency medical treatment. Teachers should have discussions with their administrators about the balance of intervening or not intervening when a child has an asthmatic episode. The administrators and teachers need to weigh the liability issues of not intervening that may result in serious illness or death against intervening with liability 6f administering medications.
Because every child's asthma management plan is different, teachers need to understand asthma medications, how to administer them, and their potential side effects. Awareness of common side effects resulting from the use of asthma medications should be part of the teacher's knowledge base. By understanding these side effects, teachers may more appropriately handle the child's behavior (e.g., irritability, nonattention) in the classroom. Teachers should be sensitive to different ways that parents may perceive their child's needs and the management of those needs in school (e.g., cultural differences, language differences, religious beliefs, parental disability issues).
Recognize the early warning signs of asthma. When recognized early, asthma can be treated, and more serious episodes can possibly be avoided (Weiss, 1994).
Know the emergency procedures for handling the child's asthma episodes, including which medications to give, the dosage, and the procedure for administration. Keep an asthma care plan (see Figure 1), for each child with asthma, in an accessible location in the classroom. This way, you can refer to the plan in an emergency situation.
Be well versed on the child's triggers and help eliminate as many triggers as possible.
Communication among the teacher, the child's parents, significant others, school nurses, and doctors is necessary to effectively manage the child's asthma at school (Celano & Geller, 1993). Be sensitive to language and cultural issues when discussing the child's asthma condition with family members. With the assistance of the asthma care plan (see Figure 1, page 34-35), you may be able to elicit relevant information from parents, as well as encourage parents to seek additional information when indicated.
Become familiar with resources that ' will help teachers educate other children about the illness (Goldberg, 1994). There are materials that can be used in the classroom to effectively educate children about asthma (e.g., children’s literature, drama centers) and assist the teacher in becoming more comfortable in working with children with asthma. (see "Resources" box).
Understand that parents and significant others often face conflict over the cause, treatment, and prognosis of their child's asthma condition (Walsh & Ryan-Wenger, 1992). When working with significant others, you should be cognizant of the stress the family may be experiencing due to medical expenses, lack of sleep, and worry.

MANAGING ASTHMA AT SCHOOL

Doctors, the child with asthma, parents, teachers, school administrators, and school health care workers are all important members of the asthma management team. When children with asthma, their parents, and school personnel are educated about the illness, there is an increased chance that the child's asthma will be controlled (Wigal et al., 1990).

Teachers who understand the basics of asthma can effectively ask the parents for the information needed to help manage the child's asthma during the school day. Unfortunately, many parents are not prepared to discuss their child's asthmatic condition (Johnson et al., 1988); some parents find it difficult to provide school personnel with the information necessary to prevent, reduce, and manage their child's asthma at school.

ENCOURAGING PARENTS AND OBTAINING INFORMATION

One simple way to elicit information about the child's asthma is to have the parent(s) fill out an asthma care plan (see Figure 1). If the children has difficulty filling out the form, the teacher can do the following:

Speak with the parents and include statements like the following:

I want you to know that I am concerned about anything that happens in the life of your child. Because your child has asthma, it is very important that I obtain all the information possible about your child's condition, the medicine your child takes, and medical procedures the school needs to follow. I want your child to be able to participate in all of our activities, so I need to be aware of things that might trigger an episode.
Initiate a discussion with parents regarding the asthma care plan. You might approach parents with statements like the following:

At our school, we have parents fill out an asthma care plan. This plan helps everyone, to understand how to reduce or prevent an asthma attack, as well as what to do when asthma symptoms occur. Please fill out this form, and if you have any questions, please ask. Your input is valued, and you know your child better than anyone else. When you share this information, it helps us take better care of your child.
If parents have difficulty filling out the necessary information on the form, you might want to
approach them in this manner:

I know this is a lot of detailed information. It is okay if you can't fill the form out completely right now. Do you think you could meet with your doctor to help you fill out the form? We need the physician's signature to carry out the procedures. We really appreciate your taking the time to make sure we have the information we need to help manage your child's asthma at school. We want your child to be healthy and enjoy school.

UNDERSTANDING PARENTS' STRESS

Teachers should be aware that families who have children with asthma may experience extra stressors, including medication costs and lack of insurance. Many insurance plans do not cover medications, and some families may not have access to medical insurance.

Further, asthma episodes can be frightening and draining and may last for a few hours or weeks at a time. A parent may have been awake all night with a child, giving breathing treatments every hour or two. Children with asthma are more susceptible to upper-respiratory infections (American Lung Association, ALA, 1994a) that may lead to hospitalization for asthma-related illnesses. The financial and emotional strain can take a toll on the child and the family system that ultimately affects the child's performance in school, as well as the child's relationship with the teacher.

Teachers also need to realize that parents often must send their kids to school even when they would probably rather keep them at home. Children with chronic asthma may have some kind of breathing difficulty every week. If the parents were to keep the child home every time the child's breathing was not "normal," the child would miss a significant amount of school, which might contribute to the child's feelings of inadequacy and level of self-esteem (Bender, 1995).

FINAL THOUGHTS

Because the numbers of children diagnosed with asthma are rising at an alarming rate it is necessary for educators to understand the etiology of the condition and its management in the classroom. Educators may assist children with asthma by locating and minimizing the common triggers that induce asthmatic episodes, creating classroom environments that enable children with asthma to experience fewer attacks, discussing the child's condition with the parents, and constructing an asthma care plan to assist the child in emergencies. Arming teachers with knowledge about asthma will elicit happy and healthy relationships for children that contribute to successful educational experiences.

ADDED MATERIAL

Yvette Q. Getch, Assistant Professor, Department of Counseling and Human Development Services; Stacey Neuharth-Pritchett (CEC Georgia Federation) Assistant Professor, Department of Elementary Education, The University of Georgia, Athens.

Address correspondence to Yvette Q. Getch, Department of Counseling and Human Development Services, The University of Georgia, Athens, GA 30602 (e-mail: ygetch@uga.edu).

Authors' Note: Because state and school policies vary, it is important for teachers to become familiar with their school's policy regarding medication, medication forms, requirements for physicians' signatures, requirements for administration of medicines, and whether children can carry their asthma medication with them. If a school's policy does not support the effective management of asthma, teachers can advocate for policy changes that will promote the health and welfare of children with asthma in the school system.

Two students performing breathing treatments (both are using an albuterol inhaler one via a spacer and the other via an aerochamber).

FOOTNOTE

To order books marked by an asterisk (*), please call 24 hrs/365 days: 1-800-BOOKS-NOW (266ú5766) or (801) 261-1187 and ask for ext. 1212; or visit them on the Web at http://www.BooksNow.com/TeachingExteptional.htm. Use VISA, NVC, or ANMX or send check or money order + $4.95 S&H ($2.50 each add'l item) to: Books Now, Suite 125, 448 East 6400 South, Salt Lake City, UT 84107.

REFERENCES

American Lung Association. (1994a),. Childhood asthma [Brochure]. New York: Author.

American Lung Association. (1994b). Facts about asthma [Brochure]. New York: Author. Bender, B. G. (1995). Are asthmatic children educationally handicapped? School Psychology Quarterly, 10(4), 274-291.

Celano, M. P., & Geller, R. J. (1993). Learning, school performance, and children with asthma: How much at risk? Journal of Learning Disabilities, 26(l), 23-32.

Center for Disease Control. (1997). Press release (August 7, 1997). [On-line]. Available: www.cdc.gov/nchfwww/datawh/statab/pubd/cc94t58.html

Feldman, W. (1996). Chronic illness in children. In R. H. A. Haslam & P. J. Valletutti (Eds.), Medical problems in the classroom: The teacher's role in diagnosis and management (3rd ed., pp. 115ú123). Austin, TX: Pro-Ed.(FN*)

Goldberg, E. (I 994). Including children with chronic health conditions: Nebulizers in the classroom. Young Children, 49(2), 34-37.

Han-Jet, K. W., Pellegrini, D. S., & Katz, K. S. (1992). Childhood chronic illness as a family stressor. Journal of Pediatric Psychology, 17(l), 3347.

Johnson, M. P., Lubker, B. B., & Fowler, M. G. (1988). Teacher needs assessment for the educational management of children with chronic illness. Journal of School Health, 58, 232-235.

MacLean, W. E., Perrin, J. M., Gortmaker, S., & Pierre, C. B. (1992). Psychological adjustment of children with asthma: Effects of illness severity and recent stressful life events. Journal of Pediatric Psychology, 17(2), 159-171.

Majer, L. S., & Joy, J. H. (1993). A principal's guide to asthma. Principal, 73(2), 42-44. National Heart, Lung and Blood Institute. (I 99 1). Managing asthma: A guide for schools. Bethesda, MD: Author. [ERIC Document Reproduction Service No. ED 350 554]

National Heart, Lung and Blood Institute. (1993). Asthma awareness: Curriculum for the elementary classroom. Bethesda, @: Author. [ERIC Document Reproduction Service No. ED 375 115]

Newacheck, P. W., & Taylor, W. R..(199.2). Childhood chronic illness: Prevalence, severity, and impact. American Journal of Public Health, 82(3), 3 64-3 7 1.

Pless, I. B., & Nolan, T. (I 99 1). Revision, replication and neglect: Research on maladjustment in chronic illness. Journal of Child Psychology and Psychiatry and Allied Disciplines, 32(2), 150-161.
Vail, K. (1996). A finger on the pulse. Executive Educator, 18(5), 24-27.

Walsh, M., & Ryan-Wenger, N. M. (1992). Sources of stress in children with asthma. Journal of School Health, 62(10), 459-463.

Weiss, J. H. (1994). A practical approach to the emotions and asthma. American Lung Association Bulletin, reprint.

Wigal, J. K., Creer, T. L., Kotses, H., & Lewis, P. (1990). A critique of 19 self-management programs for childhood asthma: Part 1. Development and evaluation of the programs. Pediatric Asthma, Allergy, and Immunology, 4, 17-3 9.

WHAT IS ASTHMA?

The American Lung Association (ALA, 1994b) has a brochure called Facts About Asthma. According to the ALA, asthma is often a chronic condition that one must live with every day. Asthma makes it difficult to breathe. When a child has asthma, the lungs produce excess amounts of mucus. There is mucosal swelling, constriction of the airways occurs, and the muscles tighten (bronchospasm). Sometimes the increased mucus forms sticky plugs in the bronchial tubes, making it even more difficult to breathe.

It is important to remember that asthma is a reversible obstructive airway disease that is characterized by sensitive airways. The airways become highly reactive and sensitive to infection, exercise, and triggers (ALA, 1994b).

Triggers are things or conditions that contribute to an asthma episode. Each child has different triggers, and the severity of asthma varies from child to child. Because each child’s asthma is different, the medication and treatment plan should be tailored to meet his or her individual needs.

COMMON TRIGGERS TO ASTHMATIC EPISODES

According to the American Lung Association (ALA, 1994a), the following are common triggers for asthma attacks:

Dust, chalk dust
Pollens
Molds
Strong smells, perfumes
Chemical smells
Smoke
Paint fumes
Cold or dry air, smog
Laughing or crying hard
Exercise
Upper-respiratory infections
Cockroach droppings
Feathered or furry classroom pets (animal dander)

EARLY WARNING SIGNS OF ASTHMATIC EPISODES

The American Lung Association (1994a), in a brochure entitled Childhood Asthma, describes the following early warning signs:

Heavy feeling of pressure on chest
Chronic, persistent cough
Shortness of breath
Exercise intolerance
Fever
Sore throat
Itchy chin, throat, chest
Restlessness
Headache, runny nose
Irritability
Comments like "My chest is tight," "My chest hurts," "I can't catch my breath," "My mouth is dry," "My neck feels funny," "I don't feel well," "My head is stopped up."
Clipped speech
Changes in breathing patterns, breathing faster than normal
Drop in peak flow reading, which measures lung function
Tired, itchy, watery, or glassy eyes
Sneezing
Change in face color
Dark circles under eyes

RESOURCES

ORGANIZATIONS

AMERICAN LUNG ASSOCIATION
1740 Broadway, 14th Floor
New York, NY 100 1 9
Phone: 212-315-8700; URL: http://www.lungusa.org
Site provides general information on asthma, including descriptions of triggers and information on medications. The site has a special section for children, as well as information in Spanish.

ASTHMA AND ALLERGY FOUNDATION OF AMERICA
1125 15th Street, N.W., Suite 502
Washington, DC 20005
Phone: 1-800-727-8462; LJRL: http://www.health-line.com
Site maintains information on allergy and asthma peer-support groups and a clearinghouse of
current and affordable educational materials. The foundation also distributes a bimonthly newsletter.

NATIONAL ALLERGY AND ASTHMA NETWORK/MOTHERS OF ASTHMATICS
2751 Prosperity Avenue, Suite 150
Fairfax, VA 22031
Phone: 1-800-878-4403; URL: http://www.aanma.org
Site contains information on frequently asked questions about asthma and written information that families may use to assist them with their child's condition.

NATIONAL ASTHMA EDUCATION AND PREVENTION PROGRAM INFORMATION CENTER
P.O. Box 30105
Bethesda, @ 20824
Phone: 301-496-5717; URL: http://www.mediconsult.com/asthma/
Site contains information on educational materials, general asthma information, access to research articles, and practical suggestions for asthma management. Site also contains an electronic support group for asthma-related questions that is monitored by a physician.

BOOKS FOR CHILDREN
Sander, N. (1993). So you have asthma too! (K. S Mauck, Illus.). Research Triangle Park, NC: Allen & Hanburys. (Primary Student Audience).

Brooke, a 7-year-old girl with asthma, discusses how to control asthma to have a healthy, normal life. She demonstrates the function and processes of the lungs for people both with and without asthma. The book introduces many vocabulary words, with simplified explanations. The book also examines the possible causes of asthmatic attacks and provides a checklist of what to do when wheezing occurs.

Ostrow, W., & Ostrow, V. (1989). All about asthma (Sims, B., Illus.). Morton Grove, IIL: Albert Whitman & Company. (Older Elementary Audience).

Eight-year-old William describes his experiences with asthma, his trips to the doctor, his fright and embarrassment, and the symptoms he felt. In several chapters, the book describes in detail the physical processes of the breathing process; what asthma is and is not; the relationships among asthma, allergies, and heredity; and preventative measures in dealing with this condition. All About Asthma offers many helpful suggestions on asthma education and daily practices for people with asthma, and even includes a list of famous people who have asthma.

FIGURE 1. ASTHMA CARE PLAN

Note to Teachers or Caregivers: The Asthma Care Plan is a useful tool for parents, day-care centers, babysitters, and schools. Included in the plan are specific instructions on what to do in the event of an asthma episode. Parents should fill out the form completely; and the form should be signed by the parent(s) and the child's physician. If parents are unable to fill out the form, they may need to obtain more information from their child's doctor.

Parents should describe to caregivers what asthma symptoms look like. Although the symptoms are listed on this form, a caregiver might not know what "nasal flaring" or "retractions" look like. It is also important for the parents and teacher to discuss the information contained on this form. The sample form included here has been filled out for a child with asthma. (Pseudonyms are used.)

Instructions for Parents:

List all medicines that your child is currently taking (including over-the-counter drugs). This is very important in a medical emergency. Emergency personnel treating a child need to know what medicine(s) he or she is currently taking.
The allergies section is also important. C4retakers must know what not to expose your child to. If the child is accidentally exposed, the caretaker or teacher must know what the child's typical reaction is.
List other symptoms that may indicate your child is not breathing well. You know your child better than anyone else. Are there specific kinds of behaviors your child shows when he or she is not breathing well? List these, even if they sound silly.
What is the child's typical behavior? Caregivers, especially new ones, need to know what is normal for your child. This will help them detect if the child is not behaving as he or she normally does.
The information on this sheet will help caregivers or teachers monitor your child's asthma and obtain appropriate medical care, if needed. This sheet can also help caregivers recognize the early signs of an asthma episode. Both a parent and the child's doctor must sign the form.

ASTHMA CARE PLAN

Child's Name: Ronnie Childress
Date of Birth: 9-17-92
Parent(s) Name: Anna Childress 555-0000, (work) 555-0000 (home)
Chad Childress 555-0000 (work) 555-0000 (home) 555-0000 (cellular phone)
Other Emergency Contact: Bonnie Childress 555-0000 Grandmother
Physician: Dr. Robert Smith 555-0000
Ambulance: 911

What to Do If Asthmatic Symptoms Occur

Step 1: Shake the inhaler and place the inhaler into aerochamber.

Step 2: Place mask over Ronnie's nose and mouth.

Step 3: Depress the inhaler to release the medicine (it sounds like a puff) and allow Ronnie to breathe in. Allow Ronnie to breathe into the mask 6 times.

Step 4: Repeat Step 3,until 8 puffs have been given and check Ronnie's peak flow reading on the peak flow meter.

Step 5: If his peak flow reading is 200 n-d (Green Zone) or above, just relax.

Check his peak flow again if you detect problems.
If you don't detect problems, check his peak flow every hour.
Plan to give 4 puffs of Albuterol inhaler every 4 hours unless he seems worse or peak flow meter reading drops.

Step 6: If peak flow reading is 170-200 ml (Yellow Zone), give 6 puffs of Albuterol inhaler.

Check his peak flow again if you detect problems.
If you don't detect problems, check his peak flow every hour.
Plan to give 6 puffs of Albuterol inhaler every 4 hours unless he seems worse or peak flow meter reading drops.

Step 7: If peak flow reading is 130-170 ml (Yellow Zone), give 8 puffs of Albuterol inhaler.

Check his peak flow again if you detect problems.
If you don’t detect problems, check his peak flow every hour.
Plan to give 8 puffs of Albuterol inhaler every 2 hours unless he seems worse or peak flow meter reading drops.
Call parents.

Step 8: If peak flow reading is 100-130 ml (Yellow Zone), give 8 puffs of Albuterol inhaler and call parents.

If you can't get parents immediately, call Ronnie's doctor and follow the doctor's instructions.
If the Albuterol doesn't help and Ronnie appears in any distress or is lethargic, call 911.

Step 9: If peak flow reading is below 100 ml (Red Zone), give 8 puffs of Albuterol inhaler and call 911. This is an emergency!!

Follow instructions given by emergency personnel.
Call parents as soon as you can.

MEDICINES

(Include medications currently taken, medications used for asthma control, medications used in an emergency, and over-the-counter medications.)
* Name: Flovent
Dose: 2 puffs via aerochamber
* Name: Albuterol
Dose: 2 to 8 puffs via aerochamber (according to peak flow reading)
Name: Albuterol
Dose: .25 n-A mixed with 3 n-A saline in nebulizer
* Name: Prelone
Dose: I teaspoon
Obtain Immediate Medical Attention If

Lips or fingernails are blue
Has difficulty talking or crying
Is unresponsive to stimuli
Chest sinks in deeply when breathing
Cannot drink liquids
Is just lying around and looks limp or extremely lethargic

ALLERGIES

* Trigger: Dogs
Typical Reaction: Coughing, drop in peak flow reading
* Trigger: Cigarette Smoke
Typical Reaction: Coughing, labored breathing, wheezing 5 drop in peak flow reading
* Trigger: Milk/Milk Products
Typical Reaction: Delayed reaction (4-12 hours after ingestion): wheezing, dark circles under eyes, runny nose, drop in peak flow reading
* Trigger: Strong Chemicals (Bleach)
Typical Reaction: Wheezing, coughing
* Trigger: Dust and Smoke
Typical Reaction: Wheezing, coughing

ASTHMATIC SYMPTOMS

Wheezing
Nasal flaring
Coughing
Rapid shallow breathing
Difficulty catching breath
Appears lethargic or unduly tired
Chest sinks in deeply when breathing

OTHER SYMPTOMS THAT MAY INDICATE BREATHING DIFFICULTY

Very cranky or irritable
Does not want to join in activities

CHILD’S TYPICAL BEHAVIOR

Ronnie is typically happy, social, energetic, and outgoing. He is not a cranky kid and tends to be lively and friendly. If Ronnie is ever lethargic, he is probably not breathing well.
Important: If his wheezing or difficulty breathing scares you, it is probably severe enough to require immediate medical attention. Please feel free to call 911.

REACTIONS OR SIDE EFFECTS ASSOCIATED WITH MEDICATIONS

Albuterol: Jittery, hyper, irritable (bouncing off the walls). Prelone: Same as Albuterol except more pronounced, increased heart rate, may be very distracted, doesn't listen or pay attention well.

OTHER SPECIAL INSTRUCTIONS

If you are unsure about Ronnie's condition, call his parents or the doctor. Ronnie's activities are not restricted. He can participate in all outdoor activities. Restrictions are only necessary if he is having problems with his asthma or the activity involves exposure to lots of dust (e.g., rolling in autumn leaves) or involves exposure to smoke (e.g., no roasting marshmallows over the campfire).

FOOD ALLERGIES

(If child has food allergies, provide a list of food the child can or cannot have.) Milk and milk products (e.g., pudding, cheese, yogurt, ice cream, chocolate candy bars, sour cream, cream soups, cheese crackers).

If Ronnie is having trouble with his asthma before school, the medications he has taken that morning will be documented and given to the teacher in case of increased breathing difficulty. This information must be given to emergency medical personnel if Ronnie's condition escalates and emergency personnel are contacted.

Signature of Parent/Guardian: Date:

Signature of Physician: Date: