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She admits that more could be done for children with chronic diseases like asthma if there were more school nurses. Technically, a school nurse is assigned to each school, but many school nurses are spread thin. For years, parents and legislators have supported efforts to add more school nurses, but there never seems to be enough money in the state coffers to fund such a measure.

“In the past, there has been legislation to increase the number of school nurses,” says Wilma Chan, a state assemblywoman who represents Oakland. “However, given the budget shortfall, and the fact that schools are being cut right now, it is very hard to get these kinds of measures passed.”

Although state legislators are not likely to fund a school nurses program in the near future, a major piece of legislation to improve asthma management recently passed. In early October, Gov. Arnold Schwarzenegger signed a bill to allow schoolchildren to carry and self-administer emergency asthma and anaphylaxis medications like EpiPen at school. California joins 30 other states that allow students the right to carry and self-administer asthma medication.

Even though the measure received popular support from most health care professionals, some school nurses are concerned there will be no one in the school to monitor the child’s behavior. “One of the drawbacks is that you could have a child sucking on his or her inhaler every 15 minutes and no one knows,” says Lynn Devine of the American Lung Association. “On the other hand, if a child needs an inhaler and they can’t get to it, that’s a bigger drawback.”

Chan believes the legislation may save lives. “There have been some incidents where a child had an asthma attack and their inhaler was locked away and the principal was out and the child ended up in the emergency room.”

Kaley says, “It’s still up to health care professionals to educate children about the proper use of their medications. Certainly, a 4-year-old should not have medication because I don’t think we can adequately train them to know when to take it and how to take it properly, but definitely an 8- or 9-year-old can be trained.”

Asthma 101

To help school nurses and educators teach children about asthma, the American Lung Association offers numerous programs, including the Asthma Friendly Schools initiative, to help schools develop comprehensive asthma management plans and programs. Additionally, the Open Airways for Schools program targets children aged 8 to 11. The program teaches them how to control their asthma, how to identify and avoid triggers, how to interact with parents and peers about asthma, and how to use medications.

“What that program has shown is that kids who have gone through it get better grades, parents get more involved in their asthma management, they have fewer asthma symptoms, and more recent studies show that it helps reduce absenteeism,” Devine says.

Another program, which started in Bakersfield and is being adopted in other towns, helps schools better monitor air quality through an innovative flag system. The way the program works is each school checks a website to determine the local air quality, and if it is bad, a red flag is flown, indicating all children should remain indoors for physical activity. A green flag represents good air quality.

Additionally, the Environmental Protection Agency developed the Tools for Schools Kit, a low-cost method for schools to inspect their indoor environments for dust, mold, and pollutants that affect air quality.

Devine says, “You would be surprised how many teachers don’t know that by storing cardboard boxes on top of the ventilation system, they decrease the ability of kids to breathe clean air.”

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