Fresh Air
Growing incidence of asthma in California places greater emphasis
on the role of school nurses
By Paul Wynn
December 13, 2004
Like many children with asthma, Jessica Bryant missed countless days from school because of severe asthma attacks. And on occasion, she didn’t have access to her medication.
“It was really hard for my teachers to understand why I missed so much class, or why after running around at recess, I would have to miss reading and take my medication or go home,” the 15-year-old high school sophomore says.
Unfortunately for Jessica, the public school she attended in Sacramento did not have a school nurse to help educate teachers and administrators about the consequences of asthma. Her mother, Moe, believes Jessica would not have missed so much school if a school nurse had been present.
“The educational component that clinically trained people like nurses bring to educators who don’t have training or personal experience could have saved a tremendous amount of heartache for our family,” she says.
School daze
School nurses face a growing asthma crisis in California. An estimated 800,000 children, or one in seven, are affected by asthma in the Golden State. The prevalence of the respiratory disease has jumped 160% since 1980, and there seems to be no end in sight. It is estimated that asthma accounts for 7 million absences from school each year in California and costs schools $231 million annually.
What is contributing to the significant rise in asthma? There are a number of factors, experts say, ranging from poor indoor and outdoor air quality to environmental and geographical factors to improved diagnosis rates.
“There has been a lot of emphasis on educating pediatricians to recognize asthma sooner,” says certified asthma educator D.J. Kaley, RN, MSN, of Children’s Hospital Oakland. “If you can catch asthma at an earlier stage, then it won’t progress as quickly.”
Asthma attacks may be on the rise because children are spending more time indoors, where they might be exposed to more allergens that trigger inflammatory responses, according to researchers at Duke University. Carpeting and pets are two of the primary sources of indoor irritants that affect children.
Despite statewide efforts by the American Lung Association and other local groups to promote better disease awareness, asthma continues to be one of the biggest health problems facing California schools.
According to a national survey of school nurses in 2003, asthma is more disruptive of school routines than any other chronic condition and has a significant impact on absenteeism. Also, many school staff may lack awareness of the causes of an asthma attack.
“We recognize the damage that can be done to the education process when 14 million school days nationwide are lost annually due to asthma,” says Linda Davis-Alldritt, RN, MA, PHN, a fellow of the National Association of School Nurses and a consultant to the California Department of Education.
Needed: school nurses
Roberta Bavin, CPNP, who oversees a school-based health center for the Clovis Unified School District in Fresno, agrees that asthma is a major problem in her school district because of the poor air quality. Fresno is known for its poor air quality because its bowl-shaped landscape traps polluted air from pesticide use and fumes from nearby oil refineries.
Clovis Unified School District created school-based health centers to provide basic pediatric health care services, like asthma treatment, to underserved kids who often lack health insurance or access to quality medical care.
To improve overall asthma management, Bavin works closely with nurses at the school sites to ensure that children with asthma have immediate access to their medications when needed.
“These kids [are] seen for illnesses and treated the same day, they get their asthma medications authorizations to use their inhalers at school,” Bavin says.
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.”