The CDC's Six Strategies for Asthma-Friendly Schools
1. Establish management and support systems for asthma-friendly schools.
* Identify your school’s or district’s existing asthma needs, resources for meeting those needs, and potential barriers.
* Designate a person to coordinate asthma activities at the district and school levels. If your school or district has a health coordinator, determine if asthma coordination can be integrated into his or her activities.
* Share these strategies with the district health council and school health team if they exist. If you do not have a council or team, help create them. Ensure that school-based asthma management is addressed as a high priority.
* Develop and implement written policies and procedures regarding asthma education and management. Promote asthma programs that are culturally and linguistically appropriate.
* Use or adapt existing school health records to identify all students with diagnosed asthma.
* Use health room and attendance records to track students with asthma. Focus particularly on students with poorly managed asthma as demonstrated by frequent school absences, school health office visits, emergency room visits, or hospitalizations. Avoid mass screening* and mass case detection† as methods for routine identification. These methods have not been shown to meet the World Health Organization’s or American Academy of Pediatrics’ criteria for population or school screening programs.11-16
* Use 504 Plans or Individualized Education Plans (IEPs), as appropriate, especially for health services and physical activity modifications.
* Obtain administrative support and seek support from others in the school and community for addressing asthma within a coordinated school health program.
* Develop systems to promote ongoing communication among students, parents, teachers, school nurses, and health care providers to ensure that students’ asthma is well-managed at school.
* Seek available federal, state, and private funding for school asthma programs.
* Evaluate asthma program strategies and policies annually. Use this information to improve programs.
* Screening for asthma (spirometry) can identify students who, in a test situation, exhibit signs and symptoms of asthma. These students may or may not truly have asthma.
† Case detection (symptom questionnaires) can identify students with asthma symptoms who may or may not have the disease. Only testing and evaluation by a health professional can confirm which students truly have asthma.
2. Provide appropriate school health and mental health services for students with asthma.
* Obtain a written asthma action plan for all students with asthma. The plan should be developed by a primary care provider and be provided by parents. It should include individualized emergency protocol, medications, peak flow monitoring, environmental triggers, and emergency contact information.17–19 Share the plan with appropriate faculty and staff in accordance with the Family Educational Rights and Privacy Act (FERPA) guidelines or with parental permission.
* Ensure that at all times students have immediate access to medications, as prescribed by a physician and approved by parents. Specific options, such as allowing students to self-carry and self-administer medications, should be determined on a case-by-case basis with input from the physician, parent, and school.
* Use standard emergency protocols for students in respiratory distress if they do not have their own asthma action plan.
* Ensure that case management‡ is provided for students with frequent school absences, school health office visits, emergency department visits, or hospitalizations due to asthma.
* Provide a full-time registered nurse all day, every day for each school.
* Ensure access to a consulting physician for each school.
* Refer students without a primary care provider to child health insurance programs and providers.
* Provide and coordinate school-based counseling, psychological, and social services for students with asthma, as appropriate. Coordinate with community services.
‡ Case management by a trained professional includes assessing needs and planning a continuum of care for students and families.
3. Provide asthma education and awareness programs for students and school staff.
* Ensure that students with asthma receive education on asthma basics, asthma management, and emergency response. Encourage parents to participate in these programs.
* Provide school staff with education on asthma basics, asthma management, and emergency response as part of their professional development activities. Include classroom teachers, physical education teachers, coaches, secretaries, administrative assistants, principals, facility and maintenance staff, food service staff, and bus drivers.
* Integrate asthma awareness and lung health education lessons into health education curricula.
* Provide and/or support smoking prevention and cessation programs for students and staff.
4. Provide a safe and healthy school environment to reduce asthma triggers.
* Prohibit tobacco use at all times, on all school property (including all buildings, facilities, and school grounds), in any form of school transportation, and at school-sponsored events on and off school property (for example, field trips).
* Prevent indoor air quality problems by reducing or eliminating allergens and irritants, including tobacco smoke; dust and debris from construction and remodeling; dust mites, molds, warm-blooded animals, cockroaches, and other pests.
* Use integrated pest management (IPM)§ techniques to control pests.
§ IPM is a proactive approach to pest management that includes looking for signs of pests, controlling water and food sources, removing pest pathways and shelters, and safely using pest control products as needed.
5. Provide safe, enjoyable physical education and activity opportunities for students with asthma.
* Encourage full participation in physical activities when students are well.
* Provide modified activities as indicated by a student’s asthma action plan, 504 Plan, and/or IEP, as appropriate.
* Ensure that students have access to preventive medications before activity and immediate access to emergency medications during activity.
6. Coordinate school, family, and community efforts to better manage asthma symptoms and reduce school absences among students with asthma.
* Obtain written parental permission for school health staff and primary care providers to share student health information.
* Educate, support, and involve family members in efforts to reduce students’ asthma symptoms and school absences.
* Work with local community programs. Coordinate school and community services, including community health care providers, community asthma programs and coalitions, community counselors, social workers, case managers, and before- and after-school programs. Encourage interested school staff to participate in community asthma coalitions.