Information for school personnel regarding treatment of asthma
Miles Weinberger, MD
Professor of Pediatrics
Allergy, Immunology, and Pulmonary
Asthma is a disease characterized by increased sensitivity of the airways. This results in airway obstruction that is reversible spontaneously or as a result of treatment. Asthma is very common; at least five percent of your students will have some manifestations of asthma. There are many misconceptions about asthma among both the medical and lay community. Specific myths that have been discredited include:
- Is asthma a psychosomatic disease? Asthma has no greater association with psychological problems than might be expected from any recurrent or chronic illness.
- Do asthma medications cause behavior or learning problems? No such association has been established. Any suspicion you have of side effects from asthma medication should be discussed with the physician caring for the student's asthma.
- Can asthmatics exercise safely? When asthma is satisfactorily controlled, asthmatics need not be restricted from any activity up to and including competitive athletics. In fact, exercise is desirable to promote physical conditioning in asthmatics. However, prophylactic inhaled medication may be needed before exercise, and there may be temporary periods when activities will be less well tolerated. School personnel, including physical education instructors, must let the student temporarily stop vigorous activities upon the judgment of the student that asthmatic symptoms are present. Please discuss with the parents and/or the physician responsible for the medical care of the student's asthma if exercise is not tolerated or if you feel the student is inappropriately avoiding activities.
There is a wide range of severity among individuals, so treatment is individualized. School personnel should be cautious in generalizing from their own personal experience with asthma which may reflect greater or lesser severity of asthma than any individual student.
Intervention for acute asthmatic symptoms
All students with asthma occasionally require intervention measures for acute symptoms, regardless of whether or not their symptoms are sufficiently chronic to justify a preventative maintenance medication. It is critical that use of the initial intervention measure, a bronchodilator inhaler, never be delayed. For this reason, it is essential that all students with sufficient maturity have their bronchodilator inhaler in their possession at all times. This bronchodilator inhaler is used at the discretion of the student for acute symptoms of asthma.
The bronchodilator inhaler is also commonly used prophylactically before exercise to prevent exercise-induced asthma.
Who keeps the bronchodilator inhaler at school?
School policy restricting possession of medication by students is insufficient grounds for preventing students with sufficient maturity from retaining possession of their bronchodilator inhaler. Such policies, when enforced, delay appropriate treatment, restrict activities unnecessarily, and require that the student be identified among peers as requiring special attention. The decision regarding sufficient maturity of the student to be responsible for appropriate inhaler use is an individual one to be made by the parents in consultation with their physician. The inhalers pose no abuse potential or other danger to classmates. It therefore constitutes unreasonable interference with the student's medical care for school personnel to unilaterally restrict possession of bronchodilator inhalers by students judged by parents and physician to have sufficient maturity to use the device appropriately. While restrictions on bronchodilator inhaler possession may be necessary for the youngest students, the earlier students begin to take responsibility for their own inhaler use, the earlier they will be able to manage their asthma sufficiently to function in a fully peer-appropriate manner and thereby minimize feelings of difference from classmates. This feeling of control and self-confidence is important in the long-term management of asthma. Possession of the bronchodilator inhaler by the student also promotes earlier use that decreases the risk of requiring emergency medical care from rapidly progressive asthma, which on rare occasion can cause hypoxia, brain damage, and death.
Responsibility for care of their medical problem is also enhanced by permitting children with asthma to take their scheduled medication on their own. Discussion among parents, physician, and school personnel can determine whether school-supervised administration would improve or deter compliance.