Breathing Easy After School
In California a student with an asthma inhaler stored on campus can only gain access to the prescription if an authorized school district staff member is available to open the school’s medicine cabinet. While access issues may emerge during the school day, accessing the emergency medication can be dangerously difficult during the hours that state and federally funded after school programs operate.
Typically, after school programs are established for elementary and middle school students through partnerships between schools and community-based organizations such as the YMCA, Campfire USA, Boys and Girls Clubs, as well as smaller local agencies. More than 400,000 California students participate each day.
The organizations that offer the after school programs use school campuses; however, their staff are not school district personnel and therefore are not permitted to retrieve and provide students the stored medication. The biggest challenge to gaining access to the prescriptions occurs after 4:30 pm when regular day staff often leaves campus.
According to California law, students are permitted to carry and self-administer their asthma medication during and after school if the district receives written permission from the physician and parent/guardian. Even if the students have the capacity to responsibly carry and manage their medication, some parents, especially those without good health insurance coverage, may find obstacles to getting the proper form completed by a physician. In addition, many campuses discourage students from carrying and self-administering because of concerns, including the student being too young to know when to use the medication appropriately, or even worry over the possibility of theft by other students.
Of course, parents are likely to assume that since their children are remaining on campus the medication that is stored for them is available during the after school program. Parents and providers can discuss having duplicate medication on hand and managed by the after school program, but the cost of duplicate medication may not be covered under medical insurance, making it expensive for lower income families to have three sets of inhalers for their child (one for home, one for school and one for after-school). Of course, this would be dwarfed by the cost of an emergency department visit due to a child’s inability to access an inhaler that is stored on campus but unavailable during after school hours.
Breathe LA is undertaking a research and policy project with the Long Beach Unified School District to identify the challenges to securing access to prescribed asthma medication in after-school programs. Together, we will develop solutions that can be standardized across the district, and, if successful, be shared with representatives of the State Department of Education and others. Often parents choose after school programs for their children to ensure their safety. Safety must entail access to asthma and other medication that can save children’s lives.
Childhood Asthma in the Imperial Valley
Fields are commonly burned to prepare the ground for the next crop, creating large plumes of smoke. Permits and specific burn dates are assigned to control air pollution.
Imperial County is known as Southern California’s agricultural oasis. Environmental allergens abound because of the vast desert region’s extreme climate changes, air pollution and pesticide exposure. Multiple regulations exist within the county in attempts to decrease pollutants entering the air. Farmers must water dirt roads to decrease dust, burn permits regulate the burning of fields and crop dusters have limitations on spraying near vulnerable populations, such as schools.
Despite these stringent efforts, Imperial County has a significant problem with asthma. Asthma is a chronic disease that inflames airways and causes recurrent wheezing, coughing, difficulty breathing and chest tightness. Attacks can be mild to deadly. If controlled, most affected people lead active, healthy lives. According to a 2005 Border Asthma and Allergies (BASTA) Study conducted by the California Department of Public Health, 20.2% of children in Imperial County are diagnosed with asthma. The national average is 13.7%. Imperial County consistently has the highest asthma hospitalization rates among all California counties. Health care providers realize we can’t change the environment, but more can be done to diagnose children early so that proper maintenance leads to active, healthy lives.
Both of my children have had asthma symptoms. We were fortunate to travel to San Diego for specialized care at Rady Children’s Hospital in the allergy/asthma clinic. It was interesting to learn that many of the children in the Imperial Valley may have an allergy to sugar beets, which is harvested locally. Fortunately, my children had early treatment and have now outgrown their symptoms. Unfortunately, this is not the case for most. Local school nurses and health care providers are fighting to get each child on an asthma action plan to ensure no additional deaths occur from a manageable disease.
Unfortunately, the county is plagued with a lack of health care providers, limited specialized resources and a large population of uninsured. From 2000 to 2004, ten asthma deaths occurred in Imperial County. The problem has gained recent attention with the death of a local 16 year old girl. Since 2001, public health, local hospitals, community health agencies, the Centers for Disease Control and the California Department of Public Health have all collaborated to provide all levels of prevention for asthma.
The Imperial Valley Child Asthma Program (IVCAP) is funded by the Imperial County Children and Families First Commission, and operated by El Centro Regional Medical Center in partnership with Pioneers Memorial Hospital. The program is designed to reduce health disparities, and to improve the development and school readiness of young children from birth through age five who suffer from asthma or asthma related symptoms. The IVCAP follows the National Institute of Health asthma guidelines. A free referral is provided by a local health care provider or parents can self-enroll. Community health workers and Aidee Fulton, RN, provide case management services.
Lessons include:
- What is asthma?
- asthma medications
- preparing for clinic visits and collaborating with your child’s MD
- proper use of inhaler, nebulizer and peak flow meter
- limiting asthma triggers at home
- recognizing early asthma symptoms and what to do when they worsen
- use of an asthma action plan
Currently, hospitalization rates are declining here, but still remain the highest in California. Both hospitals are leading the initiative because the majority of people in the Imperial Valley do not have access to primary care services. This means that they come to the ER with mild to life-threatening conditions. IVCAP is currently facing an uncertain future. Without additional grant funding, the program will end. Fullton is seeking additional partners and looking into expanding services to people ages 0-17, while exploring the addition of a mobile clinic to better serve outlying areas.
The American Lung Association has also been actively involved in bringing the Open Airways Program into local schools. Several school districts have looked into using a colored flag system to identify when air quality is poor, and additional measured need to be taken for those with asthma to prevent attacks.
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Asthma in Children: Symptoms and Risk Factors
This article was co-written by Dr. Robert Chilcote, Imperial Valley Child Asthma Program consultant
Asthma is the leading cause of chronic illness in children. It affects as many as 10%-12% of
children in the U.S. and, for unknown reasons, is steadily increasing. It can begin at any age, but
most children have their first symptoms by age 5.
What Makes a Child More Likely to Develop Asthma?
There are many risk factors for developing childhood asthma. These include:
- Presence of allergies
- Family history of asthma and/or allergies
- Frequent Viral respiratory infections
- Low birth weight
- Exposure to tobacco smoke before and/or after birth
- Being male
- Being raised in a low-income environment
Why Are More Children Getting Asthma?
No one really knows why more and more children are developing asthma. Some experts suggest
that children are being exposed to more and more allergens such as dust, air pollution, and
second-hand smoke. These factors all are triggers of asthma. Others suspect that children are not
exposed to enough childhood illnesses to build up their immune system. It appears that a disorder
of the immune system where the body fails to make enough protective antibodies may play a role
in causing asthma.
And still others suggest that decreasing rates of breastfeeding have prevented important
substances of the immune system from being passed on to babies.
How Can I Tell If My Child Has Asthma?
Signs and symptoms to look for include:
- Frequent coughing spells, which may occur during play, at night, or while laughing. It is
- important to know that cough may be the only symptom present.
- Less energy during play
- Rapid breathing
- Complaint of chest tightness or chest "hurting"
- Whistling sound (wheezing) when breathing in or out
- See-saw motions (retractions) in the chest from labored breathing
- Shortness of breath, loss of breath
- Tightened neck and chest muscles
- Feelings of weakness or tiredness
Keep in mind that not all children have the same asthma symptoms, and these symptoms can vary
from asthma episode to the next episode in the same child. Also note that not all wheezing or
coughing is caused by asthma. In kids under 5 years of age, the most common cause of asthma-like symptoms is upper
respiratory viral infections such as the common cold. If your child has problem breathing, take him or her to the doctor immediately for an evaluation.
How Is Asthma Diagnosed In Children?
Asthma is often difficult to diagnose in infants. However, in older children the disease can often be
diagnosed based on your child's medical history, symptoms, and physical exam.
- Medical history and symptom description. Your child's doctor will be interested in any historyof breathing problems you or your child may have had, as well as a family history of asthma, allergies, a skin condition called eczema, or other lung disease. It is important that you describe your child's symptoms -- cough, wheezing, shortness of breath, chest pain or tightness -- in detail, including when and how often these symptoms have been occurring.
- Physical exam. During the physical examination, the doctor will listen to your child's heart and lungs.
- Tests. Many children will also have a chest X-ray and pulmonary function tests. Also called lung function tests, these tests measure the amount of air in the lungs and how fast it can be exhaled. The results help the doctor determine how severe the asthma is. Generally, children younger than 5 are unable to perform pulmonary function tests. Thus doctors rely heavily on history, symptoms and examination in making the diagnosis.
- Response to medication: children with cough and wheezing that respond well to asthma medications, such as albuterol, likely have asthma. Other tests may also be ordered to help identify particular asthma triggers. These tests may include allergy skin testing, blood tests and X-rays to determine if sinus infections or gastroesophageal reflux disease (a gastrointestinal condition that causes reflux of acid stomach contents into the esophagus or even into the lungs) is complicating asthma.
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