Asthma management in schools encompasses a range of issues, including reducing exposures to environmental asthma triggers; identifying and assisting affected students; preventing and controlling asthma symptoms; and appropriately recognizing and treating asthma attacks. Many of these issues relate to both students and school staff. Environmental issues related to asthma in school facilities include poor indoor air quality, faulty ventilation, indoor mold, pesticide use, allergenic landscaping, cleaning agents, animal contact, and exposures to outdoor air contaminants. In some facilities, harmful exposures can occur from chemicals in workshops and science labs as well as from repair and renovation activities. Crafting strong asthma policies and establishing appropriate asthma training, management, and support systems within the school setting are essential in order to ensure that students and staff with asthma receive necessary care and support.
The California Department of Education (CDE) supports a Coordinated School Health Program (CSHP) approach to student health. CSHP addresses the complex problem of asthma in schools by focusing on eight components that depend upon active involvement of school personnel, students, health care workers, and communities; CDC has developed a comprehensive model for addressing asthma in schools based upon the CSHP (Figure 10. Strategies for Addressing Asthma within a Coordinated School Health Program).
Asthma protective policies are essential for the school setting. The California Education Code includes some regulations related to asthma and student health in general; however, health policy is more fully developed at the district level. In recent years, several key statewide health protective policies were established. For example: CDPH and CDE approved Guidelines for the Management of Asthma in California Schools, a comprehensive resource for school health and other personnel to address asthma in the school setting; State law now provides that with parental and health care provider permission, children are allowed to self-carry and self-administer asthma inhalers while at school; and other legislation requires that new schools cannot be built within close proximity to certain stationary pollution sources.†
Although considerable progress has occurred, further efforts are needed. While the Plan primarily addresses the public school system, private schools may also identify opportunities for improvements. By implementing the school specific objectives and strategies in this Plan, California will establish and implement comprehensive asthma policies and procedures for schools; assess schools to identify gaps and priorities; evaluate compliance with existing laws and regulations; increase the number of qualified school health personnel; and support comprehensive staff training on asthma and indoor air quality.
* Self-administered asthma medication law: California Education Code Section 49423.1
Figure 10. Strategies for Addressing Asthma within a Coordinated School Health Program
CDC has identified six strategies for schools and districts to consider as they develop coordinated plans for addressing asthma in schools. The six strategies for addressing asthma within a coordinated school health program are:
- Establish management and support systems for asthma-friendly schools.
- Provide appropriate school health and mental health services for students with asthma.
- Provide asthma education and awareness programs for students and school staff.
- Provide a safe and healthy school environment to reduce asthma triggers
- Provide safe, enjoyable physical education, and activity opportunities for students with asthma.
- Coordinate school, family, and community efforts to better manage asthma symptoms and reduce school absences among students with asthma.
Addressing Asthma within a Coordinated School Health Program
4.0A Objectives and Strategies
- 4A.1. Establish comprehensive and coordinated asthma policies and procedures in school districts to ensure the health and well-being of students with asthma.
4A.1.1. At the state level, collaborate with other agencies to develop a comprehensive set of model asthma policies and procedures for school districts based on existing best practices in the field and best practices guidelines. (Figure 11. Model Asthma Policies and Procedures for Schools).
4A.1.2. At the district level, encourage adoption of existing best practices for the design, construction and renovation of schools that ensure optimal indoor environmental quality.
4A.1.3. Coordinate a statewide schools asthma workgroup to advise on implementation of asthma reduction strategies, with emphasis on school facilities, health and safety, and operations. The workgroup could be composed of staff from state agencies (see Goal 1, Strategy 2.2) and augmented by non-governmental groups such as nursing associations, health care provider organizations, school based health center staff, teacher associations, facility managers associations, risk managers, and key asthma and environmental coalitions.
4A.1.4. Support efforts to identify pre-existing and develop new sources of adequate stable, long-term funding for school construction, renovation and preventive maintenance.
4A.1.5. Work with state school construction agencies and district facilities managers to adopt construction and maintenance specifications that reduce asthma exposure risks for use in school operation, renovation, and new construction.
4A.1.6. Support adoption of environmentally preferable purchasing practices for products and services that reduce asthma exposure risks including products with low exposure to allergens and asthmagens.
Figure 11. Model Asthma Policies and Procedures for Schools
School asthma policies establish practices to reduce asthma trigger exposures in the school environment and to improve treatment and management for students with asthma. CDC has developed a comprehensive model for addressing asthma within a coordinated school health program (Figure 10). This model contains six broad strategies for schools and districts to consider as they develop coordingated plans for addressing asthma in schools. Every strategy may not be appropriate or feasible for every school to implement; schools and districts need to determine their highest priorities based on the needs of the school and available resources.1. Establish management and support systems for asthma-friendly schools. Some suggested policies include:
- Identify your school's or district's existing asthma needs, resources, and potential barriers.
- Identify students with asthma to ensure appropriate control and management.
2. Provide appropriate school health and mental health services for students with asthma.
- Obtain asthma action plans for students with diagnosed asthma.
- Standardize emergency protocols for students in respiratory distress.
- Ensure access to asthma medications; develop student self-carry policy.
- Ensure acceptable staffing ratios for nursing and other health staff, and maintenance and facility staff.
3. Provide asthma education and awareness programs for students and school staff. Some suggested policies include:
- Regular staff and student education regarding asthma symptoms, triggers, and treatment.
- Integrate asthma awareness lessons into health education curricula.
4. Provide a safe and healthy school environment to reduce asthma triggers. Some suggested policies include:
- Mitigate the risk of exposure to diesel exhaust for students and staff in schools located close to busy roadways or idling vehicles.
- Purchase new school bus fleets and/or retrofit existing fleets with the latest clean vehicle and/or low-emissions technologies.
- Develo a comprehensive Indoor Air Quality Management Plan to prevent and manage indoor air quality problems in schools.
- Implement facility design, operations, and maintenance procedures to ensure safe and healthy indoor environments for students and staff.
- Plant allergen-free or low-allergen landscaping around schools.
5. Provide safe, enjoyable physical education and activity opportunities for students with asthma. Some suggested policies include:
- Encourage full participant in PE when well and provide modified activities as appropriate.
- Develop school site plan for implementing alternative activities and protocols on bad air days.
6. Coordinate school, family, and community efforts to better manage asthma symptoms and reduce school absences among students with asthma. Some suggested policies include:
- Ongoing communication procedures between the school, the student's medical provider, and the parents/guardians of the student with asthma.
For a full list of strategies, go to www.cdc.gov/Healthy/Youth/asthma/strategies.htm
- 4A.2. Assess schools/district compliance with existing codes and best practices that impact asthma, and ensure that laws and regulations adequately address indoor environmental quality issues and asthma management in schools.
4A.2.1. Develop environmental and asthma health elements for CDE to include in the School Assessment Report Cards (SARC) school safety section.4A.2.2. Monitor the implementation of and compliance with laws and regulations to ensure asthma friendly school environments, e.g., School Bus Idling law;* asthma medication law†, etc.4A.2.3. Evaluate adequacy of existing laws and regulations to address asthma and indoor air quality issues in schools.4A.2.4. Identify schools and districts in greatest need of health hazard remediation by reviewing SARCs and/or other facility assessments.* School bus idling: California Code of Regulations (CCR) Chapter 10, Article 1, Section 2480, title 13 www.arb.ca.gov/regact/sbidling/fro.pdf† Self-administered asthma medication law: California Education Code Section 49423.1
- 4A.3. Increase the number of qualified personnel in schools and districts to better meet the needs of students with asthma.
4A.3.1. Increase the nurse-to-student ratio in all California school districts to more closely approach recommended ratios‡ and at a minimum, ensure that schools have a trained, certified health assistant or community health worker on-site during each school day.4A.3.2. Work with the California School Health Centers Association to ensure that existing and future School-based Health Centers provide comprehensive, high quality asthma care, including acute and emergency care for all students with asthma.4A.3.3. Promote the use of consulting community physicians within every school district to provide advice on appropriate management of asthma and other medical conditions.4A.3.4. Increase custodial maintenance and facility staffing levels in school districts to approach optimal levels recommended by the California Association of School Business Officials.‡ The Healthy People 2010 goal is to have one nurse per every 750 students. The following organizations recommend a nurse in every school: the National Association of School Nurses, Centers for Disease Control and Prevention, the National Heart Lung Blood Institute, the American Academy of Pediatrics, and the American School Health Association.
- 4A.4. Institute targeted and specialized trainings for all district personnel on asthma and on environmental factors that impact asthma in schools; include health personnel, administrators, teachers, front office staff, coaches, maintenance and facility p
4A.4.1. Utilize professional development institutes, and/or other pre-existing opportunities to educate staff about key asthma issues including asthma symptoms, treatment, emergency response, and environmental trigger mitigation strategies.
4A.4.2. Identify and use best practice asthma and indoor environmental quality training curricula and tool kits. Explore the possibility of developing an e-curriculum on asthma, with Continuing Education Units (CEUs) or contact hours (CH), for school personnel.
4A.4.3. Provide training for district administrators and facilities staff on U.S. EPA's HealthySEAT and Indoor Air Quality Tools for Schools, and Collaborative for High Performance Schools resources to promote systematic school assessments and to track, assess, and build indoor air quality management plans based on identified needs (Figure 12. Implementing an Indoor Air Quality Management Plan in Schools).
Figure 12. Implementing an Indoor Air Quality Management Plan in Schools.
There are several resources currently available that can help schools develop their Indoor Air Quality (IAQ) Management Plan, including:
IAQ Tools for Schools (TfS): Developed by the U.S. EPA, the IAQ TfS comes as a kit to show school personnel how to conduct a practical plan of action to improve indoor air quality and address problems. The Kit provdes best practices, industry guidelines, sample policies, and a sample IAQ management plan, and includes low and no cost approaches for in-house staff to emply (www.epa.gov/iaq/schools/actionkit.html).
Healthy School Environments Assessment Tool (HealthySEAT): HealthySEAT is a free software tool, also developed by U.S. EPA, to help school districts more effectively manage all of their environmental issues. HealthySEAT is designed to be customized by districts to conduct and mange self-assessments of their school facilities and environmental, health, and safety issues (www.epa.gov/schools/healthyseat).
The Collaborative for High Performance Schools (CHPS): CHPS works with districts to facilitate the design and construction of high performance schools; that is, schools with optimal energy and resource efficiencies, plus indoor air quality, comfort, and lighting to enhance the learning environment. CHPS offers trainings and resources to schools, and sponsors recognition and certification programs focused on healthy school construction and repair (www.chps.net).
- 4A.5. Minimize exposure to contaminated outdoor air and promote safe and healthy outdoor school environments.
4A.5.1. Develop and promote guidelines on low-allergen landscaping practices for schools.4A.5.2. Promote school site guidelines to reduce their proximity to busy roadways and other diesel or pollutant sources.4A.5.3. Encourage school districts to adopt policies for managing outdoor activities on bad air days, including for children with respiratory diseases.4A.5.4. Promote diesel exhaust exposure reduction at school sites, such as retiring and/or retrofitting existing fleets with the low-emissions technologies and adherence to laws restricting school bus idling.