Vol. 20 •Issue 23 • Page 9
Asthma Drugs in the Classroom
Zero Tolerance Complicates Care
Several years ago, Mrs. Bender was called to her great-grandson’s school in the middle of the day to bring him his metered dose inhaler (MDI). The 6 year old had had an episode of asthma on the playground and was moved to the clinic area to await the inhaler. “Grandma, I think I’m dying,” he gasped, before the inhaler’s medication began to take effect.
“After that point, Austin became a 6-year-old hypochondriac,” she said. Aches, pains and other minor episodes took on a great importance for him. While she and his mother took steps to help him deal with his fear of “illness that has to wait,” that singular event stayed with him over the past two years.
This situation is just one example of what happens when schools crack down on items in a backpack, sometimes because of zero tolerance policies. Many schools will not even keep MDIs in lockboxes at a nurse’s station. As a result, asthmatic students like Austin may be forced to wait for help while frantic parents race to a school to bring the needed medication. The lucky child will be able to fend off the bronchospasm, but the remainder may be candidates for an emergency rescue call.
The Americans with Disabilities Act could fall into play when it comes to situations like this, but the breathing condition requiring the inhaler would need to be “disabling.” Even then, school personnel may not be able to assist in administering the medication, bringing the situation back to emergency services as an eventuality.
Even though physicians may be able to make a case for an inhaler being on school grounds, students still may not be able to have it in hand and available.
In 2002, one California school district was sued over a child’s fatal asthma attack. In that case, the school failed to notify the parent of school policy requiring the medication to be stored securely. Parents may assume that medical necessity will permit rapid access to the medicine, but that may not be the case in many school districts.
State Regulations
Forty-six states and the District of Columbia currently have laws that require public and private schools to allow for self-administration of asthma medication. That will not necessarily guarantee school compliance. In a September 2007 article on schools and potential for asthma medication abuse, the American Lung Association’s (ALA) chief medical officer said, “It’s not a good high.” The concern about students walking around in a drug-induced haze is only part of the issue.
Age, maturity level and ability to comprehend appropriate usage of the medicine are foremost. Six-year-old Austin might not have had the maturity or ability to administer the medication without some coaching if the attack progressed too far. In a case like this, the treatment would have to be supervised. But first it needs to be available. Mrs. Bender explained the school nurse was not permitted to administer the medication to him. But if schools are going to wait until a designated family member arrives to supervise medication intake before a child can get some relief, they may as well call 911 at the same time they call the parents. It might save them from potential lawsuits.
Obviously, children with disabling challenges cannot administer their own medications. However, a portion of this group is probably in a school facility that accommodates the situation. Kids like Austin may not present with frailty normally; nonetheless, they still need immediate care when bronchospasm strikes. Transporting a child from the playground or classroom to the nurse’s office is enough of a time delay. Add to that the time waiting for a parent to be called, found and arrive with medication compounds a child’s stress and compromises effectiveness of treatment.
The ALA’s Web site at www.lungusa.org has a Bill of Rights for asthmatic kids. It is written in “kid language” and was designed for them to sign and pass on to adults. Item six refers to a child being able to attend an “asthma friendly” school and have medication available. It also mentions having educated adults present to support the child.
This may be easier said than done. Educated adults are often hard to come by in areas ill-populated by asthma educators. As an alternative, the ALA’s Open Airways for Schools Program seeks to educate children and adults. A teacher who is competent in understanding a student’s disease process will have a better student in the classroom, and not just because of health.
Fear in the Classroom
We’ve all had problems being in the same room with someone who refuses to acknowledge any of our special needs. In the case of asthma, critical needs demand critical responses. A teacher or principal who tells kids to “shake it off” during an asthma episode only makes a case for the student wanting to get out of the classroom on a continual basis, leading to high absentee rates.
Other students are affected too. If the teachers can’t handle a crisis, students may have little respect for them handling something as complex as an algebra equation. The root of all classroom uprisings may not be fear, but a lack of confidence in a teacher being able to run the class.
Obviously, there is more at stake with a lack of timely asthma help than a child’s relief.
Cheryl Ellis is a Florida freelance writer and practitioner.
