Vol. 16 •Issue 3 • Page 18
Taking Asthma on the Field
Activity supervisors have a duty to provide a safe environment for students with asthma.
More than 80 percent of students with asthma experience a worsening of symptoms when engaging in physical activity.1 For children who don’t have their asthma under control, their symptoms create a barrier to exercise.
Physical education teachers, coaches, and athletic directors can play a key role in helping students manage their disease, yet many of these activity supervisors lack training in asthma awareness.
For example, a coach allowed a student to only play goalie during a soccer game so as not to cause an asthma attack. Another supervisor believed if a student isn’t wheezing, his or her asthma can’t be that bad. A physical education teacher admitted running laps is still used as a form of punishment for misbehaving in some schools. This potentially can cause extreme hardship on a student with asthma.
When armed with the correct information, these educators can lead students to resources to help them improve their asthma treatment so they can participate in sports and exercise.
‘Exercise and Asthma’ program
Activity supervisors must learn the signs and symptoms of asthma. They need to know what to do during an emergency, how to reduce and prevent attacks from occurring, and how to keep children active and healthy.
The American Lung Association of Oregon (ALAO) has responded to this need by introducing “Exercise and Asthma,” a one-hour professional training session for physical education teachers, coaches, athletic trainers, and community recreation personnel. The ALAO’s goal is to bridge the gap between health care and schools to provide a healthy environment where students with asthma can learn and grow.
The most important part of the program, perhaps, is that it enables educators and coaches to have conversations among their peers in a comfortable environment where asking questions and debunking asthma myths are encouraged.
And it’s not just activity supervisors who are taking interest in this course. At a recent training session in Brookings, Ore., the facilities manager in charge of bus drivers attended. He was interested in passing on information to his bus drivers because “kids can have asthma attacks on the bus, too, and we want to be prepared.”
Since its pilot phase in 2004, more than 500 school personnel across Oregon have participated in the training. That’s a great start considering approximately 60,000 children in Oregon have asthma.2
The Oregon Asthma Program, a division of the Oregon Public Health Division, provides funding that allows the ALAO to offer this program free to a limited number of schools. The ALAO provides whistles, clipboards (outlining asthma symptoms and emergency response), and CD-ROMs with handouts. These handouts include asthma action plans, letters home to parents, and a list of common asthma triggers and solutions.
Classes typically are held in a school or district building. Often, one school will host the training and open the class to other district personnel. Participation varies, but ALAO’s target is at least eight participants per class. The average class size has been 14 people.
The ALAO’s asthma program coordinator facilitates the training. By the end of a session, attendees know the physiology of asthma and understand asthma triggers on the playing field. Participants often are surprised that cutting the grass or sweeping the gym around students can cause asthma attacks.
Time is allotted for modeling the proper technique for using common asthma management devices such as peak flow meters, holding chambers, and metered dose inhalers.
In an emergency
Emergency procedures also are discussed. Schools are encouraged to have a system in place to ensure students receive rescue medications quickly when necessary. This usually involves cell phones or walkie-talkies for staff on the field to communicate with the nurse’s office if medications are kept inside.
Coaches and teachers are advised to watch for certain warning signs and call emergency services if they notice a student isn’t improving after using a rescue inhaler; a student has difficulty completing a sentence without pausing for breath; or a student’s lips or fingernails turn blue.
Of course, the supervisor must remain calm during asthma episodes. It’s extremely distressful for a student to have an exacerbation, and it’s alarming for other students nearby. A level-headed supervisor with knowledge of how to handle asthma emergencies is required.
Beyond caring for the physical aspects of asthma, activity supervisors must consider the student’s social and emotional needs.
It’s important for them to let students with asthma — and their peers — know having asthma is OK. It doesn’t make them weak or weird. Coaches can encourage students to participate by acknowledging they can do the same activities as their peers, and asthma doesn’t have to slow them down or stop them.
Pointing out star athletes who have asthma can help students realize that asthma doesn’t need to be a barrier to physical activity. Indeed, Jerome “The Bus” Bettis (Pittsburgh Steelers) and Jackie Joyner-Kersee (Olympic gold medalist in track and field) are great examples of individuals who students can look up to as asthma management role models.
Asthma action plans
Finally, participants learn how to use individual plans for children with asthma and recognize ways to prevent asthma symptoms from occurring.
All coaches and teachers are encouraged to obtain asthma action plans from their students. One of the most common complaints from physical education teachers is students who use their asthma as a reason not to exercise.
Asthma action plans help alleviate these situations by having a physician-signed document outlining when medication and medical services are needed to treat asthma episodes.
If a student is using his or her asthma as an excuse not to exercise, the teacher can use the asthma action plan to help speak with the parents and the school nurse. If the student is having difficulty controlling his or her asthma, this helps expedite the process of letting others know the student needs help.
Striving for safety
Unfortunately, many people with asthma aren’t managed optimally and don’t perceive their condition as serious.
The Oregon Asthma Program analyzed medical claims data from 2004 and found that among the Medicaid population, 41 percent of people with persistent asthma filled six or more rescue inhaler prescriptions in a year.3 Overuse of rescue inhalers is an indicator of poorly controlled asthma.
The good news is asthma is a controllable disease. With the proper medical diagnosis, pharmaceutical treatment, reduction of triggers, and monitoring of symptoms, students with asthma should have minimal or no symptoms and safely participate in all school activities.4
The ALAO is proud to offer “Exercise and Asthma” to schools across Oregon. Through this program, its mission — to prevent lung disease and promote lung health — is active and strong, as it strives to create an environment where students with asthma can thrive in classrooms and on the playground.
1. American Lung Association of Oregon. About childhood asthma. 2006. Available from: URL: www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22782#2
2. Oregon Department of Health and Human Services. Asthma in Oregon. Available from: URL: www.oregon.gov/DHS/ph/asthma/about_us.shtml
3. Oregon Department of Health and Human Services. The Oregon asthma leadership plan. 2006. Available from: URL: www.oregon.gov/DHS/ph/asthma/plan/index.shtml
4. National Asthma Education and Prevention Program. Managing asthma: a guide for schools. 2003. Available from: URL: www.nhlbi.nih.gov/health/prof/lung/asthma/asth_sch.htm
Beverly Stewart, AE-C, CHES, is the asthma program coordinator for the American Lung Association of Oregon, Tigard. She’s a certified asthma educator and a certified health education specialist.
Did You Know?
Asthma is the leading cause of school absenteeism in children with chronic illness, and it’s just one reason schools are taking a closer look at the disease. The Centers for Disease Control and Prevention reports asthma accounts for 14 million missed school days annually in the U.S.
SOURCE: American Academy of Allergy, Asthma & Immunology
Strategies for Schools
Schools need to provide safe opportunities for students with asthma to engage in physical activities, according to the Centers for Disease Control and Prevention. So, the CDC has outlined six strategies for addressing asthma within a school health program:
Implementing these strategies requires a team effort, including administrators, faculty, staff, students, and parents. Because each strategy isn’t feasible for every school, administrators should determine which have the highest priority based on school needs and resource availability.
–Beverly Stewart, AE-C, CHES