AND PHYSICAL ACTIVITY IN THE SCHOOL
physical fitness is an important goal for all students. Yet students
with asthma frequently restrict their physical activities - and
about 1 child in every 15 has asthma. Much of this restriction is
unnecessary - children with asthma can and should be physically
active. This presents a challenge to classroom teachers, physical
education teachers and coaches. The National Heart, Lung, and Blood
Institute's National Asthma Education and Prevention Program encourages
a partnership among students, families, physicians, and school personnel
in managing and controlling asthma so that students can be active.
is the programís hope that this material, "Managing Asthma
at School: Making a Difference," will help classroom teachers,
physical education teachers, and coaches help their students participate
fully and safely in sports and physical activities.
is a chronic lung condition with ongoing airway inflammation that
results in recurring acute episodes (attacks) of breathing problems
such as coughing, wheezing, chest tightness, and shortness of breath.
These symptoms occur because the inflammation makes the airways
overreact to a variety of stimuli including physical activity, upper
respiratory infections, allergens, and irritants. Exposure to these
stimuli--often called triggers--creates more swelling and blocking
of the airways. Asthma episodes can be mild, moderate, or even life
threatening. Vigorous exercise will cause symptoms for most students
with asthma if their asthma is not well controlled. Some students
experience symptoms only when they exercise. However, today's treatments
can successfully control asthma so that students can participate
fully in physical activities most of the time.
varies from student to student and often from season to season.
This is why physical education teachers and coaches need to understand
what asthma is and what the individual needs of their students are.
At times, programs for students with asthma may need temporary modification,
such as varying the type, length, and/or frequency of activity.
At all times, students with asthma should be included in activities
as much as possible. Remaining behind in the gym or library or frequently
sitting on the bench can set the stage for teasing, loss of self-esteem,
unnecessary restriction of activity, and low levels of physical
Students Control their Asthma
control of asthma means recognizing asthma triggers (the factors
that make asthma worse or cause an asthma episode), avoiding or
controlling these triggers, following an asthma management plan,
and having convenient access to asthma medications. It also means
modifying physical activities to match the students' current asthma
or playing hard--especially in cold weather
respiratory infections--colds or flu
or crying hard
trees, plants and grasses, including freshly cut grass
dander from pets with fur or feathers
and dust mites--in carpeting, pillows and upholstery
smells and chemical sprays, including perfumes, paint
and cleaning solutions, chalk dust, lawn and turf treatments
and other tobacco smoke
student with asthma has a list of triggers that can make his or
her condition worse - that is, that increase airway inflammation
and/or make the airways constrict, which makes breathing difficult.
1 lists the most common triggers.
Or Control Asthma Triggers
asthma triggers - like pets with fur or feathers - can be avoided.
Others - like physical exercise - are important for good health
and should be controlled rather than avoided.
students' known asthma triggers and eliminate as many as possible.
For example, keep animals with fur out of the classroom. Consult
the students' asthma management plans for guidance.
wood, tile or vinyl floor coverings instead of carpeting.
maintenance or pest control that involves strong irritants and
odors for times when students are not in the area and the area
can be well ventilated.
schedules for students whose asthma is worsened by pollen or
cold air. A midday or indoor physical education class may allow
more active participation.
students follow their asthma management plans. These plans are
designed to keep asthma under control.
the Asthma Management Plan
student's asthma management plan is developed by the student, parent/guardian,
and health care provider. Depending on the student's needs, the
plan may be a brief information card or a more extensive individualized
health plan (IHP).† Table
2 lists what asthma plans typically contain. A copy of
the plan should be on file in the school office or health services
office, with additional copies for the student's teachers and coaches.
The plan - as well as the student's asthma medications--should be
easily available for all on- and off-site activities before, during
and after school.
Management Plan Contents
∑ Brief history of the
on how to contact the student's health care provider, parent/guardian.
and parent/guardian signature.
of factors that make the student's asthma worse.
student's personal best peak flow reading if the student
uses peak flow monitoring.
of the student's asthma medications.
description of the student's treatment plan, based on symptoms
or peak flow readings, including recommended actions for
school personnel to help handle asthma episodes.
With Exercise-Induced Asthma
do Nancy Hogshead, Jackie Joyner-Kersee, Bill Koch, Greg Louganis,
Dominique Wilkins, and Jim Ryun all have in common?
is a famous athlete who has asthma. They come from diverse fields:
swimming, track and field, cross-country skiing, diving, basketball,
and long-distance running.
their asthma management plans helped these athletes become winners.
and encouraging each student's efforts to follow his or her asthma
management plan is essential for the student's active participation
in physical activities. Students with asthma need understanding
from both teachers and students in dealing with their asthma. If
students with asthma are teased about their condition, they may
be embarrassed, avoid using their medication, or cut class. If students
with asthma are encouraged to "tough it out," they may
risk health problems or just give up. Actions To Consider
a copy of each student's asthma management plan. Review the
plan to identify the role of the teacher and coach in the student's
asthma management plan.
asthma awareness and peer sensitivity. As students learn more
about asthma, they can more easily offer support instead of
barriers to their classmates with asthma.
That Students With Asthma Have Convenient Access to Their Medications
students with asthma require two different medications: one for
daily control and prevention, the other to treat and relieve symptoms.
These medications are usually taken by metered-dose inhaler. Preventive
asthma medications are taken daily and usually can be scheduled
for before and after school hours. However, some students may need
to take preventive daily medication during school hours. All students
with asthma need to have their medication that relieves symptoms
available at school in case of unexpected exposure to asthma triggers,
or an asthma episode. In addition, students with asthma often benefit
from using their inhaled medication 5-10 minutes before exercise.
If accessing the medication is difficult, inconvenient, or embarrassing,
the student may be discouraged and fail to use the inhaler as needed.
The student's asthma may become unnecessarily worse and his or her
activities needlessly limited.
students with asthma convenient access to their medications
for all on- and off-site activities before, during and after
school. These medications prevent as well as treat symptoms
and enable the student to participate safely and vigorously
in physical activities.
students to carry and administer their own medications if the
parent/guardian, health care provider, and school nurse so advise.
Physical Activities To Match Current Asthma Status
who follow their asthma management plans and keep their asthma under
control can usually participate vigorously in the full range of
sports and physical activities. Activities that are more intense
and sustained--such as long periods of running, basketball, and
soccer - are more likely to provoke asthma symptoms or an asthma
episode. However, Olympic medalists with serious asthma have demonstrated
that these activities are possible with good asthma management.
a student experiences asthma symptoms, or is recovering from a recent
asthma episode, exercise should be temporarily modified in type,
length, and/or frequency to help reduce the risk of further symptoms.
The student also needs convenient access to his or her medications
adequate warm-up and cool-down periods. These help prevent or
lessen episodes of exercise-induced asthma.
the student's asthma management plan, parent/guardian, or health
care provider on the type and length of any limitations. Assess
the student and school resources to determine how the student
can participate most fully.
that a student who experiences symptoms or who has just recovered
from an asthma episode is at even greater risk for additional
asthma problems. Take extra care. Observe for asthma symptoms,
and check the student's peak flow if he or she uses a peak flow
meter. Review the student's asthma management plan if there
are any questions.
the environment for potential allergens and irritants, for example,
a recently mowed field or refinished gym floor. If an allergen
or irritant is present, consider a temporary change in location.
exercise modifications as necessary to get appropriate levels
of participation. For example, if running is scheduled, the
student could walk the whole distance, run part of the distance,
alternate running and walking.
the student involved when any temporary but major modification
is required. Ask the student to act, for example, as a scorekeeper,
timer, or equipment handler until he or she can return to full
participation. Dressing for a physical education class and participating
at any level is better than being left out or left behind.
Symptoms and Taking Appropriate Action
asthma symptoms and taking appropriate action in response to the
symptoms is crucial to asthma treatment and control.
That Require Prompt Action
symptoms require prompt action to help students resume their activities
as soon as possible. Prompt action is also required to prevent an
episode from becoming more serious or even life threatening. Table
3 lists the symptoms that indicate an acute asthma episode
and the need for immediate action. The student's asthma plan and
the school's emergency plan should be easily accessible so that
all staff, substitutes, volunteers, and aides know what to do
Acute Symptoms Requiring Prompt Action
Coughing or wheezing
Difficulty in breathing
tightness or pressure--reported by the student
signs, such as low peak flow readings as indicated on the
asthma management plan
of exercise-induced asthma (coughing, wheezing, pain or chest tightness)
may last several minutes to an hour or more. These symptoms are
quite different from breathlessness (deep, rapid breathing) that
quickly returns to normal after aerobic exercise.
the student's current activity.
the student's asthma management/action plan.
the student use his or her inhaled medication.
the student fails to improve.
any of the symptoms listed on the student's asthma plan as
emergency indicators are present.
any of the following symptoms are present (consider calling
student is hunched over, with shoulders lifted, and straining
student has difficulty completing a sentence without pausing
student's lips or fingernails turn blue
That May Indicate Poorly Controlled Asthma
may have symptoms that do not indicate an acute episode needing
immediate treatment, but instead indicate that their asthma is not
under complete control. Table 4 lists these signs.
teachers and coaches who supervise students' physical activities
are in a unique position to notice signs that a child who struggles
with physical activity might in fact have asthma. Because exercise
provokes symptoms in most children with poorly controlled asthma,
the student may need to be evaluated by his or her health care provider.
It may also be that the student simply needs to follow his or her
asthma management plan more carefully.
That May Indicate Poorly Controlled Asthma
wheezing, chest tightness, or shortness of breath after
vigorous physical activity, on a recurring basis
level of stamina during physical activity or reluctance
observations of the symptoms with the school nurse and the student's
parents or guardians. Helping students get the medical attention
they need is an important way to help children become active
and take control of their condition.
students convenient access to their asthma medication.
Signs: Is It an Asthma Episode or a Need for More Support?
some times teachers and coaches may wonder if a student's reported
symptoms indicate a desire for attention or a desire not to participate
in an activity. At other times it may seem that students are overreacting
to minimal symptoms.
is always essential to respect the student's report of his or her
own condition. If a student regularly asks to be excused from recess
or avoids physical activity, a real physical problem may be present.
It also may be that the student needs more assistance and support
from his or her teacher and coach in order to become an active participant.
with the student to:
his or her concerns about asthma and activity.
reassurance that you understand the importance of appropriate
modifications or activity limits.
a shared understanding about the conditions that require activity
modifications or medications.
with the school nurse, parent/guardian, or health care provider
to find ways to ensure that the student is safe, feels safe,
and is encouraged to participate actively.
the student uses a peak flow meter, remind him or her to use
it. This may help the student appreciate his or her asthma status
and appropriate levels of activity.
peak flow meter is a small device that measures how well air moves
out of the airways. Monitoring peak flow helps a student determine
changes in his or her asthma and identify appropriate actions to
student has his or her personal best peak flow reading. This number
should be noted in the student's asthma plan or school health file.
A peak flow reading less than 80 percent of the student's personal
best indicates the need for action. A student should avoid running
and playing until the peak flow reading returns or exceeds 80 percent
of the personal best.
peak flow reading is only one indicator of asthma problems. Symptoms
such as coughing, wheezing, and chest tightness are also indicators
of worsening asthma. Follow the student's individual plan or the
school plan if you observe any of the signs or symptoms listed in
the asthma emergency section or in the student's own plan.
a Metered Dose Inhaler
is important that students take their medications correctly. Many
asthma medications are delivered by metered dose inhalers, which
are highly effective, but they can be difficult to use.
school nurse or health room technician should review proper use
of the inhaler with the student.
These instructions are provided for your information.
to Use a Metered Dose Inhaler
off the cap. Shake the inhaler.
up. Breathe out.
the inhaler in any one of these ways:
you start to breathe in, push down on the top of the inhaler
and keep breathing in slowly for 3 to 5 seconds.
your breath for 10 seconds. Breathe out.
Dry powder capsules are used differently. To use a dry powder inhaler,
close your mouth tightly around the mouthpiece and breathe in very
by permission from
Heart, Lung, and Blood Institute
National Asthma Education and Prevention Program
PO Box 30105
Bethesda, MD 20824-0105
National Heart, Lung, and Blood Institute's (NHLBI)National Asthma
Education and Prevention Program has several products on asthma
in the school: Managing Asthma At School: Making a Difference (videotape);
Managing Asthma: A Guide for Schools
(booklet produced with the U.S. Department of Education);
Asthma Awareness: Curriculum for the Elementary
School Classroom (booklet); Managing
Allergies and Asthma at School: Tips for School Teachers and Staff
(booklet produced with the National Institute of Allergy and Infectious
Diseases). To order these and other publications about asthma, write:
NHLBI Information Center, P.O. Box 30105, Bethesda, MD 20824-0105
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