Asthma in Education: a Comprehensive Approach

The first time I encountered the portrayal of asthma in a movie was in the 1985 film, The Goonies. In this film, the lead character, Mikey, is depicted as an asthma sufferer who frequently uses his inhaler. However, in the climactic moments of the movie, he discards his inhaler, suggesting a miraculous cure. For the millions of children who watched the film and lived with asthma, this portrayal was far removed from their everyday reality. Asthma was, and still is, a persistent condition that doesn't simply disappear with a dramatic gesture.

Despite significant advancements in medical science aimed at managing asthma, a definitive cure remains elusive. Today, asthma continues to exert a considerable impact on school-aged children, affecting their daily activities and academic performance. Our approach focuses on preventing asthma attacks and minimizing their occurrences among school-aged children, who are particularly vulnerable due to their environmental exposures and developmental stage.

Understanding Asthma

Asthma is a prevalent lung disorder characterized by inflammation that causes the bronchi to swell and narrow the airways, leading to breathing difficulties that can range from mild to life-threatening. Symptoms include shortness of breath, coughing, wheezing, and chest tightness. Asthma is diagnosed based on evidence of wheezing, confirmed through breathing tests. During an asthma exacerbation, respiratory and heart rates increase, and the work of respiration becomes more strenuous, often requiring the use of accessory muscles. Notably, blood oxygen levels typically remain relatively normal, even amid severe asthma exacerbations, with low levels indicating impending respiratory failure (Mustafa & Shiel, 2012).

There are two main types of asthma: extrinsic, related to allergies and typically developing in childhood, and intrinsic, a non-allergic asthma that often develops after the age of 30. Extrinsic asthma usually involves documented allergies and a strong family history of allergic conditions, such as nasal allergies or eczema. While it may subside in early adulthood, it has a high likelihood of returning later in life. Intrinsic asthma, more common in women and often following respiratory infections, can be exacerbated by obesity. This form of asthma presents chronic, year-round symptoms and is notoriously difficult to treat (Mustafa & Shiel, 2012).

Asthma and Education

Given that school-aged children spend a significant portion of their day in the classroom, it is crucial to educate not only the children themselves but also their parents and school staff. As someone who has suffered from asthma since the 1970s, I can attest to the challenges it presents. In those days, treatment options were limited to medications like quibron (now known as theophylline), along with bed rest and missed school days. When my daughter was diagnosed with asthma, I realized that while some progress had been made, it was not sufficient to ensure her safety at school, especially on days following a rough night or when she exhibited symptoms such as wheezing.

The statistics on asthma prevalence are staggering. According to the Centers for Disease Control and Prevention (CDC), the number of people with asthma continues to grow. In 2009, 1 in 12 people, or about 25 million (8% of the population), had asthma, up from 1 in 14 (7%) in 2001. More than half of people with asthma experienced an attack in 2008, with children (57%) being more affected than adults (51%). In 2007, 185 children and 3,262 adults died from asthma. By 2009, about 1 in 10 children and 1 in 12 adults had asthma. Women were more likely than men to have asthma, and boys were more likely than girls. The highest rates were among non-Hispanic blacks, with 1 in 9 affected, and nearly 1 in 6 black children having asthma. Alarmingly, there was an almost 50% increase in asthma rates among black children from 2001 to 2009.

Strategies for Management

The challenges associated with school-aged children and asthma necessitate a comprehensive educational approach involving the entire community. It's essential for all parties involved to understand asthma triggers and management techniques. Recognizing three critical steps can aid in preventing and reducing asthma attacks in elementary-aged children. The first step involves controlling the home environment to minimize asthma triggers. The second focuses on teaching proper inhaler use and medication adherence. The third step emphasizes modifying and educating the child's school community.

In my daughter's case, we made substantial changes to our home environment to mitigate asthma triggers. We improved air quality and reduced allergens, covering mattresses and pillows with dust mite prevention covers and maintaining a pet-free home. Smoking was prohibited, and dust-free conditions were maintained in her room. We also avoided known allergens, such as seafood, to prevent exacerbations.

When Samantha was 12, a physician referred us to a local asthma specialist after overhearing a conversation about her condition. During our first visit, a pulmonary function test revealed that Samantha was on the verge of respiratory failure. The doctor provided immediate interventions, including nebulizer treatments, corticosteroid shots, and new medications. This marked a turning point in her management, providing us with tools like a peak flow meter and a chamber for her inhaler.

Improving School Environments

Addressing asthma in the school setting is equally vital. Many schools, especially older ones, face challenges related to air quality, with mold, mildew, cockroach, and rodent droppings posing significant asthma triggers. Installing HEPA air purifiers in classrooms can improve air quality. Collaborative efforts with teachers and school nurses can create personalized asthma management plans, ensuring awareness of triggers, symptoms, and medications.

The Asthmatic School Children's Treatment and Health Management Act of 2004 recognizes asthma as a lifelong condition requiring ongoing medical intervention. This act permits students to carry rescue inhalers and epinephrine auto-injectors with appropriate physician documentation. While my daughter didn't carry her inhaler until 11th grade, this act underscores the importance of advocacy and awareness among parents and school staff.

In an interview with my now 19-year-old daughter, Samantha, she highlighted the need for greater education and understanding of asthma in schools. Recalling an incident where her friend Dominique tragically passed away from an asthma attack at home, Samantha emphasized the need for adults to recognize symptoms and take immediate action. Her insights underscore the critical role of education in preventing asthma-related tragedies.

Educational Strategies

Targeting elementary school children aged six to eleven, our educational strategy aligns with their cognitive and psychological development, focusing on concrete and relatable information. The Cognitive Learning Theory, emphasizing patient-driven goals and experiences, forms the foundation of our approach. It encourages active participation, logical explanations, and the use of analogies to simplify complex concepts.

Nurse educators play a pivotal role in assessing learners' needs, readiness, and learning styles. Establishing clear objectives ensures that education is effective and impactful. These objectives include understanding asthma symptoms and management, recognizing exacerbation signs, administering medication properly, and knowing when to seek emergency care.

Our teaching strategy involves short, engaging sessions, using visual aids, models, and interactive activities to reinforce learning. Written materials and hands-on demonstrations ensure that learners and their caregivers retain essential information. Feedback and ongoing evaluation enhance the educational experience, promoting lasting knowledge and skills.

In conclusion, the evolving landscape of healthcare education demands adaptability and commitment from nurse educators. Empowering students and their families with knowledge about asthma management is crucial for improving their quality of life. By fostering a supportive and informed community, we can make significant strides in reducing the burden of asthma among school-aged children.

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