Cover Story

School-based asthma program crucial to address gap in pediatric care

These variabilities in children’s access to asthma care within schools, along with the variabilities in district policies for how students with asthma receive care, led Robert F. Lemanske Jr., MD, immediate past president of AAAAI, to spearhead an initiative to develop school asthma management plans that include a school-based asthma emergency treatment plan. The projected program would would apply to all students who present with asthma symptoms but do not have a documented and updated personalized asthma action plans available for access by the school nurse or personnel.

“The basis for development of school asthma management plans is that there isn’t a standard asthma action plan — that was one of the problems,” Lemanske told Infectious Diseases in Children. “I have worked with a nurse practitioner for the last 10 years or more, who was a previous school nurse in the Madison [Wisconsin] community, and she made me aware of the fact that there’s a lot of kids with asthma that are in the schools.”

According to Gary S. Rachelefsky, MD, of the Geffen School of Medicine at the University of California, Los Angeles, and an Infectious Diseases in Children Editorial Board member, the AAAAI initiative started as a simpler idea and evolved into a standardized school-based program after the dire need for asthma management in schools was identified. However, Lemanske noted, the process was more difficult than he initially imagined.

“I initially wanted to see if I could do something simple and work out a mechanism by which we could get an asthma action plan for every student with asthma in the schools in the United States,” Lemanske said. “I thought that would be a slam dunk, but it turned out to be a much more difficult process.”

The goal was to simplify the process of getting asthma action plans into schools in response to the confusion caused by the sheer number of different asthma action plans currently in use, according to Rachelefsky.

“The effort started in part because there must be a thousand action plans, maybe even more,” Rachelefsky said. “Our first initial effort was to have an action plan that would be more generic and more adaptable to every situation for the children with asthma and design it in a way that’s easier to transport to other cities, other doctors, to have some uniformity.”

These preliminary efforts prompted a summit between the AAAAI, NASN and other stakeholder organizations, through which a comprehensive school-based asthma management program could ultimately be developed, Rachelefsky noted.

School-based asthma management in action

According to Lemanske, there are a number of key components critical to ensuring a seamless and effective integration of an asthma management program into schools throughout the United States. These components include improved methods of communication among clinicians, families and school personnel; providing educational materials regarding asthma symptom presentation and treatment; and detailed guidelines for addressing environmental triggers both at school and in the home that can lead to a loss of asthma control.

Beth Mattey

An individualized asthma action plan is a single-page document that breaks down an individual’s daily asthma management routine. Stepping up asthma therapy is denoted by “zones,” which are typically in order of severity based on the colors green, yellow and red. For example, green zones mean a child is doing well and should continue usual daily treatment; yellow zones recommend therapy options for mild to moderate exacerbation; and red zones suggest emergency intervention in response to severe exacerbation. Although asthma action plans all contain these basic elements, Rachelefsky said their design, complexity and availability can differ greatly, which can make them difficult to use in schools.

“General action plans should not be used in the school setting,” Rachelefsky said. “The forthcoming school-based program is intended to be an individualized asthma action plan, as well as other interventions through the school setting.”