One of School Health’s vendor partners, Katie Tasker, Marketing Communications Project Manager from Briggs Healthcare, wrote this blog to help educate on the use of asthma medication delivery and management devices at school.
Asthma is the number one cause of absence from school for children.1 However, by training health aides and school assistants on the use of peak flow meters and nebulizers you can help keep asthmatic children in school and working to their full potential.
Train on proper peak flow techniques in three simple steps:
Stand up if possible. Take a deep breath, place the Peak Flow Meter in your mouth and hold horizontally, closing the lips around the mouthpiece, then blow as hard and as fast as you can.
Note the number on the scale indicated by the pointer.
Return the pointer to zero, and repeat the procedure twice more to obtain three readings. Mark the highest of the three readings on your chart.
Train on use of a compressor nebulizer in four simple steps:
Twist the nebulizer cover counterclockwise to separate. Add the medication to the cup and reassemble.
Attach one end of the air tube connector to the air stem and the other end to the base of the nebulizer.
Attach the angled mouthpiece to the top of the nebulizer.
Press the power button and begin treatment.
Train on use of an ultrasonic nebulizer in four simple steps:
Remove the cover and fill water reservoir with water.
Place medication cup above water reservoir and fill cup with medication. Replace cover.
Attach battery pack to unit.
Press the power button and begin treatment.
1Managing Asthma A Guide For Schools
Pediatric Asthma Can Be Hard to Diagnose and Challenging to Treat
According to the Guidelines for the Diagnosis and Management of Asthma (EPR-3), several studies show that as many as 50–80% of children who have asthma develop symptoms before their fifth birthdays. However, asthma is often under diagnosed since there are a number of conditions that can cause asthma-like symptoms in young children. Diagnosing this age group with asthma is further complicated due to the difficulty of obtaining objective measurements of lung function. According to the Mayo Clinic, doctors may be able to check for inflammation of a child's airways with a test that measures levels of nitric oxide gas in the breath. Higher levels of nitric oxide mean the child's lungs aren't working as well as they should be, and asthma isn't under control. But most of the lung function tests used by adults and older children, such as spirometry or peak flow measurement, are too difficult for a child under five.
Once a child under 5 is diagnosed with asthma, there are additional challenges to consider as you are initiating a therapy plan. For instance, there are pharmacologic issues (finding medications approved for young children), selection of and training on a medication delivery device that is age-appropriate, and carefully monitoring the response to the therapy to identify the lowest dose of medication required to control the asthma (and subsequently reducing the chance of side effects).
Children Who are at Risk of Developing Asthma:
According to WebMD, there are many risk factors for developing childhood asthma, including:
Nasal allergies (hay fever) or eczema (allergic skin rash)
A family history of asthma or allergies
Frequent respiratory infections
Low birth weight
Exposure to tobacco smoke before or after birth
Black or Puerto-Rican ethnicity
Being raised in a low-income environment
Symptoms of Asthma in Young Children
The Mayo Clinic provides these three examples of children with symptoms of asthma:
If your child is an infant, you may notice slow feeding or shortness of breath during feeding.
If your child is a toddler or older, you may notice a decreased desire to run and play due to breathlessness. Your son or daughter may become fatigued easily and cough when exercising.
For many children under age 5, asthma attacks are triggered or worsened by colds and other respiratory infections. You may notice that your child's colds last longer than they do in other children, or that signs and symptoms include frequent coughing that may get worse at night.
Other common symptoms may include:
A child's doctor should evaluate any problems a child has when breathing.
Selecting a Medication Delivery Device for Pediatric Asthma
Medication Delivery Device Options for Children Under 5 Years Old:
Metered Dose Inhaler (MDI) with Face Mask. Children between 3 and 5 years of age commonly use metered dose inhalers as a delivery method for asthma medication. However, in addition to the inhaler, the child will probably also need a spacer with a mouthpiece and a face mask that attaches to the spacer and delivers medication while the child breathes normally.
Nebulizer with Face Mask. This device turns medications into a fine mist your child breathes in through a face mask. Nebulizers are typically used to treat young children due to their inability to use other inhaler devices.
About Peak Flow Measurements
Q: What is Peak Flow and How is it Measured?
A: Peak flow refers to the maximum rate at which you can force air out of your lungs, and it is this rate that is measured when you breathe into a peak flow meter. Once the peak flow drops, it may be indicative of increased airway resistance, which may lead to an asthma attack.
Adults and children use different peak flow meters. Some peak flow meters offer an adapter that will turn the pediatric size into an adult size or vice versa.
Each person has their own "best possible" peak flow measurement, which when achieved means that you should have no asthma symptoms.
Q: Who Should Use a Peak Flow Meter?
A: According to the American Lung Association, patients age 5 and older are usually able to use a peak flow meter to help manage their asthma. If you use daily medication to manage your asthma or have moderate to severe asthma, your healthcare provider may believe a peak flow meter is neccessary.
Q: Why is Measuring Peak Flow Important?
Just as diabetics need to monitor their blood sugar levels or you use a thermometer to monitor body temperature, asthmatics need to monitor their lung functions. Keeping a daily record of peak flow measurements will help you to:
Achieve "best possible" control of asthma.
Monitor if asthma medicine is working.
Monitor if asthma is improving or worsening.
Decide if you should seek emergency care.
By measuring peak flow, you become more actively involved in the management of asthma. You will be able to tell if your asthma is getting worse, even before there are symptoms. Peak flow measurements may also be able to help you determine asthma triggers.
Q: How Do I Know What a "Normal" Peak Flow Reading is?
A: This is best determined by a doctor or a healthcare provider using a lung function apparatus if available. A chart is available that provides the average peak flow rate for healthy children and teenagers but this should be used as a guideline only.
Q: When Should Peak Flow Be Measured?
A: Discuss with your healthcare provider when you should measure your peak flow. Some patients only use a peak flow meter when they feel their asthma symptoms are getting worse, because they know their "normal" peak flow rate. Other patients need to use a peak flow meter daily and chart their peak flow readings to identify trends in their asthma.
Tips for Measuring Peak Flow:
Blow as hard and as fast as you can into the peak flow meter for the most accurate measurement.
Record the result on a piece of paper, and then repeat for a total of 3 measurements.
Record the highest reading if charting your peak flow readings.
Clean your peak flow meter so the readings aren't affected by dirt or mucous collected in the meter.
American Scientific Resources has asked School Health to help them provide Whistle Watches to the school nursing community. Later this month we are going to be sending out an email containing the details of this campaign. Subscribe to our emails to get the full details >>
What is a Whistle Watch?
Whistle Watch™ acts as an early warning system helping to either prevent an asthma attack and possible emergency room visit or indicate if medication isn't working. Children are old enough to use Whistle Watch™ as soon as they can make it "whistle." It measures a maximum peak efficiency flow rate 427.
Shop all peak flow meters, nebulizers, and other asthma control products >>
About American Scientific:
American Scientific Resources, Inc. (OTCQB: ASFX) www.americansci.com is a purpose-driven consumer product manufacturer specializing in the clinical, home healthcare, infant and juvenile product industries. The Company designs and manufactures innovative health and safety products, developing advanced technology and intellectual property. Brands under the American Scientific Resources umbrella include Kidz-Med VeraTemp, Disintegrator Plus needle destruction device, and the VeraTemp+ professional non-contact thermometer.
For more information, visit the corporate web site at www.americansci.com, www.kidzmed.com and www.disintegratorplus.com.
Asthma is One of the Most Common Chronic Childhood Diseases
According to parent reports, students miss 14 million days of school each year due to asthma. Implementing a set of policies and procedures to keep asthmatic children in school benefits both the student and the school district since asthma is classified as a disability under the “Health Impaired” category of the Individuals with Disabilities Education Act (IDEA) of 1997. According to the American Association of School Administrators (AASA), this means schools may be required to improve school conditions, such as indoor air quality, that might act as a barrier to learning for those with asthma in addition to creating an Individualized Education Plan (IEP) and a a “504” accommodation plan for the student(s).1
Whether your school has already implemented an asthma management program that you would like to enhance or you are looking for a way to evaluate what is currently being offered at your school, the 6 free resources below should help point you in the right direction.
Asthma Action Plan - Sample Asthma Action Plan from the National Heart, Lung and Blood Institute.
You Can Control Asthma: A Guide to Understanding Asthma and Its Triggers - A brochure for parents from the Centers for Disease Control and Prevention (CDC).
Managing Asthma: A Guide to Schools - a 44-page guide developed as a collaborative project between the National Asthma Education and Prevention Program (NAEPP) (coordinated by the National Heart, Lung, and Blood Institute [NHLBI]), U.S. Department of Health and Human Services and the Office of Safe and Drug-Free Schools, U.S. Department of Education.
Better Together: Collaborating to Improve Student Success and Well-Being- A report of how state administrators and state school boards associations leveraged their leadership on behalf of students to improve the lives of children with asthma at the local district level.
In the Schoolyard and Beyond: Addressing Childhood Asthma in Your Community - Learn 6 action steps that youth-serving organizations, families and schoolscan take to ensure consistent asthma-friendly environments.
Powerful Practices: An Assessment Tool for School Districts Addressing the Needs of Students with Asthma - Use this checklist periodically to gauge your progress in managing asthma at school and to identify areas that could use more attention.
Video: What happens during a flare-up? - a video by Seattle Children's Hospital.
Find more asthma resources for school leaders at the AASA website >>
Find nebulizers, educational materials, peak flow meters, and more at www.schoolhealth.com >>
1Asthma Wellness: Keeping Children with Asthma in School and Learning
Our Product Expert Talks Nebulizers
Having sold health supplies to schools for the past 50 years, School Health is familiar with the types of questions school nurses have about nebulizers. We asked one of our product managers, Jennifer Mallo, to help "clear the air" on this potentially life-saving device.
Are nebulizers multi-use machines? Yes, however, some maintenance is involved. Most units require you to replace filters and medicine cups after a certain length of time. For example, ideally, filters should be replaced after one month, if the filter turns grey, or the device has been in storage for three months or longer.
Can more than one child use the same nebulizer? Yes, but if using with multiple students, each child will need their own mouth piece or mask.
What is the best way to clean & disinfect a nebulizer? This can vary by unit, but you can read 4 options for disinfecting your nebulizer from Seattle Children's Hospital >>
Can nebulizers be used on all ages or on special needs children? Yes, however the method of delivery of asthma medication should be determined by their doctor. Nebulizers are typically the easiest way for young children or special needs children to receive their medication.
Do some nebulizers deliver therapy more quickly than others? Yes, it depends upon the unit. Typically delivery speed varies from 5 to 15 minutes under normal conditions.
Have additional questions? Let us know by commenting below.
Shop all our asthma products >>
Jennifer Mallo began her career at School Health Corporation as an Inside Sales Representative and is currently the product manager for the majority of our school nursing product categories. In addition to her product management duties, Jennifer is a Certified Health Education Specialist and recently earned her Master of Public Health degree.
The American Association for Pediatric Ophthalmology and Strabismus (AAPOS), has partnered with the National Association of School Nurses (NASN) to develop resources to promote vision screening and to disseminate information about common eye diseases in children. A number of exciting new resources are now available as a result of this partnership including a tutorial DVD and an easy-to-use, portable vision screening kit for near and distance visual acuity.
School Nurse Vision Screening Tutorial DVD
Kathy Lee, MD, PhD, a pediatric ophthalmologist practicing in Idaho, created a School Nurse Vision Screening tutorial DVD as a project for the American Academy of Ophthalmology’s Leadership Development Program.
The School Nurse Vision Screening Tutorial DVD covers the following topics:
- Rationale for effective school vision screening
- Information regarding refractive errors, amblyopia, and strabismus
- Elements of a successful screening program
- Pearls and pitfalls of traditional vision screening
- Examples of preferred and non-preferred charts
- Demonstration of the proper use of objective vision screening devices (i.e., photorefractors)
- Presentation of other elements of vision screening, including color, stereoacuity, and near vision
- Effective screening of children with disabilities
Watch Susan Proctor, RN, DNS (PhD), author of To See or Not To See in the video clip below!
To preview additional tutorials online, go to:
New Portable Vision Screening Kit for Schools
To support the video, AAPOS, Good-Lite, and School Health entered into a formal agreement to distribute the School Nurse Vision Screening Tutorial DVD within a new vision screening kit that includes eye charts for conducting near and distance visual acuity screening with children from preschool age through senior high.
The kit experienced incredible success at its debut at NASN 2011 in Washington, D.C. All 200 kits that were shipped to the booth were sold to nurses attending lectures given by AAPOS and vision screening expert P. Kay Nottingham Chaplin, Ed.D. Additional nurses signed up to have a kit shipped to them after the conference.
The kit includes a bag for lightweight, portable transportation and these items:
- School Nurse Vision Screening Tutorial DVD
- 4 double-sided distance charts* in one spiral-bound booklet
- 4 double-sided near charts* in a separate spiral-bound booklet
- Response panel and individual cards for matching
- Occluder glasses
*Optotypes used in charts are LEA Symbols, LEA Numbers, HOTV, and Sloan Letters.
For more information on the kit, go to www.schoolhealth.com/visionkit
Download Vision Screening Presentations from NASN
You can download a free copy of Dr. Kathy Lee's Powerpoint presentation from the NASN 2010 conference, titled Efficient and Effective School Vision Screening. It is available, along with many other resources mentioned above at this AAPOS landing page:
To those of you who received a kit during or after the NASN 2011 conference, please post a comment or e-mail our Vision Screening Expert, Dr. Kay at email@example.com with your thoughts about the DVD and eye charts.