c/EPA
United States
Environmental Protection
Agency
Indoor Environments      EPA 402-K-05-002

Division (6609J)         August 2005
Office of Air and Radiation
                                               * tiil'
                                     Managing Asthma in the
                                        School Environment

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  10  Ways to Manage Asthma  in the School Environment
1.
T»
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    Use the IAQ Tools for Schools Kit
    • Help people with asthma by
      improving the school
      environment with IAQ practices
      recommended in this kit.

    Control Animal Allergens
    • Remove classroom animals from
      the school, if possible.
    • If not, locate animals away from
      sensitive students and ventilation
      systems.

    Control Cockroach Allergens
    • Use Integrated Pest Management
      practices to prevent cockroach
      and other pest problems (e.g.,
      store food in tightly sealed
      containers and place dumpsters
      away from the building).

    Clean Up Mold and Control Moisture
    • Fix moisture problems and
      thoroughly dry wet areas within
      24-48 hours to prevent mold
      growth.
    • Clean up hard, moldy surfaces
      with water and detergent, then
      dry thoroughly.

    Eliminate Secondhand Smoke Exposure
    • Enforce no-smoking policies in
      the school.
    Reduce Dust Mite Exposure
    • Make sure the school is dusted
      and vacuumed thoroughly
      and regularly.
7.
                                      8.
                                       9.
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      Your School
      • Include school policies on
        inhaler and other medication
        usage, and emergency
        procedures for school  staff for
        use when a student has an
        asthma attack.
      • Obtain the National Asthma
        Education and Prevention
        Program's Managing Asthma: A
        Guide for Schools.

      Provide School-Based Asthma
      Education Programs
      • Contact your local American
        Lung Association about Open
        Airways For Schools, a school-
        based asthma management
        program for students with
        asthma.

      File Student Asthma Action  Cards
      • Encourage students to work with
        their health care providers to
        identify their asthma triggers.
      • Make sure students with asthma
        obtain and turn in copies of their
        Asthma and Allergy Foundation
        of America action cards to
        teachers, school  nurse, etc.

l(/»  Gather Additional Asthma Information
      and Resources
      • Establish a complete file on
        existing asthma and allergy-
        related information sources
        to reference throughout the
        school year.
  Visit www.efa.jov/asttima for information on common asthma triggers and how to manage them,
asthma education programs available in your community, and no-cost resources that schools can use
                       to educate students and staff about asthma.

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The Asthma Epidemic
Asthma has reached epidemic
proportions in the United States
affecting millions of people of all ages
and races. An average of one out of
every 13 school-age children has
asthma, and the percentage of children
with asthma is rising more rapidly in
preschool-age children than in any other
age group. Asthma is the leading cause
of school absenteeism due to a chronic
condition, accounting for more than
14.7 million missed school days per
year. Asthma also accounts for many
nights of interrupted sleep, limitation of
activity, and disruption of family and
care-giver routines. Asthma symptoms
that are not severe enough to require a
visit to an emergency room or to a
physician can still be serious enough to
prevent a child with asthma from living a
fully active life.

Asthma is a long-term, inflammatory
disease that causes the airways of the
lungs to tighten and constrict, leading to
wheezing, breathlessness, chest
tightness, and coughing. The
inflammation also causes the airways of
the lungs to become especially sensitive
to a variety of asthma triggers. The
particular trigger or triggers and the
severity of symptoms can differ for each
person with asthma.

Since Americans spend up to 90% of
their time indoors, exposure to indoor
allergens and irritants may play a
significant role in triggering asthma
episodes. Some of the most common
asthma triggers found indoors include:

    • animal dander
    • cockroaches
    • mold
    • secondhand smoke
    • dust mites

Other asthma triggers include:
respiratory infections, pollens (trees,
grasses, weeds), outdoor air pollution,
including ozone and particulate matter,
food, allergies, exercise, and cold air
exposure.

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Asthma in Schools

 Each day, one in five Americans
 occupies a school building; the majority
 of these occupants are children.
 Environmental asthma triggers
 commonly found in school buildings
 include cockroaches and other pests,
 mold resulting from excess moisture in
 the building, and dander from animals in
 the classroom. Secondhand smoke and
 dust mites are other known
 environmental asthma triggers found in
 schools. In addition, some literature
 suggests that children with asthma may
 be affected by other pollutants from
 sources found in schools, such as
 unvented stoves or heaters and
 common products (e.g., cleaning
 agents, perfumes, and sprays).

 Effectively managing a child's asthma
 can best be accomplished through a
 comprehensive plan that addresses
 both the medical management of
 the disease and avoidance of
 environmental triggers. Since children
 spend most of their time in schools,
 day care facilities, or at home, it is
 important to reduce their exposure to
 environmental asthma triggers as
 much as possible in each of these
 environments. This publication focuses
 on steps that schools can take to help
 children breathe easier.

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Use  the Indoor  Air Quality
Tools  for Schools Kit
Many indoor air quality problems in
schools can impact the health of
students  and staff, including those with
asthma. Some of the indoor air quality
problems include chemical pollutants
from building or building maintenance
materials; chemical pollutants from
science and art classes; improperly
maintained ventilation systems; and
allergens from classroom animals and
cockroaches. Mold growth may result
from standing water in maintenance
rooms and near piping, or from moisture
in ceiling tiles, carpets, and other
furnishings. Also, outdoor air pollutants
and pollens may enter the school
through ventilation systems and open
doors and windows.

In order to help improve indoor air
quality problems in school buildings, the
Environmental Protection Agency (EPA)
developed the  Indoor Air Quality (IAQ)
Tools for Schools Kit. The IAQ Tools for
Schools Kit helps school personnel
identify,  resolve, and prevent indoor air
quality problems in the school
environment. Using an IAQ
management plan that includes
checklists for the entire building can
lower student and staff exposure to
asthma triggers. The checklists available
in the IAQ Tools for Schools Kit help
schools address ventilation  systems,
maintenance procedures, renovations
and repairs, classroom policies—
especially for animals and mold—
administrative offices, health offices,
food service areas, pest management,
waste management, the role of school
officials, and a walkthrough  of the entire
building.

Included in the Kit are several resources
to explain the fundamentals of indoor air
quality and guidance for improving air
inside schools:

    • IAQ Coordinator's Guide
    • IAQ Reference Guide
    • Checklists
    • Background informational piece
      for staff
    • IAQ problem solving  wheel
    • Road Map
    • Fact sheet on district-wide
      implementation
    • Summary of EPA's Awards
      Program
    • Video on how to conduct a
      walkthrough
    • Video covering the ventilation
      checklist and a case  study on
      how one school implemented
      IAQ Tools for Schools
                                                          IAQ Tools for Schools

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Most schools form an IAQ coordinating
team to implement the guidance in the
IAO Tools for Schools Kit. Because IAQ
problems can originate anywhere in the
school building, the entire staff should
be informed about and participate in
improving IAQ. In addition, students can
be involved in the process. Information
about available curricula on indoor air
quality can  be found on EPA's Web site,
www.epa.gov/iaq/schools.

School districts across the United
States have adopted IAQ Tools for
Schools. The IAO Tools for Schools Kit
can be used alone or in conjunction with
the American Lung Association's
Open Airways For Schools asthma
curriculum for eight to 11 -year old
children (see information included
in this publication on Asthma
Management and Education).
EPA has developed additional
tools and programs to help
schools and school districts
implement the IAQ Tools for
Schools Kit. This document,
Managing Asthma in the
School Environment, is one
of those tools. It is a
component of the IAQ Tools
for Schools Kit and is also
available as a stand alone
document.
For more information about EPA's IAQ
Tools for Schools Program, visit the Web
site at www.epa.gov/iaq/schools.

The IAQ Tools for Schools Kit is available
at no cost. To receive the Kit, call IAQ
INFO at 1-800-438-4318 or download it
from EPA's Web site at
www.epa.gov/iaq/schools.
  IAQ Tools for Schools

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Control Animal Allergens
 Classrooms often adopt animals as
 classroom pets or science projects. Any
 warm-blooded animals, including
 gerbils, birds, cats, dogs, mice, and
 rats, may trigger asthma. Proteins,
 which act as allergens in the dander,
 urine, or saliva of warm-blooded
 animals, may sensitize individuals and
 can cause allergic reactions or trigger
 asthma episodes in people sensitive to
 animal allergens.

 Common Sources Found in Schools
 The most common, obvious sources of
 animal allergens in schools are in the air
 and on the clothing of staff and children
 who handle pets. If an animal is  present
 in the school, there is a possibility of
 direct, daily exposure to the animal's
 dander and bodily fluids. It is important
 to realize that, even after extensive
 cleaning, pet allergens may stay in the
 indoor environment for several months
 after the animal is removed.

 The most effective
 method to
 control
 exposure to
 animal
 allergens in
 schools is to
 keep your school
 free of feathered or
 furred animals.
 However, for some
 individuals, isolation
 measures may be sufficiently
effective. Isolation measures include
keeping animals in localized areas;
keeping animals away from upholstered
furniture, carpets, and stuffed toys; and
keeping sensitive individuals away from
animals as much as possible.

It is important to make sure that
classrooms containing animals are
frequently and thoroughly cleaned. In
addition, animal allergens can readily
migrate to other areas of the school
environment through the air and on the
clothing of staff and children who
handle pets. Therefore, the entire
building should be cleaned thoroughly.

Schools are sometimes advised to use
air cleaners. Although properly used and
maintained air cleaners may be effective
for reducing animal dander in small
areas, they should only be considered
as an addition to other control methods.
It is also important to carefully review
     information on the type of air
           cleaner used to make sure
             it is suitably sized and has
             high particle removal
             efficiency. In addition,
                some air-cleaning
                 devices marketed as
                  air purifiers emit
                 ozone, which may
               be harmful to people
            with asthma.
                                                      Environmental Asthma Triggers

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Suggestions for Reducing Exposures in Schools
m Remove animals from the school, if
  possible.

If completely removing animals from the
school is not possible, then:
« Keep animals in cages or localized
  areas as much as possible; do not let
  them roam.

• Clean cages regularly. Consider using
  disposable gloves when cleaning.
• Place animals away from air vents to
  avoid circulating allergens throughout
  the room or building.

• Locate sensitive students as far away
  from animals and habitats as possible.

• Keep animals away from upholstered
  furniture, carpets, and stuffed toys.

These action items are included on the
Teachers Checklist, available in the
IAQ Tools for Schools Kit.
Control Cockroach and Pest Allergens
Cockroach allergens play a significant
role in triggering asthma throughout
inner-city, suburban, and rural schools.
Certain proteins that act as allergens in
the waste products and saliva of
cockroaches can cause allergic
reactions or trigger asthma symptoms
in some individuals.
 Pest allergens, especially rats and mice,
 have been shown to cause occupational
 asthma symptoms among laboratory
 workers. These allergens may also
contribute to allergies and asthma in the
general population.

Common Sources Found in Schools
Cockroaches and other pests, such as
rats and mice, are often found in the
school setting. Allergens from these
pests may be significant asthma triggers
for students and staff in schools. Pest
problems in schools may be caused or
worsened by a variety of conditions
such as plumbing leaks, moisture
  Environmental Asthma Triggers

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problems, and improper food handling
and storage practices. In order to
manage a pest problem, control water
and food sources. It is important to
avoid exposure to cockroach and pest
allergens by using common sense
integrated pest management (IPM)
practices throughout the entire school.

There are four key IPM methods for
reducing exposure to pests in the school
setting: 1) look for signs of pests; 2) do
not leave food, water, or garbage
exposed; 3) remove pest  pathways a, iu
shelters; and 4) use pest control
products such as poison  baits, traps,
and pesticide sprays, as needed.


Integrated Pest Management Practices for
Reducing Exposures in Schools
Check food preparation, cooking, and
storage areas regularly for signs of
cockroaches and pests:
• Look for dead cockroaches or pests.

• Look for waste products (e.g., pest
  droppings).

« Look for greasy smears on walls,
  which could indicate possible rat runs.
Confirm that appropriate food preparation,
cooking, and storage practices are
implemented:
  Review food handling and storage
  practices. Containers should be well-
  sealed, with no traces of food left on
  outside surfaces of containers.

• Make sure food is not kept in the
  classroom overnight.

  Keep animal food in sealed containers.

Maintain general cleanliness:
• Sweep and wet mop floors to
  remove food.

• Clean stoves and ovens after use.

ft Wipe counters clean with soap and
  water or a disinfectant,  according to
  school policy.

* Remove trash daily.

• Fix plumbing leaks and other
  moisture problems.

• Do not let water stand in air
  conditioning or refrigerator drip pans.

Select waste containers by considering the
kind of waste that is placed in them:
• Dispose of food waste or
  contaminated papers and plastics in
  secured, covered containers or tied off
  plastic bags to discourage pests.
                                                      Environmental Asthma Triggers

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Empty waste containers regularly and
frequently, and store them in an
appropriate location:
• Follow a regular schedule of emptying
  waste containers in order to minimize
  odors and deprive pests of their food
  sources.

• Place dumpsters away from the
  building to minimize opportunities for
  pests to enter the building.

Eliminate pest entryways, pathways,
and shelters:
B Remove clutter (e.g., stacks of papers)
  where cockroaches may hide.

• Seal small spaces where cockroaches
  may live (e.g., where plumbing or
  electrical wiring goes through walls,
  and cracks or spaces in walls around
  baseboards and window sills.)

• Block possible entry points for rodents
  and other pests.

Do not rely on widespread, indiscriminate
use of pesticides to control pests:
m Try using poison baits, boric acid, or
  traps before using pesticide sprays.

• Track cockroach populations by using
  small sticky traps or monitoring traps
  that contain no pesticide.

• Rather than using bait, trap rats
  and mice.

  Use pesticide sprays in classrooms
  only as a last resort.
If pesticide sprays are used in the school:
• Use pest control chemicals in strict
  accordance with state and local
  regulations and the instructions on the
  container.

• Consider notifying school staff  and
  parents well in advance of pesticide
  applications.

  Schedule pesticide applications for
  unoccupied periods so that the
  affected area can be well ventilated
  before occupants return.

These action items can be fount! on the
following checklists in the IAQ Tools for
Schools Kit:
Integrated Pest Management Checklist,
Teachers Checklist, Administrative Staff
Checklist, Waste Management Checklist,
Food Service Checklist, Building & Grounds
Maintenance Checklist, Ventilation Checklist,
Walkthrough Checklist
  Environmental Asthma Triggers

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Clean Up Mold and Control Moisture
Molds can be found almost anywhere;
they can grow on virtually any substance
if moiture is present. Outdoors, many
molds live in the soil and play a key role
in the breakdown of leaves, wood, and
other plant debris. Without molds we
would be struggling with large amounts
of dead plant matter.

Molds produce tiny spores to
reproduce. Mold spores travel through
the indoor and outdoor air continually.
When mold spores land on a damp spot
indoors, they may begin digesting
whatever they are growing on to survive.
There are molds that can grow on wood,
paper, carpet, and foods. If excessive
moisture or water accumulates indoors,
mold growth may occur, particularly if
the moisture problem remains
undiscovered or unaddressed. There is
no practical way to eliminate all mold
and mold spores in the indoor
environment; the way to control indoor
mold growth is to control moisture.  If
mold is a problem in your school, you
must clean up the mold and  eliminate
sources of moisture.

When mold growth occurs in buildings,
it may be followed by reports of health
symptoms from some building
occupants, particularly those with
allergies or respiratory problems.
Potential health effects and symptoms
associated with mold  exposures include
allergic reactions, asthma, and other
respiratory complaints.
Common Moisture Sources Found in Schools
Moisture problems in school buildings
can be caused by a variety of problems,
including roof and plumbing  leaks,
condensation, and excess humidity.
Some moisture problems in schools
have been linked to changes in building
construction practices during the past
twenty to thirty years. These changes
have resulted in more tightly sealed
buildings that may not allow  moisture to
escape easily. Moisture problems in
schools are also associated with
delayed or insufficient maintenance due
to budget constraints. Temporary
structures in schools, such as trailers
and portable classrooms, have
frequently been associated with
moisture and mold problems.


Suggestions for Reducing Mold
Growth in Schools
Reduce Indoor Humidity:
m Provide adequate ventilation to
  maintain indoor humidity levels
  between 30-60%.

• Control humidity levels and dampness
  by using air conditioners and
  dehumidifiers.

• Use exhaust fans whenever cooking,
  dishwashing, and cleaning in food
  service areas.

• Vent showers and other moisture-
  generating sources to the outside.
                                                    Environmental Asthma Triggers

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Inspect the building for signs of
mold, moisture, leaks, or spills:

tt Check for moldy odors.

• Look for water stains or discoloration
  on the ceiling, walls, floors, and
  window sills.

« Look around and under sinks for
  standing water, water stains, or mold.

• Inspect bathrooms for standing water,
  water stains, or mold.

• Do not let water stand in  air
  conditioning or refrigerator drip pans.

Respond promptly when you  see signs of
moisture and/or mold, or when leaks or
spills occur:
• Clean and dry any damp  or wet
  building materials and furnishings
  within 24-48 hours of occurrence to
  prevent mold growth.

• Fix the source of the water problem or
  leak to prevent mold growth.

': Clean mold off hard surfaces with
  water and detergent, and dry
  completely. Absorbent materials such
  as ceiling tiles, that are moldy, may
  need to be replaced.

• Check the mechanical  room and
  roof for unsanitary conditions, leaks, or
  spills.
Prevent moisture condensation:
  Reduce the potential for condensation
  on cold surfaces (i.e., windows, piping,
  exterior walls, roof, or floors) by
  adding insulation.

Floor and carpet cleaning:
«* Remove spots and stains immediately,
  using the flooring manufacturer's
  recommended techniques. Use care
  to prevent excess moisture or cleaning
  residue accumulation and ensure that
  cleaned areas are dried quickly.

• Avoid installing carpeting in areas
  where there is a perpetual moisture
  problem (i.e., by drinking fountains, by
  classroom  sinks,  or on concrete floors
  with leaks or frequent condensation).

These action items are included on the
following checklists found in the IAQ Tools
for Schools Kit:

Ventilation Checklist,  Building & Grounds
Maintenance Checklist, Administrative Staff
Checklist, Teachers Checklist, Food Service
Checklist, Renovation and Repair Checklist,
Walkthrough Checklist,
  Environmental Asthma Triggers

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Eliminate  Secondhand Smoke Exposure
Secondhand smoke can originate from
burning cigarettes, pipes, or cigars or
exhaled smoke. Secondhand smoke
exposure causes a number of serious
health effects in young children, such as
coughing and wheezing, bronchitis and
pneumonia, ear infections, reduced lung
function, and worsened asthma attacks.
Secondhand smoke is an irritant that-
may trigger an asthma episode, and
evidence suggests that secondhand
smoke may cause asthma in children.
EPA estimates that exposure to
secondhand smoke exacerbates
asthma symptoms in 200,000 to
1,000,000 children. Secondhand smoke
can also lead to buildup of fluid in the
middle ear, the most common cause of
children being hospitalized for an
operation.
Common Sources Found in Schools
The majority of schools in the United
States prohibit smoking on school
grounds. However, oftentimes smoking
occurs in school bathrooms, lounges,
and on school grounds, especially near
entrances. This may cause problems for
students and staff who have asthma.

It is important to enforce smoking bans
on school grounds in order to prevent
exposure to secondhand smoke. If
smoking occurs within the building,
secondhand smoke can travel through
the ventilation system to the entire
school. Even when people smoke
outside, secondhand smoke may enter
the school through the ventilation
system, open windows, and doors.

Suggestion for Reducing Exposure in Schools
• Develop no smoking policies on
  school grounds.

• Enforce smoking bans on school
  property.

• Educate staff and students on the
  effects of secondhand smoke.

• Learn more about EPA's Smoke-
  free Homes Program at
  www.epa.gov/smokefree

These action items are included on the
Health Officer/School Nurse Checklist,
available in the IAQ Tools for Schools Kit.
                                                   Environmental Asthma Triggers

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Reduce Exposure to Dust Mites
Dust mite allergens play a significant
role in triggering asthma. They may
cause an allergic reaction or trigger an
asthma episode in sensitive individuals.
In addition, there is evidence that dust
mites cause new cases of asthma in
susceptible children.

Dust mites are too small to be seen but
are found in homes, schools, and other
buildings throughout the United States.
Their food source is dead skin flakes.


Common Sources Found in Schools
Dust mites may be found in schools in
carpeting, upholstered furniture, stuffed
animals or toys, and pillows.  Stuffed
animals or toys, as well as pillows for
taking naps, are used mostly in the
primary grades. It is important to keep
classrooms free of clutter, to  dust
regularly, and to wash items frequently
that attract dust.
Suggestions for Reducing
Exposure in Schools
• Choose washable stuffed toys; wash
  them often in hot water.
• Cover pillows in dust-proof (allergen-
  impermeable), zipped covers.

• Remove dust from hard surfaces often
  with a damp cloth, and vacuum
  carpeting and fabric-covered furniture
  to reduce dust buildup. Allergic people
  should leave the area being
  vacuumed. Vacuums with high
  efficiency filters or central vacuums
  may be helpful.

• Maintain clean classrooms.

Refer to the Teachers and Building &
Grounds Maintenance Checklists, available
in the IAQ Tools for Schools Kit.
     Environmental Asthma Triggers

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Asthma Management and Education
Experts convened by the National
Asthma Education and Prevention
Program (NAEPP) and coordinated by
the National Institutes of Health (NIH)
have reviewed the scientific literature
and produced guidelines that define the
best diagnosis and management
practices for asthma. These guidelines
include recommendations for medical
diagnosis and treatment, including the
use of inhalation therapy and specific
recommendations for controlling indoor
environmental factors that contribute to
asthma severity.


Develop an Asthma Management
Plan in Your School
Schools can play an important role in
helping students manage their asthma
by providing support through the
development of an asthma management
plan. Each school should develop an
overall asthma management plan that
includes school policies on the use of
inhalers and medications, actions or
emergency procedures school staff
should take when a student has an
asthma attack, and student asthma
action cards.

The student asthma action card serves
as an individual management plan for
each student with asthma. The action
card also provides pertinent information
to school officials on each student's
asthma condition.
The asthma action card should contain
the student's medical information,
identified asthma triggers, emergency
procedures, and phone numbers. This
action card should be signed by a
physician and parent or care-giver and
kept on file at school. The Asthma and
Allergy Foundation of America's (AAFA)
asthma action card is provided in this
publication. AAFA encourages
duplication and distribution of the
asthma action card in the school setting.

Provide School-Based Asthma
Education Programs
The school setting provides an
opportunity for directly educating
children, parents, care-givers, teachers,
and other school staff about asthma
management and indoor environmental
triggers. An example of a school-based
asthma education program is the
                                                 Asthma Management and Education

-------
American Lung Association's (ALA)
Open Airways For Schools. This
elementary school-based program
empowers children and their parents by
teaching them to take control of asthma.

Through ALA's Open Airways For
Schools program, children learn specific
steps they can take to manage asthma.
Specifically, they learn to prevent
asthma episodes by reducing their
exposure to environmental asthma
triggers and using their asthma
medication correctly. Children also learn
what to do when asthma symptoms
develop, how to use medications
correctly, and when to seek help
from adults.

Designed for eight to 11 -year old
children with asthma, this curriculum
consists of six lessons and is designed
to be easy for trained volunteers or
school staff to present. Generally held
during the school day,  each lesson
takes about 40 minutes and is flexible
enough to fit any school's schedule. The
program's hands-on teaching approach
utilizes group discussion, stories,
games, and role-playing to promote
children's active involvement in the
learning process.
Children enrolled in this program
have demonstrated: increased school
performance; more confidence in their
ability to manage asthma; greater
influence on their parents' asthma
management decisions; fewer episodes
of asthma, as well as episodes of
shorter duration; and more active
management of their asthma. The
program is approved and recommended
by the National Association of
School Nurses.

Although asthma affects children of
all backgrounds, minority groups are
disproportionately affected. To reach
children from all backgrounds, artwork
in the curriculum was designed with a
distinctive multi-cultural appeal with
specially designed cartoon illustrations
of children in urban, rural, and suburban
settings. To reach an even broader
audience, ALA's Open Airways For
Schools is now available in English
and Spanish.

For more information about the American
Lung Association's Open Airways For
Schools program, contact your local Lung
Association at 1-800-LUNG-USA (1-800-
586-4872) or visit the ALA Web site
(http://www. lungusa. org.)
  Asthma Management and Education

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Asthma Action Card
Name:
Homeroom Teacher:
Parent/Guardian Name:
Address:
Parent/Guardian Name:
Address:
Emergency Phone Contact #1 :
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National Asthma Education and
Prevention Program
Grade: Age:
Room:
Ph: (H)
Ph:MA
Ph: (H)
Ph:(\M

                              Name
                                                          Relationship
                                                                                  Phone
Emergency Phone Contact #2:
                              Name
                                                          Relationship
                                                                                  Phone
Physician Treating Student for Asthma:
Other Physician: 	
                             _Ph:
                              Ph:
Emergency Plan
Emergency action is necessary when the student has symptoms such as
                      ., or has a peak flow reading of.
Steps to take during an asthma episode:
1. Check peak flow.
2. Give medications as listed below. Student should respond to treatment in 15-20 minutes.
3. Contact parent/guardian if:  .                       	
4. Re-check peak flow.
5. Seek emergency medical care if the student has any of the following:
       • Coughs constantly
       • No improvement 15-20 minutes after initial treatment with medication and a relative cannot
          be reached
       • Peak flow of	
       • Hard time breathing with:
             • Chest and neck pulled in with breathing
             • Stooped body posture
             • Struggling or gasping
       • Trouble walking or talking
       • Stops playing and can't start activity again
       • Lips or fingernails are grey or blue
Emergency Asthma Medications
                                      ID Photo
  Name
Amount
When to Use
1,
2.
3,
A

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Daily Asthma Management Plan
(Identify the things which start an asthma episode. Check each that applies to the student.)
Q Exercise
Q Strong odors or fumes
Q Other
a Respiratory infections   Q Chalk dust/dust
Q Carpets in the room     Q Animals
QFood  	
Comments   	
                                 Q Change in temperature
                                 Q Pollens
                                 Q Molds
Control of School Environment
(List any environmental control measures, pre-medications, and/or dietary restrictions that the student needs to prevent an
asthma episode.) 	
Peak Flow Monitoring
Personal Best Peak Flow Number:
Monitoring Times:  	
Daily Medication Plan
  Name
1.	
             Amount
          When to Use
2.
3.
4.
Comments/Special Instructions
For Inhaled Medications
Q I have instructed
   It is my professional opinion that	
   use that medication by him/herself.
Q It is my professional opinion that	
   medication by him/herself.
                           in the proper way to use his/her medications.
                          	should be allowed to carry and
                                          should not carry his/her inhalec
               Physician Signature
                                     Date
               Parent/Guardian Signature
                                     Date
          AAFA • 1233 20th Street, N.W., Suite 402 , Washington, DC 20036 • www.aafa.org • 1-800-7-ASTHMA

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Additional Resources
For more information on asthma contact:
U.S. Environmental Protection Agency
www.epa.gov/iaq/schools
Download the IAQ Tools for Schools Kit
from EPA's Web site.
www.epa.gov/asthma
Find more asthma resources on EPA's
Web site.
www.epa.gov/cleanschoolbus
Learn about EPA's clean school bus
initiative on EPA's Web site.

U.S. EPA Indoor Air Quality Information
Clearinghouse (IAQ INFO)

(800)438-4318
(703) 356-5386 Fax
Call to request the IAQ Tools for Schools Kit.

Allergy and Asthma Network/Mothers of
Asthmatics, Inc.

(800) 878-4403
www.aanma.org
Ask about obtaining their School
Information Packet.

American Lung Association

(800) LUNG-USA
www.lungusa.org
Ask about the Open Airways for
Schools program and the Asthma-
Friendly Schools Toolkit.
Asthma and Allergy Foundation of America

(800) 7-ASTHMA
www.aafa.org
Ask about AAFA's Asthma Management
at School presentation for parents and
school personnel. Also available are
additional school-based child and teen
education materials.

Center for Disease Control and Prevention

(888) 232-6789
www.cdc.gov/asthma
Find out more information on the
Asthma Prevention Program by visiting
this Web site.
                                                         Additional Resources

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in Schools Web site
schoolipm.ifas.ufl.edu
Find out more IPM information by
visiting this Web site.

National Association of School Nurses

(207)883-2117
www.nasn.org
Ask about obtaining Asthma Modules to
present to school staff.

National Asthma Education and
Prevention Program

(301)592-8573
www.nhlbi.nih.gov
Ask about obtaining four publications:
Managing Asthma: A Guide lor Schools,
Asthma and Physical Activity in School,
How Asthma Friendly is your School?, and
the Asthma Awareness Curriculum.

National Education Association Health
Information Network

(800)718-8387
www.neahin.org
Call to request information on a variety
of health  issues  in schools, including
asthma. Check this Web site for IAQ in
schools information.
Names, phone numbers, and e-mail addresses are
provided for informational purposes only. EPA
does not endorse products, services, or general policies
of any organization. The organizations mentioned in this
publication are not the only sources of information on
asthma in schools. Additional information may be
       from your physician or other health care
provider, insurance carrier, school system, or state or
local public health agency as appropriate.
         Additional Resources

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EPA REGIONAL  OFFICES
US EPA/Region 1 (CAP)
(CT, ME, MA, NH, Rl, VT)

1 Congress Street
Suite 1100
Boston, MA 02114-2023
(617)918-1639
(617) 918-1505 fax
US EPA/Region 6 (6PD-T)
(AR, LA, NM, OK, tt)

1445 Ross Avenue, Suite 1200
Dallas, TX 75202-2733
(214)665-7547
(214) 665-6762 fax
US EPA/Region 2 (R2DEPDIV)
(NJ, NY, PR, VI)

290 Broadway
28th Floor
New York, NY 10007-1866
(212)637-4013
(212) 637-4942 fax
US EPA/Region 3 (3PM $2)
(DC, DE, MD, PA, VA,
1 650 Arch Street
Philadelphia, PA 191 03-2029
(215)814-2086
(215)814-2101 fax
US EPA/Region 7 (ARWRALI)
(IA, KS, MO, HE)

901 North 5th Street
Kansas City, KS66101
(913)551-7020
(913) 551-7065 fax
US EPA/Region 8 (8P-AR)
(CO, Ml NO, SD, UT, IVY)

999 18th Street
Suite 300
Denver, CO 80202-2466
(303)312-6031
(303) 312-6044 fax
US EPA/Region 4
(AL, FL, GA, KY, MS, NC, SC, TN)

61 Forsyth Street, SW
Atlanta, GA 30303-3104
(404)562-9143
(404) 562-9095 fax
US EPA/Region 9 (Air-6)
(AZ,CA,HI,NY,AS,6U)

75 Hawthorn Street
San Francisco, CA 94105
(415)947-4192
(415) 947-3583 fax
US EPA/Region 5 (AE-17J)
(IL, IN, Ml, MN, OH, Wl)

77 West Jackson Boulevard
Chicago, IL 60604-3590
(312)353-6053
(312) 886-0617 fax
US EPA/Region 10 (OAQ-107)
(AK, ID, OR, WA)

1200 Sixth Avenue
Seattle, WA 98101-9797
(206) 553-4273
(206) 553-0110 fax
                                                          Additional Resources

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  Remember.

  'ID Wv

                           JJJ
  8
  9.
10
   I •     Use the IAQ Tools for Schools Kit


  At     Control Animal Allergens



  5 •     Control Cockroach Allergens



     •     Clean Up Mold and Control Moisture
     •     Eliminate Secondhand Smoke Exposure



  O •     Reduce Dust Mite Exposure
    »       Develop an Asthma Management
     •     Plan in Your School
      Provide School-Based
•     Asthma Education Programs
      File Student Asthma Action Cards
      Gather Additional Asthma
•     Information and Resources

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                                              «.
                        &EPA
                           United States
                           Environmental Protection
                           Agency
-r-

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