Reprinted from
National Jewish Medical and Research Center, 1400 Jackson Street, Denver, Colorado 80206
School Asthma Plan
Name of Student_______________Date_______,
School Age Children and Asthma
Asthma is the most common pediatric lung disorder. It affects as many as five percent of children under the age of 15 years, this is between two to five million children in the United States. Children with asthma have swollen, sensitive airways that lead to episodes of breathing difficulty. Although there is no known cure for asthma, it can be controlled effectively. When asthma is under good control, the inflammation and obstruction in the airways will be decreased. Because children spend most of their day at school, it is important that school professionals understand asthma and asthma management. This handout introduces asthma management concepts and gives school professionals detailed information about this student's asthma management program. Managing asthma will make it possible for the child to participate in school to the level of their ability. If you would like more information about asthma management, please call the Lung Line® at 1-800-222 LUNG. Registered Nurses will be able to answer your questions and send you written information about school issues and asthma management.
Asthma Triggers
Asthma triggers are the things that make asthma worse immediately or slowly over time. Every child with asthma has different asthma triggers. Triggers should be avoided or controlled in the school environment. These things can make asthma worse. Things that can make asthma worse are irritants (i.e., smoke and fumes), allergens (i.e., furry animals, grasses and trees), exercise, infections and emotions. Although emotions may trigger asthma symptoms, they do not cause asthma. Things That Make Asthma Worse: ______________________________________________________ ______________________________________________________
Peak Flow Monitoring
Children with asthma can effectively monitor their breathing at school by using a peak flow meter. A peak flow meter measures the flow of air in a forced exhalation in liters/minute. Peak flow monitoring can help identify the start of an asthma episode, often before the child is actually having symptoms. Peak flow zones divide the peak flow meter into the colors of a traffic light and can help children and school professionals make decisions about asthma management.
Personal Best:________________
- Green Zone (All Clear) Above ______________________________
- Yellow Zone (Caution) ___________________ TO _____________
- Red Zone (Medical Alert) Below_____________________________
Asthma Signs and Symptoms
Early warning signs and symptoms are indicators that a child's asthma may be getting worse. Monitoring asthma signs and symptoms is very important in managing asthma at school. Signs and symptoms are things that children feel or that you may notice when asthma is getting worse. Common symptoms to watch for include: wheezing, coughing, shortness of breath or chest tightness.
Early Warning Signs: ________________________________________________________ Asthma Symptoms: ________________________________________________________
Asthma Medications
Asthma medications are divided into two groups - bronchodilators and anti-inflammatory medications. Bronchodilator inhalers (i.e., Proventil®, Ventolin®, Maxaire®) work quickly to relax the muscles around the airways. Bronchodilators are used to treat asthma symptoms. Anti-inflammatories work slowly over time to decrease the inflammation in the airways. Anti-inflammatories may be inhaled (i.e., Beclovent®, Vanceril®, Azmacort®, Aerobid®) or oral (i.e., prednisone, Medrol®) medications. Anti-inflammatories are steroids, but they are not the same steroids used illegally by some athletes to enhance performance. Most children use a combination of bronchodilators and anti-inflammatories to manage their asthma. Spacers or holding chambers attach to the inhaler to increase the amount of medication that is delivered to the child's airways.
Asthma Action Plan
for______________________ ______(Student's Name). This action plan has been individually designed to help school professionals work with ________________________________________ (Student's Name) to control and treat asthma at school. It is based on monitoring peak flow numbers and asthma symptoms.
Name of School: ____________________________________________________________
Date of Birth: _____________________________________Grade:__________________
Parent(s') or guardian(s') names: ____________________________________________________________
Mother Telephone: (H) _________________(W) _____________________
Father Telephone: (H) _________________ (W) _____________________
Health Care Provider's Name: _____________________________________
Type of Insurance: ___________________________________________
In case of emergency, contact: Name: _____________________________
Telephone: ____________ Relationship: ___________
Name: _____________ Telephone: ____________Relationship: _______
Name: _____________ Telephone: ____________Relationship:_______
Hospital Preference if 911 is called:_______________________________
If peak flow number is from __________ to __________ or you notice any of these symptoms ______________________________________________
- ________________________________________________________
- ________________________________________________________
- ________________________________________________________
If peak flow number is from __________ to __________ or you notice any of these symptoms ______________________________________________
- _______________________________________________________
- _______________________________________________________
- _______________________________________________________
PARENT SIGNATURE / DATE___________________________
PHYSICIAN SIGNATURE / DATE________________________
Note: This information is provided to you as an educational service of National Jewish. It is not meant to be a substitute for consulting with your own physician.
This page is produced by the National Jewish Medical and Research Center, 1400 Jackson Street, Denver, Colorado 80206. Call LUNG LINE® -- 1-800-222-LUNG (5864) for information.
