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HelpingYour Child Manage Asthma at Home and at School

A Guide for Parents and Staff from the United Federation of Teachers

Michael Mulgrew, President

52 Broadway, New York, NY 10004

(212) 777-7500 • www.uft.org

UFT OFFICERS

Michael Mulgrew, President

Michael Mendel, Secretary

Mel Aaronson, Treasurer

Robert Astrowsky, Assistant Secretary

Mona Romain, Assistant Treasurer

VICE PRESIDENTS

Karen Alford, Carmen Alvarez, Leo Casey,

Richard Farkas, Aminda Gentile, Sterling Roberson

Copyright 1999 United Federation of Teachers

Revised July 2010

Illustrations courtesy of the Daily News

Copyright 1998

Produced by the UFT Communications Department

Asthmatic Breathing

Brief attack(lasting minutes) tightening of the muscle narrows the air tubes

Longer attack(lasting hours or days) Inflammation has increased

Asthmatic air tube (mildly inflamed)

During an attack, the air passages are narrowed as muscles tighten and are clogged from increased mucus and swelling of the lining of the airways. Patients may gasp for air and feel they are suffocating. When an attack begins, the patient complains frequently of a feeling of tightness in the chest. In addition, the patient has a hacking cough and shortness of breath. Thick mucus called phlegm develops in the lungs, and the cough becomes more intense. The patient may feel temporarily better after coughing up the phlegm.

TRINE GIÆVER DAILY NEWS

BREATHING DURING AN ASTHMA ATTACK

mucus

lungair tube

muscle

air way

air way

Blood vessels leak from allergic reactions

Airways swell and become inflamed

Mucus secretion increases

Muscles squeeze down and choke the airways

Four main ways an asthma attack results in blocked airways:

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A sthma is a chronic lungdisease. People whohave it are susceptible

to “attacks” in which airways inthe lungs become inflamed and narrow. This makes it verydifficult to breathe.

What isAsthma?

No one knows what causesasthma. No one can say forcertain what will cause or“trigger” an asthma attack —it’s different for every personwith the disease. If your child has an asthma

attack, she or he will show oneor more of these symptoms: B Itching throat.B Wheezing, which

is a high-pitchedwhistling sound madeduring exhales.

B Persistent coughing,especially at night.

B Tightening of the chest. B Shortness of breath.

DOES YOUR CHILD HAVE ASTHMA?

If you’re unsure whetheryour child has asthma, try thislittle quiz:In the last year: 1. Has your child had a

sudden severe episode orrecurrent episodes ofcoughing, wheezing orshortness of breath?

2. Have these episodesoccurred during a partic-ular time of the year, orwhen your child was in aparticular place, orexposed to certain things(like animals, tobacco,smoke or perfume)?

3. Has your child had coldsthat go to the chest ortake more than 10 daysto clear up?

4. Have you given yourchild any medication to

help him or her breatheeasier? Have these med-ications helped relievethe symptoms?

In the last month:5. Has your child had

episodes of coughing,wheezing or shortness ofbreath in the morning?In the middle of thenight — enough to wakehim or her up? Aftermoderate exercise?

If you answered “yes” toany of these questions, yourchild may have asthma. Makean appointment with yourchild’s doctor to be sure.

WHAT TRIGGERS ANASTHMA ATTACK?

You probably know some asthma triggers, but others might surprise you.They include: B Strong odors from per-

fumes, paints, sprays,etc.

B Air pollution.B Pollen.B Cigarette smoke.B Dust, mold and

cockroaches.B Vigorous exercise.B Furry animals.B Cold air or changes in

the weather.B Respiratory infections.B Allergies to foods such as

nuts, chocolate and fish.

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C hances are you know achild or an adult whohas asthma because the

disease is growing in NewYork City. Asthma is the lead-ing cause of serious chronicillness among children and,among those with chronic ill-nesses, it’s the leading causeof school absenteeism.

Asthma’sImpact onLiving andLearning

14.2 - 38+6.5 - 14.20 - 6.5

WHERE ASTHMA STRIKES THE HARDESTPer 1,000, by Zip code, children ages 0 to 14

KEY PER 1,000

This map shows how often children up to 14 are hospitalized for asthma across the city. It matches hospitalizations against a neighborhood's population to show how many children out of every thousand were admitted in 1996. Hospitalizations reflect the worst cases of asthma. Experts say high rates may be caused by both the prevalence of the disease and a lack of primary medical care in hard-hit neighborhoods.

TRINE GIÆVER DAILY NEWS

There are several theories onwhy more and more childrenare getting asthma in NewYork City. Some attribute it toincreasing air pollution or con-ditions in deteriorating hous-ing. But everyone agrees thattoo many children are going to

emergency rooms to treat theirasthma, and too many chil-dren are missing precious timein school. Asthma is a seriousdisease, but you can manage itwith your child so that he orshe can stay out of danger andin school.

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W hat should you do ifyou think your childhas asthma? First of

all, don’t panic: You’re notalone, and there are steps youcan take to manage the dis-ease. More than 130,000 chil-dren in New York City livewith asthma every day — andthe vast majority lead normal,healthy lives.

STEPS TO TAKE AT THEDOCTOR’S OFFICE

The initial — and mostimportant — steps towardmanaging your child’s asthmashould come while you’re stillat the doctor’s office. B Make sure you’re com-

fortable with the doctor’sdiagnosis of your child’scondition. If you’re not,insist on a referral to alung specialist.

B Try to determine whattriggers your child’s asth-ma attacks. (You maynever determine all thepossible triggers.)

B Teach your child how to:• Recognize asthmawarning signs.• Contact someoneother than you forhelp, if necessary.• Rest and relax duringan attack.• Take his or her medicine.• Do deep coughs afteran attack.

B Make an action plan withyour doctor and yourchild. It should include:

4 Ways to keep your child away from triggers.

4 A prescription for medicine,if necessary.

4 A shopping list for any asth-ma “tools” that the physicianprescribes. The most com-mon are a metered doseinhaler, a spacer, a nebulizerand a peak flow meter, all ofwhich could help your childprevent or ease an attack. Youshould get them from yourdoctor and check to seewhether your health insurancecovers it.

4 Careful instructions for youand your child from the doc-tor on how to use thesetools before and during anasthma attack.

4 A list of goals that your childshould strive to meet for theupcoming school year, suchas “I won’t forget to carry myasthma medicine with me,” “Iwill always rest when I feelout of breath” and “I willalways let my teacher knowabout my asthma.”Ê

ManagingYourChild’sAsthma

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THE TOOLSEVERYASTHMATICNEEDS

METERED DOSE INHALERWHAT IT IS: A small, hand-held

device comprised of acanister of medicationand a pipe-shapedpiece of plastic calledan actuator.Medicine is deliveredin an aerosol spray.

WHAT IT’S FOR: Fastdelivery of measured doses

of bronchodilator medicine to openclogged airways.HOW TO USE: Shake inhaler. Exhale.Place in mouth and inhale slowlywhile pressing down once on thetip of inhaler. Continue breathingin slowly and deeply. Wait oneminute between puffs.

SPACERWHAT IT IS:An attach-ment orholdingchamber thatfits overmouthpiece of ametered dose inhaler. Varyingstyles and shapes.WHAT IT’S FOR: For youngerchildren and others unable to usean aerosol inhaler. Traps medicinein chamber so it’s not lost.HOW TO USE: Place face over mouthand nose. Breathe in and out. Holdbreath for count of 10. Releaseslowly. Child’s nose should be heldduring this procedure to be sure thechild is breathing through mouth.

NEBULIZERWHAT IT IS: Electricair compressordelivering asthmamedication in amisty vapor.Breathing throughplastic mask ortube, patient drawsmedication into lungs.WHAT IT’S FOR: Delivers stronger doses of airway-opening medications. Used with b-adrenergic agonists, which open bronchial tubes, or cromolyn sodium, an anti-inflammatory agent.HOW TO USE:Medicine is inhaled inslow, deep breaths. Hold eachbreath for one to two seconds.Continue until all medicine isconsumed – about 10 minutes.

PEAK FLOW METERWHAT IT IS: Plastic tube-like gaugeto measure how effectively air ismoving from the lungs.WHAT IT’S FOR: An early warningsystem alerting asthmatics whentheir airways are narrowing.Asthmatics determine a personalpeak air flow by recording highscore when asthma is undercontrol, then measure future scoresagainst it.HOW TO USE:Whilestanding, take deepbreath. Hold it. Closelips tightly aroundmouthpiece. Blow hardin a quick puff wherethe indicatorstopped. Thatnumber is thecurrent peakflow. Record the highest ofthree tries.

THE TOOLSEVERYASTHMATICNEEDS

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STEPS TO TAKE AT HOME

When you return homefrom the doctor’s office, dis-cuss the action plan with yourchild and practice the correctuse of the asthma “tools.” Whenasthma management becomesroutine, your child will be saferand less afraid to participate insports and other fun activities.Nothing is more importantthan making sure your childis comfortable with the planand knows how to properlyuse the “tools” — after all, youcan’t watch your child 24hours a day. When your child has

an attack:B Stop whatever activity

is taking place.B Help your child into

a comfortable sittingposition — do not layhim or her down.

B Move him or her away from any possible triggers.

B Administer treatmentif needed according tothe management plan.

Remember: Most asthmaattacks should not result inhospitalization if you followthe steps outlined above — so don’t rely on a trip to thehospital to treat your child’sasthma, unless it’s an emer-gency (see box). Contact your doctor for advice. Here is what you can do at hometo reduce the chance thatyour child will have an asthma attack: (next page)

ASTHMA EMERGENCIES

Although most asthma attacks are notemergencies, recognizing when yourchild needs immediate medicalattention could save his or her life.

During an emergency, follow the foursteps at left then immediately call adoctor or dial 911.

Tendency to lean forward with shoulders held high.

Over-inflated chest with depressed rib spaces.

High pulse rate KIDS: Over 150 ADULTS: Over 100.

Inability to say more than a few words between breaths.

Flared nostrils with blue or grey lips.

A peak flow reading less than half of the child’s

TRIN

E G

IÆVE

R D

AILY

NEW

S

EMERGENCY SIGNS

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FURNITURE

B Put mattresses, pillowsand box springs in air-tight, dust-proof coversand tape over the zipper.

B Wash your child’s bed-ding — including non-feather pillows — everyweek in water that is atleast 130 degrees.

B If possible, don’t let yourchild lie down on uphol-stered furniture.

B Remove carpeting, espe-cially in the bedroom.

B Keep plants out of yourchild’s room.

CLEANING

B Use a damp cloth whendusting.

B Keep windows open andyour child in anotherroom when cleaning.

B Use air conditioning orfans to keep rooms dry.

B Use a dehumidifier toreduce mites and avoidmold; do not use humidi-fiers.

B Avoid using aerosol orspray cleaners in yourchild’s bedroom.

B Keep your child awayfrom vacuuming, freshpaint, solvents, roomdeodorizers and perfume.

B Aggressively exterminatecockroaches with traps,not sprays.

AIR

B Cover air vents withcheesecloth to reduce theamount of dust and otherparticles that come intothe room.

B Avoid tobacco and wood smoke.

B Wash furry pets regularly.

STEPS TO TAKE AT SCHOOL

Once you’ve done all youcan at home, you need tomake sure your child’s asth-ma needs are met at school.Here are some suggestions:B Ask the school secretary

for a “504 Form” andhave your doctor fill itout. This document,which is required byfederal law, describesyour child’s medicalneeds and makes it pos-sible for the school tokeep and dispense med-ication, both in schooland on class trips. It alsomay allow your child tocarry an inhaler inschool. Without it,inhalers are not permit-ted at school. Unfortu-nately, few parents rou-tinely fill out a 504Form — meaning manystudents with asthmawho needed to keepmedication at schoolwere unable to do so.

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B Ask to meet with theprincipal and schoolnurse to discuss yourchild’s needs. Here aresome issues to raise:

B Ask if classrooms andhallways are free of com-mon asthma triggerssuch as excessive moldand dust, animal waste,roaches and poor ventila-tion. Or request a tour ofthe school.

B Ask if your child’s class-rooms are well-ventilatedand free of commonschoolroom triggers suchas insecticide sprays.

B Ask if your school partic-ipates in special pro-grams such as the Ameri-can Lung Association’sOpen Airways ForSchools, which teaches3rd graders and their par-ents how to manageasthma and tracks thesestudents in subsequentgrades.

B Ask what precautions theschool takes for studentswith asthma.

B Discuss the action planyou and your child havedeveloped with your doc-tor. Write the plan on acard and make surecopies are kept in theschool’s health office andin your child’s pocket orbackpack at all times.

If you’re not satisfied withthe answers you get to yourquestions, insist that the prob-

lem or procedures bechanged. But even if yourprincipal is sympathetic, yourrequest may not be enough tobring needed changes. Forone thing, the solution mayinvolve a large expenditure(such as improving a ventila-tion system). You may have totake up your concerns withthe school’s parent associa-tion or the local school boardor superintendent. Anotherresource is your school’s UFTrepresentative, who is knownas the UFT chapter leader andcan be reached through theschool secretary. The UFT rep-resentative can bring yourconcerns about school condi-tions to one of the UFT’sHealth and Safety Commit-tees, which have representa-tives in each borough.

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Howteachers canhelp…T eachers want to do every-

thing they can to helpyour child manage her or

his asthma. Keep in mind,however, that they are notdoctors — they can’t diagnoseasthma and they can’t treat it. It is up to you to tell them

about your child’s asthmaneeds. Give them a copy ofyour child’s action plan.Teachers will use this infor-mation to protect your childfrom possible asthma triggers,but keep in mind, too, thatteachers can’t control all thephysical conditions in theirclassrooms. For this reason,we advise you to talk to yourprincipal about ridding yourchild’s school of asthma trig-gers such as dust and mold.

Here’s what teachers can do:B Emergencies: During an

emergency, teachers willcall for assistance and, ifnecessary, help yourchild administer asthmamedication. As notedpreviously, you must fillout a 504 Form torequest permission foryour child to carry med-ical equipment at school.

B Non-emergencies: At allother times, teachers willgive your child time toself-administer medica-tion or visit a nurse, aslong as your child adheresto a treatment schedulethat you provide.

B School trips: Your childhas a right to participate inschool trips. Teachers canhelp your child avoid situa-tions that might trigger anasthma attack, but only ifyou warn them that anupcoming school trip mightpose a danger. You mayneed to make specialarrangements with theschool to make sure yourchild is properly moni-tored, either by a nurse oranother adult. This deci-sion can be made only byyour doctor in consultationwith school health staff —not by your child’s teacher.

B Animals in classrooms:In some schools, furryanimals are kept in class-rooms. If these animalscould trigger an asthmaattack in your child, you

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should warn the school.Make sure your child sitsas far away as possiblefrom the animal’s cage,and ask the teacher tokeep the animal caged asmuch as possible; cleanthe cage regularly; andlocate the animal awayfrom ventilation systemvents to avoid circulatingallergens throughout theroom or building. If thesesteps don’t work, discussother solutions with theteacher or school nurse.

B Classroom supplies: Ifcertain classroom suppliestrigger asthma attacks inyour child, you shouldalert the teacher. Onceyou do, the teacher willtry to prevent your childfrom coming into contactwith these supplies.

B Excessive dust, moldand water leakage: Ifthese conditions triggeran asthma attack, ask theprincipal to see if theseconditions can be correct-ed. In addition, ask theteacher if the UFT repre-sentative can also speakto the principal. The UFThas an excellent trackrecord when it comes togetting the Board of Edu-cation to remove water-logged porous material,because soaked ceilingtiles, sheetrock and evenbooks can quicklybecome breedinggrounds for mold.

What yourschoolnurse can do…B If the school nurse

knows about your child’sasthma, she can offerhelp in managing the dis-ease at school. This mayentail:

B Providing you and your child with informa-tion about asthma and its triggers.

B Helping your child stickto her or his action plan.

B Coordinating observa-tions of asthmatic stu-dents by parents, teach-ers and students them-selves.

B Helping studentsthrough asthma attacks.

B Maintaining up-to-datemedical records of your child and otherasthmatic students.

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Where toseek helpFrom the Daily News, March 1,1998. Phone numbers updatedSeptember 2010 by the UFT.

MEDICAL PROVIDERS/ASTHMA CLINICSBRONX:

Jacobi Medical Center1400 Morris Park, Bronx 10461(718) 918-5000 (adults)

Lincoln Medical & Mental Health Center234 East 149th St.(718) 579-5000 (adults)

Montefiore Medical Center Asthmaand Allergy Center3400 Bainbridge Ave. 2nd Fl.(866) 633-8255

South Bronx Children’s Health Center911 Longwood Ave./ 871 Prospect Ave.(718) 991-0605

BROOKLYN:

Asthma Center of Excellence/University Hospital470 Clarkson Ave. Suite A(718) 270-1000

Brooklyn Jewish Hospital/Interfaith Adult Asthma Clinic520 Prospect Place(718) 636-1000

Coney Island Hospital2601 Ocean Parkway(718) 616-3000

Cumberland Diagnostic & Treatment Center100 North Portland Ave.(718) 260-7883

East New York Diagnostic & Treatment Center2094 Pitkin Ave.(718) 240-0400 or (718) 245-31231

Kings County Hospital Center451 Clarkson Ave.(718) 245-3131

Lutheran Medical Center Sunset ParkFamily Health Center150 E 55th St.(718) 630-7208

St. John’s/Interfaith Pediatric Asthma Clinic1545 Atlantic Ave.(718) 604-6000

Woodhull Medical & Mental Health Center760 Broadway at Flushing Ave.(718) 963-8101

MANHATTAN:

Bellevue Hospital Center462 First Ave. (212) 562-1000

Children’s Lung Center at ColumbiaUniversity Medical Center3959 Broadway(212) 305-5122

Harlem Hospital Center506 Lenox Ave.(212) 862-8564 or (212) 939-1000

Metropolitan Hospital Center1901 First Ave.(212) 423-7000 or (212) 423-6262

Mt. Sinai Hospital Pediatric Pulmonary CenterMadison Ave. at E. 100 St.(212) 241-7788

New York and Presbyterian Hospital Childrens AIR (Allergy Immunology Respiratory) Center622 West 168th St.(212) 305-9817

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Renaissance Health Care NetworkDiagnostic & Treatment Center215 West 125th St. (212) 932-6500

St. Luke’s Hospital1111 Amsterdam Ave. at West 114th St.(212) 523-2424 (Adult Asthma Clinic)(212) 523-3891 (Ped. Pulmonary Clinic)(212) 523-4000 (General)

QUEENS:

Family Health Center of Western Queens3611 21st St., Long Island City(718) 482-7772

Elmhurst Hospital Center79-01 Broadway(718) 334-4000 (General)(718) 334-2715 (Adults)(718) 334-3025 (Pediatrics)

Jamaica Hospital Pediatric Asthma Clinic8900 Van Wyck Expressway(718) 206-6000

New York Hospital-Flushing Medical CenterPediatric Asthma 139-26 Booth Memorial Ave., Flushing(718) 670-1920

Queens Hospital Center86-68 164th St., Jamaica (718) 883-3000

STATEN ISLAND:

Sisters of Charity Family Asthma Detection Center1 800-CARE-421 (227-3421)

NEW YORK AREA ASTHMA SUPPORTGROUPSAsthma/Emphysema Self-Help GroupsPost Office Box 20321Tompkins Square StationNew York, New York 10009(212) 777-0486

B Manhattan-based self-help groups,publishes quarterly newsletter,Respiratory News & Views.

Asthma Helping Asthmatics (AHA)Harlem Lung Center506 Lenox Ave. 10037Eugenia Edwards (212) 939-1014

B People with asthma helping others inmanaging the illness and findinghealth care.

Parents of Asthmatic & Allergic Chil-dren(212) 889-3507

B Provides information and support forparents of children with asthma andfood allergies.

Resources for Children with Special Needs, Inc.116 E. 16th St. - 5th FloorNew York, New York 10003(212) 677-4650

B Information referral, advocacy andtraining for parents and professionalsworking with Asthmatics up to the ageof 21.

Better Breathers ClubMontefiore Medical Center Hospital111 East 210 St., Bronx, NY 10467(718) 920-4445 or 2439

B Support group meets last Tuesday ofthe month. Family and friends ofasthmatics encouraged.

American Lung AssociationB New York City (212) 889-3370116 John St., 3rd FloorNew York, NY 10016

B Nassau-Suffolk (516) 231-5864or (631) 265-3848

B New Jersey (908) 687-9340B Westchester and Hudson

Valley (914) 347-2094B Or call (800) LUNG-USA for information on asthma support services and Open Airways inschools program.

Respiratory Activity GroupBonnie DeLyon (201) 291-6344Paramus, NJ 07652

(800) VALLEY-1

B Support group meets on the first Thursday of every month (September – June).

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NATIONAL ASTHMASUPPORT AND SERVICE GROUPSAmerican Lung Association61 Broadway, New York 100061-800-LUNG-USA 586-4872(212) 315-8700 or 8701http://www.lungusa.org

Allergy and Asthma Network Moth-ers of Asthmatics, Inc.www.aanma.org(800) 878-4403

National Asthma Education and Prevention ProgramPost Office Box 30105Bethesda, Maryland 20824(301) 592-8573http://www.nhlbi.nih.gov

Asthma and Allergy Foundation of AmericaAsthma and Allergy Information Line8201 Corporate Drive, Suite 1000Landover, MD 20785(800) 7-ASTHMA • http://www.aafa.org

National Jewish Center of Immonulo-gy and Respiratory Medicine1400 Jackson St.Denver, CO 80206(800) 423-8891(800) 222-LUNG• http://www.njc.org

American Academy of Allergy, Asthma and Immunology555 East Wells St., Ste. 1100Milwaukee, WI 53202(414) 272-6071• http://www.aaaai.org

American College of Allergy, Asthma and Immunology85 West Algonquin Rd., Ste. 550Arlington Heights, IL 60005(847) 842-7777 or (847) 427-1200http://allergy.mcg.edu

BOOKS ANDPUBLICATIONSChildren with Asthma: A Manual for ParentsBy Thomas F. PlautPublished by Pedipress, 1995

Family Guide to Asthma and Aller-gies – How You and Your ChildrenCan Breathe Easier By the American Lung AssociationAsthma Advisory Group with Nor-man H. Edelman, M.D.Published by Little, Brown and Co.

Green Guide to AsthmaAvailable Free from: Mothers & Others,40 West 20th St., 9th Floor(212) 242-0010In Spanish and Englishmothers@mothers.org

The Asthma SourcebookBy Francis V. Adams, M.D.Published by Lowell House, Los Angeles

Read:“New York, NY Battle Plan for aCity’s Asthma Epidemic” http://www.lungusa.org