The following set of guidelines for the proper treatment of asthmatic schoolchildren has been distributed to teaching staff throughout Victoria. This plan may be used in the promotion of asthma awareness and management among school staff in other localities.
ASTHMA MANAGEMENT AND AWARENESS
Asthmatic students attending the school should always carry, or have available in the school, appropriate medication including, for example, a bronchodilator metered dose aerosol puffer.
The following information on every asthmatic student should be recorded:
Name;
Normal maintenance medical program;
Medication to be used when symptoms develop;
Medication to be used during crisis situations;
Name, address, telephone number of an emergency contact;
Name, address and telephone number (including an after hours number) of the child’s doctor;
Name and telephone number of the child’s pharmacist.
(Teachers must be sure they can alert an appropriate carer without delay: deteriorating asthma cannot wait hours for attention.)
If an emergency contact cannot be made, call the Ambulance Service. All ambulance officers are trained in asthma management.
EMERGENCY CARE
In the event of a child developing what appears to be an asthma attack:
Allow the child to sit in a restful atmosphere, keeping others away so that there is adequate fresh air;
If the child is capable of self-medicating, encourage immediate use of the prescribed medication to be used when symptoms develop;
If necessary, use the medication prescribed for a crisis situation;
. Should the prescribed medications not be available, assist the child to take 2-4 doses of the bronchodilator from the school’s first aid kit hand-held metered dose aerosol puffer;
. If the child does not show improvement within 10 minutes of taking the bronchodilator medication, medical assistance must be sought without delay — use the telephone contacts recorded. Maintain the above treatment regimen until assistance is obtained.
Note 1: Bronchodilator metered dose aerosol puffers are quite safe. An overdose cannot be given by following the above instructions, and their use may be life saving. They will do no harm even if the observed symptoms are not asthmatic in origin.
Note 2: Devices can easily be sterilised by the use of hot water and soap to prevent cross-infection.
Each school’s first aid cabinet should contain a hand-held metered dose aerosol bronchodilator — puffer brand names being Ventolin, Alupent, Berotec, Bricanyl or Respolin. It is also desirable that a large volume spacer be available — Nebuhaler or Volumatic — as an aid for using the puffer. As with all medication, attention should be given to the expiry date.
Pharmacists dispensing aerosols for inclusion in school first aid kits will be able to give instructions about dosage, precautions and the recognition of the therapeutic need for aerosol use to the representative of the principal of the school when the aerosol is supplied.
EXERCISE-INDUCED ASTHMA
Children with asthma should be encouraged to exercise because it builds up their muscles, including those used in breathing, and thus improves their ability to cope with asthma. However, it must be taken into account that exercise — particularly strenuous exercise in any form — will frequently bring on exercised-induced asthma in about 85 percent of children who have asthma. They will experience the general symptoms of asthma, including tightness in the chest, shortness of breath, difficulty in breathing and coughing.
If children experience an onset of symptoms while exercising, they should immediately cease the exertion, rest and take appropriate medication — usually a bronchodilator, using a hand-held metered dose aerosol inhaler. Once all symptoms disappear, they may be able to resume their exercise program. However, if symptoms persist and the asthma worsens, medical assistance should be sought.
Exercise-induced asthma can frequently be prevented by a simple warm up period and premedication a few minutes prior to commencing strenuous exercise, usually 2-4 puffs of a bronchodilator, Intal (using a puffer), or other medication as recommended by a doctor.
A small percentage of children with experience of severe exercise-induced asthma may be advised not to engage in any strenuous exercise. These children should have a doctor’s note to present to the school.
Note: Exercise-induced asthma often is most noticeable some time after exercise — maybe 20 – 30 minutes after stopping the activity — and should be treated as above.
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