School Nurses and Asthma

School Nurses are essential partners in helping students successfully manage their asthma. They play a key role in ensuring students with asthma have the knowledge and tools they need to effectively manage their asthma, particularly while at school.

Appropriately managing asthma in the school setting requires strong partnerships and team-based care. School staff, parents/guardians, medical providers, and students can work together to keep students healthy and in school. Local Health District Office staff are also available to partner with schools and providers to support their population health and system goals related to asthma.

School Nurses are often at the center of this network of partnerships aimed to provide effective support around each student.

This webpage is principally for School Nurses to offer a central repository for resources, tools, and tips to support their students with asthma.

 

Asthma in Vermont Schools

In Vermont, 1 in 12 children (8%) have asthma. This means that for every Vermont classroom with 30 students in it, two may have asthma. Furthermore, among children with asthma 60% report having uncontrolled asthma, putting them at risk of an asthma flare up that might disrupt their learning, require them to visit the School Nurses’ office and miss classroom time, or have a more serious asthma-related emergency. 

 

Managing Asthma in Vermont Schools

Managing asthma in schools is important for a variety of reasons:

  • Asthma is a leading cause of chronic disease-related missed school days. 
  • Asthma causes activity limitation and sleep disruption, impacting a student’s ability to concentrate, learn and engage in school activities. 
  • Asthma can be life-threatening. 

With the right medications, reduced environmental triggers, and education on self-management, asthma can be managed. 

 

School Nurses support students with asthma, as they similarly do with other conditions and needs, by:

  • Coordinating with medical providers to ensure students have an updated asthma action plan, requesting appropriate consent to share forms between the clinic and school, and understanding permissions for each student to self-carry and self-administer their asthma inhaler.
  • Supporting students in self-managing their asthma so it is well controlled, supporting them to participate in classroom and extracurricular activities.
  • Administering asthma medications for younger children and those needing extra support.
  • Responding and assisting a student with worsening asthma symptoms
  • Communicating with families about understanding the student’s asthma action plan, notifying them when a student’s asthma symptoms are increasing, and ensuring all required paperwork is complete.
  • Providing appropriate emergency care, if needed.

School Nurses make a big difference by:

  • Reducing absences due to asthma.
  • Ensuring students with asthma spend less time in the School Nurse office and more time in the classroom and school activities.
  • Helping ensure students can learn without hindrance and breathe easy.

 

Best Practices for School Nurses:

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Tip #1: Ensure each student with asthma has an updated Asthma Action Plan

Everyone with asthma – especially children and teens – should have an up-to-date Asthma Action Plan every year. This is a written plan that is filled out with a medical provider to help control asthma and know what to do in emergencies. Updates should occur every 12 months or when a significant change in the treatment plan has occurred.

Asthma action plans can help establish an open line of communication with families, medical providers, and school personnel to promote consistent and current information about a student’s asthma management.

Learn more: about what an Asthma Action Plan is, who should have one, and how to use it

Uncontrolled Asthma in Schools

Among Vermont children, 60% report having uncontrolled asthma, meaning 6 in 10 kids with asthma in schools are likely to have uncontrolled asthma. These students can be supported by receiving Asthma self-management education (AS-ME) or supplementary coaching on skills and information about asthma, symptoms, triggers, use of the Asthma Action Plan to keep asthma well-managed, and when to get help in an emergency. AS-ME also provides tools to assess and improve asthma control.

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Key action: Provide asthma self-management education in your school to at least one student with uncontrolled asthma.

Become trained to provide AS-ME to students in your school! 
Learn more: Contact the Vermont Asthma Program for orientation and access to the "AS-ME in Schools" packet on delivering AS-ME to students with uncontrolled asthma.

School policies & law (medications)

There is a Vermont statute, 16 V.S.A. 1387, that permits Vermont schools to allow students with life-threatening allergies or with asthma to possess and self-administer emergency medication at school, on school grounds, at school-sponsored activities, on school-provided transportation, and during school-related programs. Please refer to the statute for further information.

Best Practice for managing the School Environment

The school environment impacts the health of students and school staff. For those with asthma, it can have even greater impacts. Exposure to asthma triggers in schools can increase asthma symptoms, leading to school absences, missed activities, poor performance, and possibly an asthma-related emergency. 

Any kind of scent could trigger asthma symptoms – including air fresheners, disinfecting wipes, essential oils, cleaning supplies, and tobacco. Ensuring the school environment is safe for those with asthma requires strong partnerships between School Nurses, teachers, administrators, custodial staff, students, and their families. 

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Tip #2: Take steps to improve indoor air quality

Improve indoor air quality by reducing or eliminating environmental asthma triggers, improving ventilation and air filtration, and using asthma-friendly cleaning products.

Learn more: about improving indoor air quality by visiting Vermont’s Envision Program

School policies & law (Environmental Triggers)

  • School Bus Idling Rule: The operator of a school bus shall not idle the engine while waiting for children to board or to exit the vehicle at a school and shall not start the engine until ready to leave the school premises.
  • Green Cleaning Law: A distributor or manufacturer of cleaning products shall sell, offer for sale, or distribute to a school, school district, supervisory union, or procurement consortium only: environmentally preferable cleaning products utilized by the Department of Buildings and General Services under State contracts; or cleaning products certified as environmentally preferable by an independent third party. This law also extends to air fresheners - a distributor or manufacturer shall sell, offer for sale, or distribute air fresheners to a school, school district, supervisory union, or procurement consortium only if the air fresheners are certified as environmentally preferable by an independent third party. Contractors who provide cleaning services for schools must meet these requirements as well.
A lightbulb with the words Quick Tip under it.

Tip #3: Provide tobacco-free environments

There is no safe exposure to tobacco smoke, especially for children, and is dangerous to those with asthma. Avoid tobacco smoke and vapors by making your school smoke-free.

Learn more: about Secondhand Smoke

Tobacco use prohibited on public school grounds (Statutes 16-001-008-140): No person shall be permitted to use tobacco products or tobacco substitutes as defined in 7 V.S.A. § 1001 on public school grounds or at public school sponsored functions. Public school boards may adopt policies that include confiscation and appropriate referrals to law enforcement authorities.

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Key action: Nominate your school for being asthma-friendly

Is your school asthma friendly? Becoming an asthma-friendly school is simple to do and benefits all students and staff. Nominate your school for being asthma-friendly.

Challenges to Asthma Control

  • Extreme heat, cold dry air from air conditioners, exposure to frequent transitions between indoor and outdoor environments with varying air quality, and increased physical activity during sports seasons can present challenges for individuals with asthma in managing their condition. Reinforce with students and their families the importance reviewing and following their Asthma Action Plan, and encourage them to contact their medical provider if they have difficulty keeping asthma in control.
  • Often people with asthma stop taking medications, especially controller medications, when symptoms go away. But this is a sign that the medications are doing their job. It’s important for students with asthma to continue taking medications as prescribed to prevent future flare-ups.
  • Strive to have up-to-date Asthma Action Plans on file for all students with asthma. This means a plan prepared by the student’s medical provider in the past 12 months or when a significant change has occurred in the treatment plan. Attach the student’s Asthma Action Plan to their Individual Health Plans (IHPs). Follow your school or district policy regarding medication administration. Of note, if there is an up-to-date Asthma Action Plan signed by a medical provider, there is no need to get additional signatures or authorizations to administer asthma medications, as it serves as an order.
  • Confirming a student can use their inhaler devices properly is key to supporting asthma control. The best way to confirm proper use is to have the student demonstrate to you how they use their inhaler and then provide coaching to correct or reinforce proper technique.
Videos on Proper Device Use
How to use the QVAR Redihaler
How to use an Ellipta Inhaler
How to use a Diskus inhaler | Boston Children's Hospital
How to use a Pulmicort Flexhaler | Boston Children's Hospital
How to use an Asmanex inhaler | Boston Children's Hospital

Downloadable tools and resources

Vermont’s Annual Asthma Action Plan

General supports
  • Vermont State School Nurses’ Association is Vermont’s School Nurses’ professional organization whose mission is to advance the specialty of school nursing through excellence in education, research and practice to optimize student health and learning.
  • Standards of Practice: School Health Services Manual Page: This Manual addresses Vermont school health services in partnership with PREK-12 education. The Manual is Vermont’s guide for school nurses, school administrators, and others who develop, implement, and evaluate continuous improvement activities of school health services. See the sections on allergy management, environmental health, health appraisals, immunizations, medications, and students with special health needs.
  • Local Health Offices | Vermont Department of Health (healthvermont.gov): Local Health district offices have staff that can partner with schools and medical providers on their population health and system goals related to asthma.
  • Vermont Asthma Program Pages: Other resources and information from the Health Department’s Asthma Program.
  • Asthma-friendly Schools Program: recognizes schools for becoming asthma-friendly.
  • Vermont Healthy Schools Page: Steps to take to maintain a healthy school environment, including lead and radon testing.
  • Vermont’s ENVISION Program provides model environmental health management plans, policies, and guidance to Vermont schools to help them address indoor air quality issues.
National organization’s guidance on asthma in schools

Centers for Disease Control and Prevention (CDC)
American Lung Association (ALA)
Asthma and Allergy Foundation of America (AAFA)
Allergy & Asthma Network (AAN)
Environmental Protection Agency (EPA)
National Environmental Education Foundation (NEEF)
National Heart, Lung, and Blood Institute (NHLBI)