 I can remember my first experience with a student who had asthma. Kids were running from one end of the gym to the other end of the gym. And everyone else is down at one end of the gym, and he's still on a line. So he says, I just need to get my bag. I reach as any calmly, administers his medication, and looks up, still smiles, OK, I'm ready to go. You know, I mean, it wasn't that quick, but basically, to me, it seemed like it wasn't quick. Asthma is a common health care problem. About two children in every classroom of 30 have asthma. Asthma is the number one cause of absenteeism due to chronic illness. It interferes with a student's ability to participate in school activities and can even cause a medical emergency. But with an improved understanding of this illness and its management, school personnel can help the student with asthma participate more fully in school activities and lead a happier and more productive life. Everybody who's involved in the child's care needs to understand about asthma, and that includes the child him or herself, the parents, the people at school, and, of course, the health care providers. Asthma is an illness that primarily affects the airways, the tubes through which air flows into and out of the lungs. Asthma has episodes of airway narrowing or obstruction caused by three factors, temporary contraction of the muscles of the airways, immediate swelling, or inflammation of the tissues in the airway walls. The swelling, in turn, creates more swelling and increased sensitivity, and clumps of mucus that may become lodged inside the airways. Although the episodes of asthma or an asthma attack may come and go, it is now known that asthma is a chronic condition. Even when a person feels fine, there is underlying inflammation making the airways sensitive to a variety of things. The things that make asthma worse, that is, cause an asthma episode, can vary from person to person. Some common things are allergies to pollen, household dust, animals or mold, respiratory infections, colds or flus, exercise, irritants such as cigarette smoke, secondhand smoke, perfumes or air pollution, and cold air and changes in weather. Asthma episodes brought on by exercise are particularly common among children, especially when exercising in cold air. Symptoms may occur within minutes of a student beginning vigorous exercise. Recognition of the causes and dangers of asthma can help minimize risks to children with asthma. The whole concept of not being able to breathe is really something that's frightening, and I think most teachers are afraid of two things, a child going into some sort of a seizure and a child not being able to breathe. So the staff was very ready to accept any type of training concerning what to do when the child exhibited symptoms of asthma. The basic symptoms of asthma are wheezing and then coughing. Lots of times kids cough, they may not wheeze, they may just cough a lot when they're running around, or shortness of breath or they experience it as tightness. And those are signs maybe that the child should, you know, stop and rest and take the inhaler like you were just saying. It is very important that children use their inhaler properly. This procedure can be very tricky because it requires coordinating breath inhalation with medication release. Children must take their medication correctly in order to benefit from it. Everybody take a deep breath and let it out. Very good, that's your lungs that work. Those are your lungs. Education programs such as the open airways and the A-plus asthma program provide students and school personnel with the knowledge and skills to manage asthma effectively. I like the A-plus asthma club. It is fun. It teaches a lot about asthma. It told me some things I didn't know about asthma. At the end of the tubes are tiny sacks of air. They look like a bunch of grapes. It doesn't bother me about having asthma. And it's bothering my friends. They help me out a lot. How do you feel when you can't play tag or kick the ball? You feel left out? You feel left out. So what do you do when you feel left out? Anybody can help? What do you do when you feel left out? You play with somebody else? You play with somebody else. My advice to a child that has asthma will be, gonna be afraid of it. It's normal, it's okay. As long as you have your asthma medicine, you're fine. I'm unstoppable. I can do anything I wanna do as long as I take my asthma medicine, I can control myself. School personnel working as a team can keep the child with asthma involved in all activities. The role of physical education teacher in some ways is probably the first line of recognition of children having asthma attacks. Asthma attacks occur more often in gym or physical exercise than probably any other place in the school. So phys ed teachers need to be able to recognize the symptoms of asthma so that they can help the children stop, step out, take a break, take their medicine, really initiate treatment. Children with asthma can most certainly participate in physical education and other outdoor activities. Most children with asthma can do anything that any child can do as long as their asthma is well managed. What is the importance of pre-medicating before a physical activity? Pre-medication really prevents the whole process from getting started. See, one of the things that happens in the lung is not just what we call bronchospasm, things tightening down, but it's also a process of irritation. And once that process starts, it can be harder to stop it than it is to prevent it. For most people, effective management of asthma means working with their doctor to identify and control any environmental factors affecting their asthma and by taking the right medicine at the right time. Medications fall into two categories. One is called a bronchodilator. This type of medicine relaxes the muscles that constrict the airways. Bronchodilators generally are taken by inhalation early in an asthma episode or before activities like exercise. Bronchodilators provide fast relief of the immediate asthma symptoms but do not affect the underlying inflammation. Another major group of medicines is called anti-inflammatories. These act by reducing swelling and inflammation inside the airways and are generally given by inhalation. Anti-inflammatory medications are increasingly being recommended for a greater number of asthma sufferers as a daily medication to prevent episodes from occurring. The principal and teacher play a key role in asthma education by encouraging school staff to learn about asthma and ensuring that children with asthma can take their medicine during the school day. It's important that schools allow students with asthma to bring their medications to school and to have them administered in the way that's most appropriate for that student. Asthma, if it's not treated early and appropriately, can get very severe. Some schools are concerned about allowing students with asthma to carry medications with them because of drug-free schools. It is vital, however, that they develop exceptions for students with asthma so that they may carry their medications with them. An asthma episode requires quick action to prevent a medical emergency. School personnel should have an asthma action plan for each child. What an action plan does is it spells out some steps that you take right away to deal with asthma. It's really a recipe to follow when you have an attack and it makes it much easier to manage the attack and to think clearly if you know what steps you're going to take. If we're out in the schoolyard and a child has an attack, how do we know that, you know, the attack is severe, so severe that it's an emergency situation? If a child can't really walk or talk, if they have trouble actually getting the breath to talk to you or if they sort of suddenly sit down and they just don't want to move, those are clues that the child may really be having a lot of trouble breathing. If a child's posture changes and they're sitting like this, they may raise their shoulders a little bit. They're really trying to make it easier for themselves to breathe. Classroom teachers may also observe a student having episodes of coughing, shortness of breath, or wheezing. If that student has not been identified as having asthma, the teacher should inform the parent and encourage them to see their doctor. Sometimes children who have asthma in school are stigmatized because they have asthma. It may be that other kids don't understand it and then make fun of them because of that. The school teachers and physical education teachers and school nurse can play a role in that by running programs in the classroom so that every child in the school understands what asthma is. Do the children ever outgrow asthma or do they stay with it throughout their life? Well, some kids do outgrow asthma and other kids don't and there really isn't any way to tell now when they have it. We hope we might be able to learn something in the future but really the best thing to do is to tell kids if you take good care of your asthma now, the chances that it'll be troublesome later on are probably less. The end goals for schools in dealing with students with asthma is to keep the student in school and in the classroom so they can be learning. And with the right kind of treatment plan that's understood by everyone in the school, that's really possible. Kids should be able to take part in sports and kids should be able to take part in all school activities if they're receiving the right treatment. Asthma in and of itself is something that we can do something about. There are so many medical problems that we can't do anything about. But asthma, that is something you can deal with. You can actually change what's going to happen for that child through an education program. When you teach them young, they carry that through the rest of their lives.