As the respiratory season approaches, the risk of asthma emergencies often increases, particularly for those with preexisting conditions. Respiratory illness, cold weather, and fluctuating temperatures can all exacerbate asthma symptoms, leading to potentially serious health complications. Understanding how to mitigate these risks is crucial for maintaining respiratory health and ensuring a safe and healthy season.
As schools across the US have just ended their fall semester, students of all ages will spend their time off away from school. Respiratory season is among us, and children with asthma are at risk for severe asthma exacerbation from viruses that may lead to hospitalization. Since students will soon return for their spring semester, it is important to be reminded of asthma care during respiratory season.
Ten percent of school-aged children in the US have a diagnosis of asthma, with a higher prevalence in lower socioeconomic populations. In a classroom of 30 students, three students carry an asthma diagnosis. Of these children, the National Institutes of Health (NIH) reports 60% will experience asthma exacerbations. These exacerbations not only cause patients with asthma to have a total of 13.8 million absences annually but also lead to approximately 767,000 emergency department visits and 74,000 hospitalizations on an annual basis.1
As we consider these statistics, safe asthma care during respiratory season requires preparation and a proactive approach. Partnering with families and school personnel will increase the likelihood that students will have a safe return for their next semester.
Patients with asthma are at higher risk for complications from respiratory illnesses such as COVID-19, influenza, respiratory syncytial virus (RSV), and streptococcal pneumonia viruses. While RSV vaccination is not widely available yet, vaccination is recommended as early as possible for influenza and COVID-19, as well as consideration for streptococcal pneumonia for patients with severe asthma. Vaccination for all family members should also be considered by the health care team. The health care team should regularly check in with families of patients with asthma to ensure they are educated about the importance of vaccinations and opportunities for immunization.2
Most children with asthma submit their asthma action plan to their school at the beginning of the year. It is important for families to be reminded that if there is a change to their asthma action plan, the updated plan should be discussed and reviewed with school personnel who are responsible for medication administration. Health care providers often will partner with schools and families to create a 504 plan. Many families may not be familiar with this plan and how to request one. Within the state of Illinois, for example, some school districts require 504 plans and others do not. It is derived from Section 504 of the Americans with Disabilities Act and is a contract outlining a child’s asthma care while at school. Families should be reminded that these 504 plans need to be updated at least once a school year.3
Asthma guidelines recommend all children with asthma have access to quick relief medications.4 While this guideline exists, we are reminded by families that their child oftentimes has difficulty obtaining their medication while at school. Despite stock albuterol programs considered by the NIH as being a safe, practical, and potentially lifesaving option for children with asthma, schools across the country are slow to adopt this practice.1 Families often express financial concern about accessing these medications, mainly due to insurance quantity limitations for either single maintenance and reliever therapy intervention or short-acting β2-agonist therapy.
While self-carry is an option in all 50 states and the District of Columbia, parents report poor memory and reliability of their child to administer their medication appropriately. Parents report their children have a poor understanding of time and may administer medication too frequently, or they lack the necessary dexterity to properly administer an inhaler. The correct use of inhalation devices and adherence to prescribed therapy are key aspects in achieving better clinical control and improved quality of life. Parents express fear associated with children having access but poor direct supervision when using their quick relief medication.5 Families need a minimum of two quick relief inhalers (one for home and one for school)—or even three in a co-parenting situation.
Stock albuterol programs mitigate the risk of quick relief medication accessibility. Families may have been required to leave a quick relief inhaler with the school nurse when school started last fall. Despite medication being available from a stock program or supplied from a family, medication expiration dates should be monitored to ensure the medication is available when needed.1 It is important to remind families to track the expiration of medication and request a refill from their asthma provider for replacement at school if a stock albuterol program is not available.
Mitigating the risk of asthma emergencies during respiratory season requires a proactive approach. By partnering with families and schools through vaccination, updating asthma action plans, creating 504 plans, and working to ensure quick relief medication is available, providers and families can work together to decrease the risk of asthma emergencies during respiratory season. Taking these steps can lead to a safer and healthier respiratory season for all.
Emily Simmons, MSN, APN, CPNP-PC, and Alexandra Kacena, MSN, APN, CPNP-PC, are advanced practice provider colleagues at Ann & Robert H. Lurie Children’s Hospital of Chicago, Division of Pulmonary & Sleep Medicine. Partnering with one of the attending pulmonologists, they provide evidence-based, state-of-the-art care to high-risk patients with severe asthma, both within the hospital and in a mobile asthma clinic setting.
References
1. Lowe AA, Gerald JK, Clemens CJ, Stern DA, Gerald LB. Managing respiratory emergencies at school: a county-wide stock inhaler program. J Allergy Clin Immunol. 2021;148(2):420-427.e5. Preprint. Posted online February 10, 2021. doi: 10.1016/j.jaci.2021.01.028
2. 5 Reasons Why Children With Asthma Need Important Vaccines for the Back-to-School Season. Asthma and Allergy Foundation of America. https://community.aafa.org/blog/5-reasons-why-children-with-asthma-need-important-vaccines-before-heading-back-to-school
3. Dudvarski Ilic A, Zugic V, Zvezdin B, et al. Influence of inhaler technique on asthma and COPD control: a multicenter experience. Int J Chron Obstruct Pulmon Dis. 2016;11:2509-2517. doi: 10.2147/COPD.S114576
4. Volerman A, Lowe AA, Pappalardo AA, etc. Ensuring access to albuterol in schools: from policy to implementation. An official ATS/AANMA/ALA/NASN policy statement. Am J Respir Crit Care Med. 2021;204(5):508-522. doi: 10.1164/rccm.202106-1550ST
5. Volerman A, Kim TY, Sridharan G, et al. A mixed-methods study examining inhaler carry and use among children at school. J Asthma. 2020;57(10):1071-1082. Preprint. Posted online July 16, 2019. doi: 10.1080/02770903.2019.1640729
6. Toups MM, Press VG, Volerman A. National analysis of state health policies on students’ right to self-carry and self-administer asthma inhalers at school. J Sch Health. 2018;88(10):776-784. doi: 10.1111/josh.12681
7. 504 Plans for Asthma. Asthma and Allergy Foundation of America. https://aafa.org/asthma/living-with-asthma/504-plans-for-asthma/