Special Health Care needs - Asthma

 

 

Introduction 

 

Childhood asthma has increased in recent decades, partly due to a better understanding of the disease and consequently more children being diagnosed with it. The exact cause is not yet known, although there are a number of risk factors present. Whilst the majority of children will have mild symptoms and minor levels of absence from school, for others it means regular absences that will affect their performance at school. Asthma is a major cause of hospitalization of Canadian children. Given the commonness of asthma in schools today, the following information presents what you need to know to help these students lead a normal life. 

Definition 

 

Asthma is a disease causing inflammation of the airways resulting in the obstruction of air going into and out of the lungs. The frequency and severity of the symptoms  can vary greatly from person to person and can be triggered by numerous environmental factors. Asthma is a chronic condition, i.e. it recurs over a lifetime and requires careful and continuous monitoring and treatment to ensure that someone with asthma can participate in all regular activities. It is often associated with childhood as the number of asthma episodes or attacks tend to diminish into adulthood, to the extent that it looks like it has gone away (in remission). However, there is no cure for asthma but it is possible to become symptom free by maintaining treatment and avoiding triggers.   

Prevalence 

The prevalence of asthma in Canada, as in many other countries, is increasing. Being the most common chronic disease, just over 15% of children in Canada between the age of 4 and 11 years old are diagnosed. The majority of these children will have mild asthma symptoms, while the incidence of severe asthma attacks is decreasing. 

 Etiology 

Research has not yet been able to determine the exact cause of asthma but there are known, strong risk factors (or triggers), for example: 

·   family history of asthma and/or allergy in the family (heredity) 

·   exposure, as a baby, to high levels of antigen (a substance that, when introduced into the body, produces antibodies) like house dust mites 

·   exposure to tobacco smoke or to chemical irritants 

 Triggers can be allergic or non-allergic. Other trigger examples include: 

·   mould, animal dander, pollen, cockroach  (all are allergic triggers) 

·   certain drugs, chemicals and fumes, respiratory viral infections, weather, strenuous exercise, air pollution (non-allergic triggers) 

Assessment / Diagnosis 

 

To diagnose asthma, the level of obstruction in the airway must be determined. This is done with a spirometer, into which a person breathes to measure airflow. An allergy skin test is also performed to see which substances can trigger the inflammation. Symptoms that would lead a person to seek a diagnosis include: 

·   shortness of breath 

·   tightness in the chest 

·   coughing 

·   wheezing 

 

Medical intervention 

 

Children and adults diagnosed with asthma are normally treated with oral steroids and inhaled reducers and controllers to control the inflammation in the airways. The amount and frequency of medication depends on the level of inflammation and severity of attacks. There is a wide range in the level of severity of asthma symptoms, which can vary between one episode and the next, and flare up intermittently. 

 

Knowing the triggers for asthma allows a person with asthma to try to control his/her environment as much as possible. This is a little more difficult for children, especially if the trigger is linked to indoor air quality. Adults, such as teachers, educational assistants, day care workers, etc, need to be well aware of what the particular triggers are for that child and make adjustments to the environment to get rid of or reduce the triggers as much as possible.  

Developmental consequences 

If a child uses inhaled steroids such as corticosteroids for a long time, there is the possibility that it will slow the growth rate of the child. Disturbed sleep as a result of using certain inhalers can have serious implications for a child’s health including increased risk of gaining weight, of being depressed and anxious and of having attention and/or behavioral problems. 

 

There are also emotional consequences as a result of having asthma. Children may experience fear as a result of having an attack, where they cannot breathe and may need to go to the hospital. They may also feel shame or embarrassment and may not want anyone to see their medication – the consequences of this can be dangerous to their health if they are not consistent in using their controllers.  

 

Educational implications 

 

Being absent from school due to asthma is common and this absenteeism affects over half of all children with asthma. This can have a substantial effect  on learning, especially if the child is away regularly, during the winter season, for example, or for an extended period of time. The building blocks of learning can be interrupted, causing children to struggle and/or fall behind their peers. This academic disadvantage can also make it more difficult to maintain social relationships with peers. 

 

Ways to accommodate: 

 

·   peer tutoring or individual teaching session with the  teacher to catch up; 

·   lesson plans or on-line activities that can be done at home; 

·   regular community circle sharing;

·   class blog, including diaries of special days or activities;

 

In terms of physical exercise, participation should be encouraged as much as possible, with a warm up/ stretch being very helpful for a child with asthma. By breathing through the nose, air will be warmed and humidified before entering the lungs, thereby causing less inflammation. Avoiding physical exercise can lead to social isolation and to weight problems, both of which may lead to other health issues.  

 

Ways to help: 

 

·   encourage the child to take medication before the activity starts, according to directions, and have it easily accessible if symptoms flare;  

·   allow rest as necessary; 

·   modify the program, i.e. fewer repetitions of an exercise, or a shorter lap; 

·   if participation is not possible, find another way to have the child involved, e.g. score keeper or equipment manager; 

·   during recess, encourage  friends to play chess or another game in the library with the child; 
 

 Air quality is often a problem at school, where allergens may lurk in carpeting, behind bookshelves or in art or science materials as chemical irritants. The use of perfumed personal care items can also be triggers. 

 Ways to help: 

·   make schools scent- free; 

·   avoid use of chemicals with known triggers 

·   avoid use of spray cleaners when students are present 

·   dust and vacuum regularly 

·   keep school pets out of classrooms used by child with pet dander allergy 

·   keep doors and windows into the school closed when school buses arrive and depart,  to prevent fumes coming into the school 

 

References

 Winzer, M. (2008) ‘Children with Exceptionalities in Canadian Classrooms’, 8^th Edition, Person Prentice Hall, Toronto, pp. 406 – 408

 www.livestrong.com/article/181381-effects-of-asthma-on -development-health

 www.chop.edu/service/allergy/allergy-and-asthma-information/asthma-and-school-attendance

 www.asthma.ca/adults/about/asthma_facts_and_statistics.pdf