When children with asthma get into respiratory trouble while at school, nurses are on site to assess their symptoms, to dispense medication if necessary and to help calm a child through distress.
Older students in middle and high school have always been able to keep emergency rescue inhalers with them in the classroom with doctor’s permission. But asthma attacks can still occur.
Nurses say many children and adults with asthma may not use their inhalers in a manner to get the full dose of medication into the lungs to open their airways most effectively.
Officials with the St. Louis Regional Asthma Consortium spoke to nurses on this topic at a recent nursing conference.
“Actually, you’re really supposed to have a spacer, and attach that spacer to your inhaler and use it that way,” said Debbie Wade-Wilson, RN, the school nurse at Beaumont and Sumner high schools and the Fresh Start Alternative program in St. Louis.
“And a lot of people do the two-fingers and then they huff it in – and the doctor who was talking to us said that most of that medication gets stuck in the back of your throat. And you wonder why it’s ineffective.”
A law passed last year in Missouri allows students at school or at school-related activities to self-administer prescribed medication for chronic conditions such as asthma or anaphylaxis (extreme, possible life-threatening allergic reactions) with a written treatment plan by the physician and the approval of the parent or guardian.
Debbie Hager, a nurse at Duchesne Elementary School in the Ferguson-Florissant School District, said thus far, neither parents nor doctors are allowing it at her building – preferring to keep the school nurse as the point person for the child’s health.
“Most of the elementary schools are smaller, and access to us nurses is pretty quick,” Hager says, adding that parents and students are not requesting it either.
“Especially when they come in with a new inhaler and I tell them about the new policy, and 100 percent of the parents say, ‘Oh, no – I want you to keep it and you take care of my children.'”
Hager said she thinks it’s because of limited maturity levels in this age group, with children playing with the inhalers, losing them, or panicking and using the inhaler too much.
“When I worked at a different school, I did have one sixth-grader that carried his, but he had such bad, severe asthma that even coming downstairs to me made a difference,” Hager said.
“This was a very mature young man, and we had orders from the doctor for him and the doctor totally agreed.”
Third-grader Khyreeck Briggs said he sometimes runs into difficulty during physical education class.
“Sometimes when I am in P.E. my chest starts hurting and I have to come to the nurse and take my inhaler,” he said. “It feels like a squeeze, like when somebody is squeezing your hand real, real hard.”
Fortunately, such episodes don’t occur very often.
Hager has a process that allows her to observe the presentation of symptoms while Briggs gets to catch his breath.
“She gives me my inhaler and I wait for a couple of minutes and I sit down, and I’ll be quiet then when I get ready to go back to P.E.,” Briggs said.
At home, the regime is pretty similar.
“I usually give him his inhaler, make him lay down or be still for a little bit and monitor him and see how he’s doing,” said Irene Hunter, Khyreeck’s mother. “Probably like 30 minutes I make him be still; then he’s good to go.”
Â
