Health Matters

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WORKING TOWARDS COMPREHENSIVE ASTHMA MANAGEMENT

The Ohio Department of Health Asthma Program and the School-based Asthma Management Program (SAMPROTM)

BY MIMI SANG AND OLIVIA LAUER, ODH ASTHMA PROGRAM

Asthma is the most common chronic disease in children and one of the leading causes of school absenteeism. Asthma symptoms can include wheezing, coughing at night or early in the morning, chest tightness, and shortness of breath, resulting in fatigue and restrictions in performing daily activities.

Asthma is a major public health concern in the United States. As of 2014, asthma is one of the top 20 reasons for emergency department (ED) visits in the U.S., accounting for approximately 1.7 million visits every year1. Of the 10 U.S. cities that had the highest rate of asthma-related ED visits, four were in Ohio: Dayton, Cleveland, Akron, and Columbus1. While emergency care may be necessary due to an asthma attack, effective asthma management can help reduce asthma-related ED visit rates and hospitalization rates.

One in two children with asthma report school absences due to asthma each year. These asthma-related absences influence academic achievement, leading to decreased levels of reading proficiency and increased risk of learning disabilities. Improving health and school-related outcomes for children with asthma requires the use of school-based partnerships that focus on integrated care coordination amongst families, clinicians, and school nurses. The ODH Asthma Program (ODHAP) focuses on leveraging partnerships and policies to expand EXHALE strategies created by the Centers for Disease Control and Prevention (CDC). CDC has determined that EXHALE strategies, based on the best available evidence, can improve asthma control and reduce health care costs. The EXHALE strategies include Education on asthma self-management, X-tinguishing smoking and exposure to second-hand smoke, Home visits for trigger reduction and asthma self-management education, Achievement of guidelinesbased medical management, Linkages and coordination of care across settings, and Environmental policies or best practices to reduce asthma triggers from indoor, outdoor, or occupational sources. ODHAP utilizes these strategies to provide resources and support to people with asthma and their caregivers across the state.

A comprehensive approach to increasing asthma support ensures that efforts and resources are focused on improving learning and health. ODHAP partnered with the engineers of School Asthma Management Program (SAMPROTM) to promote the free online toolkit, developed by the Summit Stakeholder Workforce. SAMPROTM is a central resource to assist students with asthma and their families with consistent management of their conditions at school.

There are often significant barriers to comprehensive asthma management, including a lack of communication among families, clinicians, and school nurses. This results in: • Students without access to asthma medications, including rescue medications, in school. • Students exposed to asthma triggers at school. • School nurses who are unaware of the asthma management plan developed by the health care provider.

SAMPROTM advocates four components to integrate schools, and specifically school nurses, within the asthma care team. These components are: 1. Creating a Circle of Support among the families, clinicians, and schools nurses centered around the child with asthma. 2. The creation and transmission of Asthma Management

Plans to schools. This includes an Asthma Emergency

Treatment Plan for emergency management of asthma symptoms and an individualized Asthma Action Plan for each child with asthma. A standardized Asthma Action

Plan is available. 3. A comprehensive Asthma Education Plan for school personnel. 4. A comprehensive Environmental Asthma Plan to assess and remediate asthma triggers at home and in school. The SAMPROTM toolkit includes: • A slide set to learn how to approach the SAMPRO TM program and support the creation of a Circle of Support in hospitals, clinics, and schools. • Tools for engaging clinicians, school nurses, and families to establish the Circle of Support, and how to foster good communication between these groups. • Information to help use and transmit Asthma Emergency

Treatment Plans and Asthma Action Plans. • Tools for school nurses to provide asthma education to school personnel. • Additional resources to support effective school-based asthma management.

This toolkit is intended for school nurses, education administrators, clinicians, and healthcare administrators who are interested in implementing SAMPROTM at their school or organization.

Users are encouraged to complete the free registration process to download all available SAMPROTM materials included in the toolkit. The included tools will provide information for implementation of SAMPRO™ into local communities.

Sources 1. Asthma and Allergy Foundation of America (AAFA). Asthma Capitals Report, 2019. 2. https://www.cdc.gov/healthyschools/asthma/index.htm