Castle Rock mom Heather Clark was so concerned that her 13-year-old daughter, Sami, would have an asthma attack at school and that no one would know what to do, she took to sneaking an inhaler into her daughter’s backpack, just in case. She calls it her “don’t ask, don’t tell” policy.
She didn’t realize that there was no need to treat the inhaler as if it were contraband. In fact, since 2005, Colorado law has given students with asthma the right to carry their inhalers with them and to self-administer their asthma medication, as long as they have a care plan on file with the school.
Last year, the legislature amended that law to remove the requirement for the care plan. But students and their parents are required to sign a contract with the school stating that the student knows how to properly administer the medication.
Douglas County schools, where Sami is a student, have adopted a policy in line with state law.
“I didn’t know that, but I’m excited to know it now,” said Clark, who also had asthma as a child. But she’s pretty sure that stated policy and actual practice don’t always coincide.
“The school doesn’t allow it,” the mom said. “I’ve gotten calls saying she couldn’t have it with her. I’m going to print out a copy of this law and make sure Sami has it in her backpack, along with her inhaler.”
Sami says she’s only had to sneak a puff on her inhaler a couple of times in the past two years, but she likes the security of knowing it’s there.
“At school, if you’re having a problem, you have to go down to the nurse’s office,” the teen said. “Unfortunately, for me that’s a couple of staircases away. That’s kind of scary, to be honest.”
The law is one thing, reality something else
Sami’s situation illustrates a greater problem confronting Colorado students with asthma, their parents and their schools:
The law is one thing. The realities confronting overworked doctors, spread-too-thin school nurses, perplexed school secretaries and anxious parents may be something else altogether.
- A CDC study shows 34 million Americans, or 1 in 9, have been diagnosed with asthma at some point in their lifetimes.
- An estimated 22.9 million Americans – including 427,000 Coloradans – currently suffer from asthma.
- Asthma prevalence is highest among blacks at 10.2 percent, followed by whites at 7.6 percent, and Hispanics at 6.8 percent.
- Nearly a third of all children with asthma will miss three or more days of school this year.
“This is a topic that just needs more attention,” said Cindy Liverance, vice president of programs for the American Lung Association in Colorado. “One out of four people in Colorado has asthma. It can be viewed as commonplace. But people can die from asthma. If you don’t access to your medications, or you don’t know how to use them properly, you can end up in the emergency room.”
While Colorado law empowers children to carry asthma medication with them, health educators are now pushing for every school to develop an asthma action plan for every affected student.
That action plan would start with a long conversation between the student, their parents and the school nurse or health care provider. The school should have a list of all medications the child is taking, what the child’s symptoms are, what medications should be used and when, and at what point emergency medical responders should be called.
“Does that happen every time for every child? Sometimes not,” acknowledged Kathy Patrick, assistant director of the Office of Health and Wellness for the Colorado Department of Education and a state school nurse consultant.
“I’m coming from the perspective of a school nurse,” Patrick said. “When you have 4,000 or 5,000 students, how do you get to sit down with a student with asthma and make sure they know how to use their inhaler, make sure they know how to access help when needed?
“Nurses do what they can with the limited time they have available. But the nurse to student ratios, as they are, it’s unfortunate.”
Doctors, too, are often too busy to insure newly diagnosed young asthma patients get the education they need to stay out of trouble. The youngsters need to be made aware of things that will trigger their asthma, what to do if they start having trouble, and, above all, how to properly use their inhaler.
“If the doctor is well-versed in having these conversations, it takes five minutes tops,” said Eliza Lanman, senior director of programs for the American Lung Association in Colorado. “But if they’re not used to doing it, these conversations can take longer, and they just don’t see it as a priority.”
As a result, she said, newly diagnosed children with asthma typically end up in the emergency room an average three times in the first year after their diagnosis, because they don’t know how to minimize an oncoming asthma attack.
Lack of education in proper use can have devastating results
Sami Clark says she didn’t know how to properly use her asthma inhaler for the first two years she had it.
“Because I was never taught,” she said. “I finally learned the right way to use it at asthma camp. I sat down with a nurse there, and it took me two days to learn it.”
- Read the 2008 Asthma Surveillance Report, which outlines the extent of the problem in Colorado, including health and economic impacts, and populations most at risk.
- See a sample Asthma Action Plan, suggested by the Colorado Department of Education.
- Read the Colorado legislation giving students the right to carry asthma inhalers with them, and to self-medicate when needed.
This lack of education can also lead to situations such as an incident in January in Monument involving two middle school girls. One of the girls loaned her asthma inhaler to the other girl because she thought her friend was having an asthma attack. When school officials found out, both girls were suspended because school policy prohibits sharing of any prescription drug. The girl who borrowed the inhaler was eventually expelled.
“These two girls are a perfect example of why students need to be educated,” Liverance said. “To think you can just hand an inhaler to a friend is wrong.”
Some Colorado school districts already have asthma policies in place and do a good job of making sure every student with asthma has a care plan on file in the office.
Denver Public Schools, in particular, has partnered with National Jewish Hospital to provide asthma education across the district. Liverance cites Cherry Creek and Aurora as other model districts for asthma care.
But she can’t say how many districts have policies in place, let alone how many actually follow them.
“It’s hard to figure out,” she said. “That’s something we’ve been working on since the bill went into effect last year. It’s in flux. The more districts we talk to, the more interested they are in implementing this.
“But it not only means more work for schools, it also means more work for doctors, more work for parents. It’s understanding that asthma isn’t something you can take lightly.”
Adopting and implementing asthma care policies isn’t something just limited to large districts. Jody Stroh, the school nurse in Creede, is a certified asthma educator. She’s traveled around southern Colorado training her peers in best practices when it comes to managing students with asthma.
“Our goal is to improve asthma literacy among all the school nurses in Colorado,” Stroh said. “But I know that it will probably be a school secretary doing the education about asthma with a child, so we’ve designed a file system with all the different worksheets about what asthma is, what medications you’d use, how to exercise without triggering asthma.”
“A tremendous amount of thought has gone into making sure kids have their medicines available to them immediately,” she said. “We find out who has asthma, who is carrying an inhaler, and those who’ve had any problems in the past year will get a care plan. If you have a child old enough to carry an inhaler, we have a document that we have them sign, and have their parents sign, that says they understand that they’re not to share that inhaler and that they’re must have it labeled.”