News-Sentinel.com

Thursday, 05/04/2000

ASTHMA: THE BATTLE TO BREATHE

Schools challenged in efforts to help students breathe easier

By Jennifer L. Boen of The News-Sentinel

Each morning when Chad Arnett arrives at Washington Center Elementary School in Fort Wayne, he drops his book bag in the classroom and heads to school nurse Linda Steele's office for an asthma treatment.

After he checks his peak flow — how much air he exhales — he breathes in medication from an inhaler and returns to class.

Chad is one of 18 children at his school — and one of nearly 1,500 in the Fort Wayne Community Schools district — diagnosed with the respiratory illness that affects thousands of Allen County youngsters.

Among the four Allen County public school districts, 2,580 children are on record as having asthma. School officials believe the number is much higher because many children go undiagnosed.

Asthma is now the No. 1 reason for children's hospitalizations and causes an estimated 10 million missed days annually in U.S. schools.

"Cases have been growing in monumental numbers," said Lynn Knee, head nurse at suburban Homestead High School, where just under 10 percent of students are reported to have asthma.

"I have a whole variety, from mild to very serious," said Knee, who has worked at the school for 14 years and witnessed the increase.

On several occasions, Knee has called 911 to transport an asthmatic student to a hospital. But most asthmatics' conditions can be controlled, with proper treatment and reduced exposure to triggers.

"What concerns me is that some students are not well-controlled. They don't take their medicine. They don't want to feel different. I encourage them to always carry their inhalers."

Also of concern is teachers who don't understand the illness, said Miss Indiana Kelly Lloyd, a lifelong asthmatic. She recently told a group of Bloomingdale Elementary students with asthma how it felt to be pulled out of class by her fifth-grade teacher. The teacher asked if she was being abused because she had hives and frequently missed school.

"I realized that my teacher didn't understand asthma," said Lloyd, 23.

"I remember one time I was supposed to run in gym," Lloyd said. "I was really having a hard time breathing. The gym teacher said, `You're just making up excuses so you don't have to run laps.' "

Indianapolis Little League coach Charles Flasch's son, Jon, 12, died of asthma in May 1999. His son didn't die while playing a sport, but Flasch has witnessed how some coaches react to children with asthma.

"Some coaches are sensitive to it," he said, "but some are still of the mentality of `You've got asthma? Get tough! You get out there and run!' More often than not, coaches and teachers just don't understand the disease and the problems."

Because of the stigma of the illness, middle- and high-schoolers often conceal their illness.

"I've seen kids hide their inhalers," Flasch said.

"High school students or teen-agers are often embarrassed about their asthma and avoid taking their medications when they know they should," said Shane Houser, respiratory therapist at Lutheran Lung Center in Fort Wayne.

"The most difficult task is convincing the asthmatic that asthma can be a severe, life-threatening disorder," Houser said.

But many find out the hard way when a severe attack sends them to an emergency room, he added. More emergencies. More hospitalizations. More missed school days.

Before fifth-grader Andrew Karn's asthma was brought under control, he missed 20 to 30 days each year through third grade, said his mother, Julie Karn.

"It seemed like he was sick all the time. You feel really guilty when the teacher tells you during a conference your child has missed too much school. I felt like I was doing something wrong."

Sharron Wilkins shares Karn's feelings. "It makes you feel like a bad parent when you get a call and they say, `Come get your kid. He's not breathing,' " said Wilkins, whose son, David, 10, missed at least seven days of classes this year at Franke Park Elementary.

Parents' lack of monitoring their children's health, working parents' schedules and inaccessibility to affordable health care all contribute to the growing number of schoolchildren with uncontrolled or undiagnosed asthma.

"Sometimes we don't find out until a child has an attack at school," said Nancy Heaton, head nurse for Northwest Allen County Schools. "It leaves schools feeling vulnerable."

In addressing undiagnosed asthma among schoolchildren, Dr. Terry Gaff, president of the Indiana affiliate of the American Lung Association, said schools should do pulmonary screenings, much like vision and hearing tests, to identify children with breathing problems.

Gaff said checking peak flows should be part of sports physicals, with such large numbers of kids involved in school athletics. Peak flow meters tell how well the lungs are functioning by measuring how much air is exhaled. Green zone indicates the patient is doing well, yellow zone means lung function is decreased, and red is a medical alert.

The problem is getting peak flow meters into the hands of low-income children so they can monitor their asthma at home, said Betsy Hardesty, clinical nurse practitioner. Medicaid does not pay for the device.

"It's very frustrating because using it is key to management," said Hardesty, who visits Washington Center Elementary weekly via a mobile health clinic. The unit is run by St. Joseph Hospital and funded by St. Joseph Community Health Foundation.

Medicaid normally pays for one nebulizer — an electric machine that administers asthma medication — for the child's lifetime, said Hardesty.

She recalls being told by an asthmatic boy's family that his nebulizer was broken when the landlord who was evicting them tossed it out the window. He also threw out all his medications, Hardesty recalled.

Knee said her office is equipped with peak flow meters and nebulizers, but what she most needs from parents is students' individualized asthma action plans.

"We have to have their plan so I know what is their yellow zone, what is their red zone. I have to have the medicine, and I have to have the medication form from the parents so I know what to give them."

Schools are charged not only with managing treatment but also the environment of buildings. Fort Wayne Community Schools last year began an Indoor Air Quality Program, which includes frequent building control checks, classroom control checks, and monitoring of practically everything that could affect the air students and employees breathe.

Teachers and administration now consider even how and where classroom pets — such as hamsters, rabbits and snakes — are kept in classrooms because some children might be allergic to them. The district also instituted a process for responding to concerns of employees and parents who suspect something in the school is causing health problems.

Because David Wilkins is allergic to dust mites and numerous other things, the school steam-cleaned his classroom carpet during spring break in an effort to eliminate allergens. Opening classroom windows during warmer weather also should help the boy breathe easier.

"We have in some cases removed carpet and gone to tile floors. We're encouraging schools to go to tile rather than carpet," said Mike Lindsey, manager of maintenance and operations for FWCS.

Many of the problems found so far, he said, have been ventilation-related. "The more closed up, the tighter an area is, the worse it can be," he said.

But the challenge to schools comes not only in reducing asthma triggers, but also in providing hands-on care and education. Schools need to keep asthma medications available, even when children are away from the building. When students are taken on field trips, bags of inhalers are taken along, said Deb Bendall, school nurse at Aboite Elementary in Southwest Allen County Schools.

The problem is children who haven't had an attack in a long time may unwittingly encounter a trigger and not have medications readily available, she said.

Since Chad Arnett is monitored daily at school, the dark shadows under his eyes — called allergic shiners — have disappeared, and he has more energy to do his favorite subject, math. He's doing better schoolwork, said his mother, Janet Tulk.

"I feel tremendously better with him doing his preventive medicine at school each day," said Tulk, who administers evening and weekend doses.

Learning about asthma is key to controlling it. Even young children can learn to handle their illness.

"The sooner you have children take charge of their own disease, the better off you'll be," said Dr. Norman Edelman, spokesman for the American Lung Association.

These days, Chad feels better and in control of his illness. He's learning the names of his medications and knows when his breathing tests indicate trouble.

"I'm in the green area," said the youngster, after blowing into his peak flow meter. "That's good."