Asthma

Asthma
Asthma is a chronic lung disease in which an individual’s airways are inflamed (irritated) and overactive. This condition is sometimes known as reactive airway disease. During an episode, the lining of the airway swells, which causes mucus production, then the muscles which surround the airway contract. As a result, the airway is partially blocked, and asthmatic symptoms such as wheezing, chest tightness, coughing and shortness of breath begin.

It is estimated that over 10 percent of school-age children in Georgia have asthma. Asthma is the most common chronic disease of childhood and the leading cause of school absence from chronic illness. Exercise-induced asthma (EIA) occurs when physical activity causes bronchoconstriction, which can lead to wheezing, coughing, chest tightness or shortness of breath during and after exercise. Most children with asthma will also have EIA, and some children can have EIA without having chronic asthma.

Asthma education in schools can help to improve self-management skills and lead to decreased absenteeism. The school nurse plays a key role in monitoring and assessing asthma control in the student. Indicators of poor asthma control in the student need to be identified and communicated to the parent, including advising medical follow-up. In addition, the school nurse should be alert to children who have signs and symptoms of asthma but have not been diagnosed; nurses should educate and encourage families to seek medical attention.

Guidelines for the care and management of asthma were released in August 2007 by the National Heart Lung and Blood Institute (NHLBI) nhlbi.nih.gov/health-topics/guidelines-for-diagnosis-management-of-asthma. These guidelines emphasize the importance of asthma control and introduce recommendations for managing asthma in three age groups (0-4 years of age, 5-11 years of age and youths>12 years of age). The classification of asthma severity is determined at the time of diagnosis with the goals of asthma therapy aimed at reducing impairment caused by symptoms and risk of future exacerbations from poor control. The classifications of asthma severity based on symptoms without any medication are as follows:

• Intermittent asthma – Daytime symptoms less than or equal to two times a week; brief exacerbations requiring the use of quick relief medication less than or equal to two times a week; nighttime symptoms less than or equal to two times a month; no interference of normal activity.
• Mild persistent asthma – Symptoms greater than twice a week, but not daily; nighttime symptoms three to four times a month; need for quick relief medication more than two times a week but not daily; minor limitation of normal activity.
• Moderate persistent asthma – Daily symptoms; daily use of quick relief medicine; exacerbations affect activity; exacerbations occur twice a week and may last days; nighttime symptoms greater than once a week.
• Severe persistent asthma – Continual symptoms; frequent exacerbations; frequent nighttime symptoms; limited physical activity.

The presence of one clinical feature of severity is sufficient to place a student in that category and initiate treatment accordingly. The ultimate goal of treatment is to enable the student to live free of limitations. Ongoing monitoring is essential to this end as asthma is a highly variable disease.

Causes
The cause of asthma is a sensitive and over-reactive airway. The airway of an individual with asthma can be triggered by a variety of factors. The airway can be triggered by allergens such as molds, dust mites, pollen or weeds; irritants like smoke, air pollution or strong odors; or other factors such as exercise, weather changes or cold air.

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Asthma