LIVING WITH ASTHMA. Resource Kit for Secondary Schools Contents Lesson 1 Understanding Asthma 3 Lesson 2 Impact on Lifestyle

Transcription

1 LIVING WITH ASTHMA LESSON PLANS FOR USE WITH THE RUNNING SHORT DVD (DVD provided to all schools registered with the Asthma Friendly Schools program) Funded by the Australian Government Department of Health and Ageing Resource Kit for Secondary Schools Contents Lesson 1 Understanding Asthma 3 Lesson 2 Impact on Lifestyle 9 Lesson 3 Taking Responsibility 14 w.asthmafriendlyschools.org.au - 1 -

2 Introduction The following set of lessons has been adapted from the Living with Asthma Teachers Resource Kit developed by the Asthma Foundation NSW with Susie Lough, then Education Officer Asthma Foundation NSW, as Project Manager. The original Living with Asthma resource was developed as part of the Greater Newcastle Asthma in Schools Project (GASP). These resources were developed in consultation with the NSW Department of Education and Training Professional Support and Curriculum Directorate. The 2008 Resource Kit for Secondary Schools provided here has been adapted to integrate with the Running Short DVD produced by the Triple A (Adolescent Asthma Action) Program and made available for use in the Asthma Friendly Schools Program. The Running Short DVD is provided free to schools when they register with the Asthma Friendly Schools program. This DVD is not intended for use as a stand alone resource but in combination with the following lesson plans to maximise education outcomes. The Asthma Friendly Schools Program acknowledges the work of the above projects and their significant contributions to asthma education in schools. Schools are encouraged to consider the Triple A Program, a peer education program for secondary schools, as a complementary activity to the Asthma Friendly Schools (AFS) program accessible through the Asthma Foundations of Australia website, Lessons are packaged in broad topics with a variety of activities in each. These activities are flexible for delivery collectively or separately to suit various time allocations

3 LESSON 1: UNDERSTANDING ASTHMA RESOURCES AND TEACHER PREPARATION - DVD OF Running Short - 2 straws per student - Balloon OUTLINE OF ACTIVITIES (i) What we know about asthma (ii) Understanding how asthma affects people (iii) Running Short DVD (i) WHAT WE KNOW ABOUT ASTHMA LEARNING OBJECTIVES: to explore information students believe about asthma and to consider some of the impacts of the condition Small group activity (or whole class brainstorm) Ask students to work in small groups and consider What we know about asthma. Have them record all responses. There are myths about asthma that may be amongst their responses (eg people with asthma cannot play sports). Working as a whole class group, organise the responses into headings of, What we know is true What we believe to be true Not sure Make a copy of this to revisit at the end of the asthma lessons. Having developed a knowledge base of asthma, explore its impacts by discussing, Who is affected? When does asthma occur? How does asthma affect a person? What is the physical impact of asthma? What is the medical impact of asthma? What is the social impact of asthma? Add any new responses to the know / believe / not sure record

4 (ii) UNDERSTANDING HOW ASTHMA AFFECTS PEOPLE LEARNING OBJECTIVES: to undertake a practical to simulate a range of levels of difficulty breathing; students to consider their physical and emotional responses; to develop an understanding of the signs of asthma. Whole class practical: Asthma Symptom Simulation These experiments will provide a first-hand experience of how it feels to not be able to breathe properly. WARNING: This could cause discomfort for students with asthma and they should be exempted from the activity, remaining involved as observers. It is important that all students do these activities for no longer than the 10 seconds indicated and know that they can stop if they experience any discomfort (if they do get anxious, sit student down and get them to take slow breaths, counting these out loud. Reassure them that their discomfort will quickly disappear and breathing return to normal) Provide each student with 2 straws. Experiment 1: Airway Narrowing 1. Place both straws in mouth side by side, pinch nose and breathe through the straws for 10 seconds 2. Remove one straw from mouth, keep nose pinched and breathe through the remaining straw for 10 seconds 3. Join the 2 straws together (tape or slide one into other), pinch nose and breathe through end to end straws for 10 seconds Discuss the level of difficulty breathing using these various methods (gets progressively more difficult). Point out that there are different levels of an asthma attack (mild, moderate and severe) associated with the difficulty breathing. Experiment 2: Exercise and Asthma 1. Students cut a straw in half 2. Students jog on the spot for 1 minute 3. Have them place the half straw in their mouth and pinch nose. Breathe through the straw while jogging on the spot for another 10 seconds Discuss how much harder it is to breathe when exercising. Point out that exercise induced asthma is a common trigger for many people with asthma. Get students to reflect on their reactions during the experiments. Brainstorm to make a list of their reactions. Help students to classify these into two categories, PHYSICAL: what happened to their bodies (eg faster breathing rate) EMOTIONAL: how they were affected (eg worried, surprised) - 4 -

5 Whole class discussion How might these reactions further affect your breathing? How would it feel to often not be able to breathe properly? What do think it s like for people when they have an asthma attack? Having considered these, develop a list of Signs of Asthma (ie what you might see or hear; ensure that both physical and emotional aspects are covered) Show the slides (or provide handouts), Where Asthma Occurs and What is Asthma? (colour slides on Asthma Friendly Schools website). Where Does Asthma Occur? Asthma Foundations of Australia What is Asthma? Three changes which narrow airways make breathing difficult: Airway muscles tighten Inflammation and swelling increased Excess mucus production Asthma Foundations of Australia - 5 -

6 Indicate that asthma occurs in the small airways of the lungs (near the alveoli) and that there are 3 effects of asthma that effect the flow of air through these airways (which are about the thickness of a human hair) muscle tightening, inflammation and mucus. Each person s asthma is different and may be due to any one or combination of these reactions. Demonstration: Restricted Flow of Air 1. Blow up the balloon and let the air our (keep hold of balloon but do not restrict the neck opening). Repeat as necessary. Relate to air leaving the lungs when breathing out 2. Blow up the balloon, this time pinching the neck as the air is released. A loud whistling sound is made 3. Ask students to identify why this noise was made (air under pressure pushing through tight opening). Relate this to the restricted airways for someone with asthma and the wheezing sound that often accompanies asthma. Wheezing is one common sign for asthma Refer to the slide What is Asthma? and point out the reduction in the size of the airway opening. Relate to the balloon experiment and wheezing as an asthma symptom. Extension Activity (optional) If available, Asthma Airway Tubes Models can be passed around. These pair of airways depicts a healthy open airway and a restricted asthma airway. The tubes are available for purchase from your Asthma Foundation. Teachers Notes When the airways narrow, often there is a distinctive sound of air leaving the lungs that can be heard this is called a wheeze. Note that a wheeze is not always present as a sign of asthma. In a severe asthma attack, wheeze is sometimes absent

7 (iii) RUNNING SHORT A DVD ABOUT ADOLESCENT ASTHMA LEARNING OBJECTIVES: to develop awareness and understanding of the seriousness of asthma through the events shown in the DVD; to develop knowledge of the issues associated with asthma for adolescents Explain to the class that they will be watching a DVD titled Running Short showing an asthma incident in a school setting. Ask them to look for issues related to signs of asthma and the management of asthma. Have them think about what messages the DVD has for young people. Let them know that they will view the DVD again in lesson 3. Watch the Running Short DVD. Small group activity (or whole class discussion) In small groups explore the information in the DVD using these questions, How did the main characters feel at different stages in the DVD? Have you or your friends had any similar experiences? (note that students with asthma may not want to share information about their condition and should not be prompted to do so if they are uncomfortable with this) What issues were raised in the DVD? What could be done to address such issues? What are the main messages in the DVD? Whole class discussion Explore the responses to the first 4 dot points with the whole class. Identify issues related to signs of asthma and management of asthma, both by individuals and schools. Collate the messages from the last dot point and reach agreement on the key messages for young people in the DVD. Re-word these appropriately with all students as the target audience (over 10 years old for language / sophistication). Extension activities (optional) Discussion: Should asthma education be aimed at all students or students with asthma? Media studies: Groups take one agreed key message and develop a suitable means of communicating the message to a wider audience of young people

8 Teachers Notes The use of a mask to treat asthma for a teenager as in the DVD is not usual but is considered appropriate if available and when the person is having extreme difficulty breathing. Most commonly, students with exercise induced asthma will use their reliever puffer (and spacer preferably) prior to physical activity. A Bricanyl Turbuhaler can also be used as shown in the DVD. There are different types of asthma medications. In the hospital scene two medications can be seen. Asthma can be treated with preventer medication to keep the condition under some level of control long term (school staff will see this type of medication on camps as it is generally taken twice daily, morning and night). All persons with diagnosed asthma would have a reliever medication for use in emergencies and also for use prior to exercise (for those with exercise induced asthma). In exploring key messages from the DVD, some responses might include, Asthma is serious; Smoking and asthma don t mix; You can control your asthma; Asthma tell your friends; etc

9 LESSON 2: IMPACT ON LIFESTYLE RESOURCES AND TEACHER PREPARATION Access to computers and internet OR request Fact Sheets (from Asthma Foundation) OUTLINE OF ACTIVITIES (i) Impact of asthma on lifestyle (ii) Asthma triggers (i) IMPACT OF ASTHMA ON LIFESTYLE LEARNING OBJECTIVES: as with any medical condition, asthma has an impact on the lifestyle of the person; asthma can be managed and controlled; people with asthma and schools have different responsibilities for asthma management Whole class discussion From what has been learned so far, brainstorm and list some of the ways we would expect asthma to impact on the lifestyle of a young person? (Information sources for responses could include the DVD, personal / family / friends experiences). Pose the following questions, recalling the Running Short DVD (revisit order of events) What evidence was there in the DVD that asthma can be managed? How could the impact seen in the DVD have been minimised? How could young people reduce the impact of asthma on their lives? Match responses to the last question with the listed impacts. Address any impacts without a response, looking for ideas of how to reduce or control these. Teachers Notes Responses for impacts could include, Taking medication; remembering to take medication; time off school due to asthma; unable to go stay in smoky places; difficult to play sport; having to carry a puffer (and spacer) everywhere; having to go to hospital for asthma; Doctor visits for asthma, etc. Ways to control and manage asthma include, Always have your asthma medication with you; take your preventer medication; know what causes your asthma and avoid if possible; exercise regularly; visit your Doctor regularly and insist on an Asthma Action Plan; provide your school with a copy of your Asthma Action Plan; follow your Asthma Action Plan

10 (ii) ASTHMA TRIGGERS LEARNING OBJECTIVES: to be aware of the variety of asthma triggers and the steps individuals and schools can take to manage these; good asthma management can reduce asthma incidents and the impacts on lifestyle Explain that the common terminology used for factors that bring on one s asthma is referred to as triggers. Different people have different triggers for their asthma. Whole class discussion What was the asthma trigger shown in the DVD? (exercise) What other triggers have we mentioned so far that could set off someone s asthma? Does anyone know of any other triggers for asthma? Show the slides (or provide handouts), Signs and Symptoms and Asthma Triggers (colour slides on Asthma Friendly Schools website). Signs & Symptoms Shortness of breath Wheezing Distress / panic / anxiety Behaviour changes Rapid breathing Difficulty talking Tight chest Persistent cough Blue lips Pale and sweaty Sore tummy in young children Sucking in of skin over chest/throat Asthma symptoms will vary from person to person and from time to time for an individual. Asthma Foundations of Australia Asthma Triggers Colds and flu Exercise / activity Smoke Pollens / moulds Animals / pets Changes to weather / air temperature Dust and Dust mites Deodorants / perfumes Chemicals Foods / additives Certain medication Emotions Knowing your asthma triggers contributes to good asthma management Asthma Foundations of Australia

11 Reinforce that good asthma self-management involves knowing what triggers your asthma and knowing the early signs of asthma so you can quickly take appropriate steps to control the onset and avoid escalation to a severe asthma attack. Questions Which triggers from the slide would you expect to be the 3 most common? (Colds and flu; Exercise / activity; Smoke) Which triggers would be common to encounter in a school setting? Use the teachers notes to expand on the information for each trigger. Teachers Notes ASTHMA TRIGGERS Although we don't know what causes asthma, we do know that under certain circumstances the airways react and asthma symptoms develop. We refer to the stimuli that can lead to asthma as triggers. Different people react to different asthma triggers and many people with asthma react to a variety of triggers. Asthma may develop from exposure to one trigger or from a number of triggers simultaneously (e.g. a student with a cold goes into a change room where deodorant has been sprayed). For some people it is difficult to determine what triggers their asthma. Avoiding or reducing exposure to known asthma triggers for an individual is one form of control, but is not always possible. Asthma medications can reduce the likelihood of asthma developing. Colds and Flu: The most common trigger, particularly for children. When a student with asthma has a cold or the flu it is highly probable that they will develop asthma symptoms. Exercise / activity: A trigger for many people with asthma. Students with asthma should be encouraged to take part in school based exercise and physical activity to contribute to their cardiovascular fitness and their general well-being. People with asthma should be able to participate in almost any sport or exercise. Most individuals with EIA can exercise to their full potential if the condition is properly treated. Many top athletes competing at national and international level have asthma. Scuba diving is the only activity not recommended for people with asthma. Smoke: As well as active and passive cigarette smoke, woodsmoke from open fires, burn-offs or bushfires can trigger asthma

12 Pollens / moulds: Pollens from flowers, grasses and weeds carried in the air are difficult to avoid, particularly in spring and summer. At times, staying indoors is the best measure. The airborne spores of moulds may be encountered in wet areas of houses as well as in mulch, potting soil, compost and leaf litter. Animals / pets: Animal hair, skin (dead flakes), urine and saliva may trigger asthma. Major source is cats and dogs (sweat and saliva); other animals include guinea pigs, birds, mice & rats, rabbits and horses. Changes to weather / air temperature: Changes in air temperature in the order of 10 degrees (either way, cold to hot or hot to cold) can aggravate asthma, e.g. moving from a heated classroom to cold outdoors. Significant shifts in weather can have the same affect. It is the change of temperature of the air entering the lungs and passing through the airways that can trigger asthma. Dust and dust mites: Dust in the air, particularly on hot, dry and windy days, and household dust that may become airborne from dusting, sweeping or even vacuuming can bring on asthma. Dust mites are microscopic creatures that are a common asthma trigger. Dust mites tend to be prevalent in carpets and bedding, liking moist conditions and feeding on shed skin. Stuffed toys can be a source of dust mites. Deodorants / perfumes: Personal hygiene products can be a trigger for asthma, including perfumes, after-shaves, hair sprays and deodorant sprays. Some schools have banned the use of anti-perspirant deodorant sprays, even in sports change rooms. Chemicals: Certain strong smelling household chemicals can trigger asthma, including paints, adhesives, ammonia and bleach. Strong smelling chemicals used in the classroom, e.g. glue, can trigger asthma it is worthwhile to consider ventilation options that may help overcome this. Foods / additives: Fairly rare and usually affects very young children, but reactions can be extreme and life-threatening. Triggers can be peanuts, shell fish, dried fruits (sulphur dioxide), mono sodium glutamate (MSG) and yellow food colouring (Tartrazine 102). Certain medications: Medications known to trigger asthma include aspirin, antiinflammatories (non-steroidal, e.g. ibuprofen) and beta blockers (used for heart conditions and high blood pressure). A person with asthma should always ensure that the Doctor or pharmacist is made aware of their asthma when considering a new medication and monitor themselves for any asthma signs. Emotions: Emotional reactions such as laughter, crying, excitement and stress related can trigger asthma. For students, stress from the pressure of exams is a known factor

13 Group research activity Divide the class into 5 groups (or more groups / individuals with some doing the same topic). Allocate each group a topic from, Exercise Food Tobacco smoke Outdoor environment Indoor environment Have each group research their asthma triggers topic, guided by the questions, 1. How can the person with asthma minimize the effect of this trigger? 2. How can other people help to minimize the effect of this trigger? Groups identify key messages for school students from their findings. Have groups present their findings to the class in an oral report using visual aids to reinforce their key messages. Whole class discussion After group presentations, explore in general terms, Why is it helpful for all people to be aware of asthma triggers and their impacts? Are there times when a person with exercise induced asthma should not participate in physical activity? (Exercise should not be avoided by people with asthma unless they are unwell [making them susceptible to an attack] or have asthma symptoms at the time) Where would a person with asthma get the best information about how to manage their asthma? (From their Doctor who will develop an Asthma Action Plan with them [focus in next lesson]. This should be reviewed regularly) Extension activity (optional) Have groups present their findings and messages to a wider student audience (eg: other classes; school assembly; school s website) Teachers Notes Some useful websites are, Asthma Friendly Schools National Asthma Council (substantial links page) Asthma Foundations (Vic) American Lung Association If internet access is not possible, contact your Asthma Foundation for Fact Sheets. Asthma information may also be available at local pharmacies

14 LESSON 3: TAKING RESPONSIBILITY Resources and teacher preparation - Running Short DVD - Asthma Emergency Kit (reliever puffer and spacer) - Asthma First Aid poster (download from (A reliever puffer and spacer from a school First Aid Kit can be used if there is no Asthma Emergency Kit in the school) OUTLINE OF ACTIVITIES (i) Importance of management plans (ii) Managing an asthma emergency (iii) Asthma First Aid (iv) Asthma guest speaker (optional) (v) Review (i) IMPORTANCE OF MANAGEMENT PLANS LEARNING OBJECTIVES: to understand the importance of having an Asthma Action Plan; to be aware of the different types of asthma medications, particularly those for use in an emergency Explain that the good practice standard for an individual s asthma management is to have an Asthma Action Plan developed with their Doctor. This plan encourages people with asthma to assume greater control of their condition by taking on greater responsibility guided by a medical professional s advice. Whole class discussion What would you expect to be included in an Asthma Action Plan? (Prompts could be, symptoms; triggers; medication; emergency response; when to seek medical aid). Does asthma management involve more than just taking medication? (Yes! Also, avoiding triggers; taking peak flow measurements) How is the type(s) of asthma medication needed for a person determined? (by a Doctor) What types of asthma medications have we come across in our discussions? Show the slides (or provide handouts), Asthma Action Plan, Asthma Medications - Reliever and Asthma Medications - Preventer (colour slides on AFS website)

15 Go through the Asthma Action Plan, noting and discussing the type of information it provides for the person with asthma, for a parent / carer and for a school. Asthma Medications Reliever eg. Airomir, Asmol, Bricanyl, Epaq, Ventolin Relaxes airway muscles Works in minutes Used in asthma emergency Carried by students and in Asthma Emergency Kits Use over 3x per week indicates poor asthma control Use When Needed Asthma Foundations of Australia Asthma Medications Preventer eg. Alvesco, Flixotide, Intal, Intal Forte, Pulmicort, Qvar, Singulair, Tilade. Reduces inflammation Can take weeks to take effect NOT for asthma emergency May be seen on excursions & camps Prescribed medications Used Daily (usually morning & night) Asthma Foundations of Australia Go through the information on the medication slides and note the differences

16 Questions What do you think would be involved for a student with both types of medication? (Preventer morning and night; possibly need reliever before sport; have reliever close by always in case of an emergency). What are the benefits of self-managing your own asthma? (Self reliance; independent; develop good life-long practices that work for you; in control; less sickness; able to participate more fully; confident) Teachers Notes ASTHMA MEDICATIONS Due to the three types of changes that can restrict the flow of air through the airways (you could ask what these are), we require different medications to treat the appropriate symptom. There are 4 groups of asthma medications, Relievers, Preventers, Symptom Controllers and Combination Medications. The most common of these for school staff to come across or use in the management of students asthma is Reliever medication. RELIEVERS Reliever medications come in puffer form (point out the puffer on the slide). Reliever medication is what students with asthma will have with them for use in an emergency and is also kept in Asthma Emergency Kits. Reliever medication works quickly to relax the muscles around the airways, opening these up so breathing can return to normal. The use of a blue reliever puffer (and spacer) may prevent a more serious asthma attack from occurring. A reliever puffer (and spacer) should be available at all times either through the student carrying their own, the teacher having this easily available if holding for a younger or less able student, or through quick access to an Asthma Emergency Kit. It is the responsibility of parents / carers to ensure that their child has their asthma medication at school and the responsibility of schools to have emergency asthma medication available for situations where a student may not have their medication with them or if they experience their first asthma attack. Whenever a student develops asthma symptoms at school, they should be encouraged to use their reliever medication immediately. Remember, time is critical. Other types of asthma medications are NOT SUITABLE for use in an asthma emergency (the exceptions being a Bricanyl Turbuhaler and Symbicort (under the SMART protocol) either of which can be used if reliever medication is not available or if a student s Asthma Action Plan requires this)

17 Reliever puffers have expiry dates that must be checked regularly. If used regularly the puffer can run out of medication. You can check that there is still medication available in a puffer by shaking it (as for a deodorant). A reliever puffer used with a spacer device is the most efficient method of relieving asthma symptoms in an emergency. A reliever puffer (with a spacer device) is also used prior to physical activity for person s with Exercise Induced Asthma (EIA). This is an established and accepted precaution. If it noticed that a student is using their reliever puffer more than 3 times in a week, (not including use for EIA), this is an indication that their asthma is not well controlled and that a consultation with a Doctor might be required. Parents / carers may not be aware of this (if it happens more at school) so it is worthwhile to inform them. Reliever medication is extremely safe to use, even if it turns out that the condition being treated is not asthma. There can be side effects from the use of reliever medication. These including raised heart rate, hyperactivity, shakiness or headache. Different people react differently to reliever medication and the dosage they experience, but these side effects usually subside quickly and are preferable to the potential damage from not being able to breathe. If any side effect distresses a student, reassure them that this is a normal reaction and that it is expected and is ok. PREVENTERS Preventer medications are prescribed by a Doctor and taken on a regular basis to help control asthma. Students may need to use preventer medication when on camps or excursions outside of regular school time. As these medications are generally taken morning and night, they are unlikely to be seen during a regular school day. Preventers work by reducing the level of inflammation that can block the airways and by drying up mucus. They can take up to several weeks to take effect if a medication is new to the student. Preventer medication is NOT SUITABLE for use in an asthma emergency situation. Children should rinse there mouth out after each use of preventer medication to reduce common side effects (thrush, hoarse voice). SYMPTOM CONTROLLERS AND COMBINATION MEDICATIONS These types of medications are prescribed by Doctors for certain asthma situations. Symptom controllers: long acting reliever medication used with other asthma medication. Combination medications: combine a preventer and a symptom controller in one device

18 Show the slide (or provide handout), Spacers (colour slides on AFS website). Spacers Why Use A Spacer? Recommended for everyone who uses a puffer Greatly increases medication reaching airways Reduces medication deposited in mouth and throat Asthma Foundations of Australia Show the class a puffer and spacer from an Asthma Emergency Kit or First Aid Kit. These diagrams show that using a spacer with an asthma puffer (for both reliever and preventer puffers) is significantly more effective than a puffer on its own. The medication is delivered efficiently into the small airways in the lungs (point this out on RHS diagram) where it is needed (approximately over 3 times more effective). Less medication is deposited in the mouth (point this out on LHS diagram), reducing irritation and the side effects associated with preventer medications. These diagrams show laboratory results using a Breath-A-Tech spacer. There are a range of spacer devices available and all have similar effectiveness. All spacers are suitable for use by school aged students. Whole class discussion How worthwhile is it to use a spacer with asthma puffer medication? Some adolescents do not use their spacer because it is large and obvious (not cool). Explore the issues here and ask the class for ideas to encourage spacer use at school

19 (ii) MANAGING AN ASTHMA EMERGENCY LEARNING OBJECTIVES: to gain an understanding of the various signs and symptoms of asthma and their relationship to the levels of severity of an asthma attack Explain that despite good self management of asthma, emergency situations can occur. When a person with asthma develops symptoms and their ability to breathe is reduced it is important that they (and others) can react quickly and respond appropriately. Watch the Running Short DVD again. Ask students to focus on, Signs and symptoms of a severe asthma attack What they can do to assist a person having a severe asthma attack (Signs are what we can see or hear; symptoms are what is felt by the person. Some indicators can be both) Show the slides (or provide handouts), Recognising and Assessing an Asthma Attack Mild and Moderate; Severe (colour slides on Asthma Friendly Schools website). Recognizing & Assessing an Asthma Attack Mild Cough Soft wheeze Minor trouble breathing Talks in sentences Moderate Persistent Cough Loud wheeze Difficulty breathing Shortened sentences Administer First Aid for all attacks. Treating a mild / moderate attack may prevent escalation to severe. Asthma Foundations of Australia Recognizing & Assessing an Asthma Attack Severe Wheeze may be absent Distressed / anxious Pale / sweaty / blue lips Gasping for breath Few words per breath Sucking in of skin over ribs / throat A severe asthma attack is life threatening. Commence Asthma First Aid and ALWAYS call an ambulance. Asthma Foundations of Australia

20 Compare the signs and symptoms for mild, moderate and severs level asthma attacks. What signs and symptoms were present when Patrick had his attack? (Gasping for breath [symptom]; Distressed [both]; Pale and sweaty [sign]) What made the situation worse? (Keeping his condition secret; Moving away from where he could be easily seen) What could Patrick have done before and during the race to improve the situation? (iii) ASTHMA FIRST AID LEARNING OBJECTIVES: to know that there is an agreed medical procedure for asthma first aid; to gain an understanding of the 4x4x4 asthma first aid procedure Invite a health professional if possible to demonstrate the asthma first aid procedure to the class (eg Doctor, School Nurse, Respiratory Health Professional). Provide each student with a copy of the Asthma Friendly Schools program asthma first aid poster (this can be downloaded and photocopied in A4 size from the website, or ask your Asthma Foundation to post a copy). Using a reliever puffer and a spacer (from one of the school s Asthma Emergency Kits or First Aid Kit), go through the asthma first aid plan for someone having an asthma attack with the class. Use two volunteers from the class to act out the procedure, under direction from yourself (refer to teachers notes) or the invited guest. Repeat with different volunteers if desired. Ask the class why this procedure is called the 4x4x4 asthma first aid response. (4 breaths - 4 puffs per 4 breaths; 4 minute wait; also 4 steps) Have the class consider, Would they feel confident to help a friend having an asthma attack with asthma first aid? If they could not help themselves, who could they get to help (various scenarios)? Do they know where in the school the Asthma First Aid poster is displayed? How important do they think it is for the school to be Asthma Friendly?

21 Teachers Notes The information here provides more detail for the provision of the 4 step asthma first aid protocol. This protocol is an Australia wide standard adopted by the Asthma Foundations. Only if a person s Asthma Action Plan is known and differs from this standard would you then provide a different response. In all other situations the 4x4x4 procedure is the correct response. Step 1: Sit the student in an upright position Don t leave the student alone Remain calm yourself and reassure the student Have someone bring you an Asthma Emergency Kit / reliever puffer and spacer Step 2: Shake the reliever puffer and remove cap Insert puffer into spacer; ensure student places mouth over spacer mouthpiece and gets a good seal Press down once on the puffer then have the student breathe in and out 4 times Repeat so the student receives 4 separate puffs, taking 4 breaths after each puff Reinforce strongly 1st Puff then 4 Breaths in and out through spacer 2nd Puff then 4 Breaths in and out through spacer 3rd Puff then 4 Breaths in and out through spacer 4th Puff then 4 Breaths in and out through spacer each time you do step 2. Step 3: Wait 4 minutes If asthma is relieved, discontinue medication Step 4: If there is little or no improvement repeat steps 2 and 3 (4 puffs taking 4 breaths after each puff; wait 4 minutes) If no improvement, condition worsens, or concerned - Call an ambulance immediately (000) - Continue to repeat steps 2 and 3 while waiting for the ambulance

22 (iv) ASTHMA GUEST SPEAKER Extension activity (optional) If you are able to secure the services of a health professional to go through the asthma first aid procedure, you could them to also talk generally about asthma and answer questions that have arisen through the lessons and the DVD. Persons to consider would include a Doctor, a nurse, a respiratory health professional. Other options to consider are a teacher or parent with asthma, an athlete with asthma, or a panel of students with asthma prepared to share their experiences. Prior to this activity, have students develop questions individually or in groups suited to the guest speaker. Encourage specific questions rather than general ones. (v) REVIEW Going back to the first part of the asthma lessons, review the list of What They Know about Asthma with the headings, What we know is true What we believe to be true Not sure moving responses to their correct heading as necessary. Provide opportunity to reflect on what has been learned about asthma and how this has changed their understanding of the condition. Explore any behaviour changes they believe have or will occur (eg to know if friends have asthma; to help others avoid triggers)