May is Asthma Awareness Month, and respiratory

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1 Diane Rhodes Has Made Asthma Education Her Life s Work The winner of the 2008 EPA National Special Achievement Award is on a mission to ensure school children with asthma get the care they need May is Asthma Awareness Month, and respiratory therapists will once again be out in force to educate their communities on this chronic lung condition. As an award-winning director of asthma education at the North East Independent School District (NEISD) in San Antonio, TX, AARC member Diane Rhodes, BBA, RRT, AE-C, tackles asthma awareness on a daily basis. Here she shares what she s doing and how she believes it s helping students better control their asthma. What kinds of things are you doing on the cover to raise asthma awareness? Being part of a large school district with 67 campuses, we have to adapt to the district s individual school events and be sensitive to the academic calendar. Each year we hold two asthma blowouts in the fall and the spring. We plan the event by cluster a cluster includes a high school and the feeder middle and elementary campuses and we rotate through the district based on our data of asthma prevalence. We present a resolution to our school board of trustees, asking them to proclaim NEISD Asthma Mary C. Haskin, Photographer Diane Rhodes, BBA, RRT, AE-C Awareness Week during the week of the fall event. We hold our spring awareness event before district-wide state-mandated testing begins. To celebrate Asthma Awareness Month, we hold a superintendent awards ceremony in May to recognize everyone who participated in our asthma blowouts for the entire year. Since we usually have 1,500 2,000 people in attendance at our asthma blowouts, we usually recognize about 150 people. We acknowledge and honor the physicians and respiratory therapists who donate their time from the medical community, as well as our school nurses, physical education staff, custodians, food nutrition staff, and administrators who were involved in these huge community outreach events. I use this awards ceremony to promote Asthma Awareness Month by recreating the student education area. I display the handson activities that took place in the six stations so that all who worked the events can now observe what the elementary students learned in their education area during the actual events. What is your philosophy about the role of the respiratory therapist in asthma awareness activities? Given our background with respiratory patients, RTs are best educated to understand what asthmatics experience and try to reduce any barriers to understanding and controlling their disease. We know asthma can be controlled, and we strive in our daily practice to educate our patients to reach the goal of asthma control and self-management. As a respiratory therapist I feel there is nothing more rewarding than when you are instrumental in the process of educating a patient on his disease management. It s very rewarding to witness when a person with asthma starts to understand his disease, becomes self-empowered to manage it, and takes the approach that he can be in control of his asthma by applying the education we have provided. As an asthmatic myself, with numerous exacerbations during my childhood, I will never forget the first time I received education on asthma. I was 15 years old during another hospitalization when a respiratory therapist sat down with me and explained to me what was happening within my lungs. It was eye opening and gave me the tools to better manage my disease. It was life AARC Times April

2 changing. Asthma is a family disease and lasts a lifetime. We, as RTs, should take every opportunity to educate our patients and their families on how to control asthma. After visiting with parents/students about asthma education, there is nothing more heartwarming than when they share with me the same experience I personally experienced as a teenager. It is amazing how the asthma education provided can impact their outlook and quality of life. We may feel it is only basic information, or we may assume the physician has covered it; but we, as RTs, must realize the power and self assurance we can give to a parent of an asthmatic who feels overwhelmed and helpless or a child who feels different and left out. The RT s asthma education provides families with tools and understanding they can use to advocate for themselves or their family member, and it shows them they are not alone in trying to manage their child s asthma. We are there to raise their expectations and help them realize that asthma can be controlled and that they should be able to lead normal lives. The superintendent of the NEISD received this from a parent who made contact with me when she was concerned about sending her asthmatic child to school. I am just delighted to see the interest that NEISD has taken in asthma awareness. I have a daughter who will be starting kindergarten next year. She has asthma, and I have been concerned about the classroom air environment and also whether she could be cared for sufficiently while she was in school. After my fourth grade son brought home the flyer Diane Rhodes distributed, my fears were somewhat relieved. I then called Ms. Rhodes and spoke to her and my fears were Diane Rhodes directs asthma education at the North East Independent School District in San Antonio, TX. even further relieved. My daughter s consistent attendance at school is important to her being able to learn. Providing an environment that helps prevent asthma attacks makes consistent attendance more possible. Thank you for this proactive measure that is so important to the many families who deal with asthmatic children. It is greatly appreciated. Mary C. Haskin, Photographer AANMA To Launch New Initiative on Asthma Awareness Day Capitol Hill has long been an annual event spearheaded by the Allergy & Asthma Network/Mothers of Asthmatics (AANMA). This year the organization is launching a new initiative called the Great American Asthma Challenge (GAAC) to mark the event on May 4. GAAC is a program in which patients, health care providers, and policymakers come together with the common purpose of eliminating asthma deaths and suffering through a variety of educational and awareness activities that take place at home and school, and in the community, workplace, and policy arena, says Sandra J. Fusco-Walker, director of patient advocacy at AANMA. Congressional members and state legislators will be asked to sign on in support of the challenge, taking the message back to their constituents. 6 AARC Times April 2010

3 After every asthma blowout event, I have at least one parent specifically find me or other administrators and tell us how thankful they are that someone has offered them education on how to manage the disease, how grateful they are that we, as a public school system, understand their child s needs and that we are working as a team to help their child succeed not only academically but physically. One parent told me, I learned more tonight than I have during all of the doctor visits over the past 13 years. Statements like these are priceless. As schools are under severe funding issues, an RT who gets the ear of someone who makes decisions and implements policy must point out the non-obvious costs associated with asthma and the added revenues the district will receive if asthma education takes place. What is in your asthma program, and why did you choose these components? My whole approach to the asthma awareness activities with the schools follows the National Asthma Education and Prevention Program guidelines framework and its four components awareness, medication, environment, and education. We have 7,000 asthmatics within our school district, so we take those four components and adjust them to address asthma systematically by creating policies and practices, providing education to all of our stakeholders students, staff, parents, and community and creating an asthma-friendly environment within our school setting. Since I cannot see every asthmatic within our district, I have created asthma-friendly classroom policies and practices to try to enhance the level of asthma management understanding among those who have daily direct contact with our asthmatic students. We have registered nurses on all of our 67 traditional campuses. Education and resources are critical to our nursing staff so they can be proactive for our students with asthma. By being more proactive in our day-to-day activities in the clinic, we can catch potential problems before they happen so that the child can reach full academic potential every day. Our four-component model attempts to bring asthma management to all of our stakeholders from a school district s perspective. The model is fluid; we make changes based on data we collect and results we have achieved. The basic objectives reach across different levels, from student and staff activities, to things we do to try to bring the information to parents and the community. For awareness, we try to bring an understanding of asthma prevalence to stakeholders and to assess the need for improved processes. For example, we send an asthma awareness letter to all 63,000 students at the beginning of each school year defining asthma control. Asthma Awareness Day The program is based on the revised Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma from the National Institutes of Health (NIH). AANMA is working with the NIH s National Asthma Control Initiative on this effort. Fusco-Walker urges respiratory therapists nationwide to join the GAAC and encourage their patients and colleagues to take the asthma challenge. For more information call (800) Respiratory therapists will again be a big part of AANMA s asthma day activities. Respiratory therapists are involved every year at Asthma Awareness Day Capitol Hill, says Fusco-Walker. We couldn t do the program without them. RTs are key to determining a patient s disease and helping patients understand their asthma and how to keep it under control. AARC Times April

4 In terms of medication, we have made tools available and created processes to eliminate barriers to adequate medication/health care to improve quality of life. For example, we created an emergency nebulizer protocol and provided each campus with a nebulizer compressor and medication for any asthma student in distress. To address the environment, we have assessed culture and reduced exposure to known environmental risk factors. Our asthma-friendly campus award for schools that take the steps to educate their staff in creating a healthy environment and understanding asthma symptoms is an example. For education, we provide information to all stakeholders and reinforce all other components into daily lifestyle. For instance, our asthma blowout event allows each cluster throughout the district to provide asthma education to our entire community. Have you encountered obstacles to providing asthma education? Initially, many people felt a school district should not get into the specifics of a child s health. They felt that was beyond our scope and was the responsibility of the child s parents and physician. But since public school funding is tied to attendance, and we are held accountable for all children s academic success, a student s health becomes a concern that the district cannot ignore because this disease is responsible for so many missed school days and time out of the classroom. Creating an asthma-friendly environment has created some rather sensitive obstacles, as well. Following up on a child having symptoms requiring frequent trips to the school nurse led us to look closer at the classroom for potential triggers. That invaded the personal space of some of our teachers, who feel the classroom is their domain. When I first began addressing asthma triggers in the classroom, many resisted the thought of removing the live guinea pigs, the popular room fragrances, and the over abundance of stuffed animals in the classroom. But through education and our tips for healthier air quality in the classroom, teachers are more willing because they have begun to understand the reasoning behind it. Teachers love their students and would never knowingly do something to harm them. Following education for staff on asthma symptoms and triggers, they have been more compliant to the changes we have instituted. What also reinforces our efforts is that teachers now observe less coughing, wheezing, sneezing, and sniffles in all their students, not just those with asthma. That buy-in has spread among their teaching peers, and the data we have collected supports the positive impact this policy has made. How have you used the AARC s Peak Performance USA program, which was begun last year? Much of the education that is used in the Peak Performance curriculum is covered in our program, and it would be a valuable tool for districts that don t have any internal asthma policies/practices in place. The AARC allowed me to review the Peak Performance material before it was released, and I found that it covers much of what we have implemented. What can RTs do to get involved with their communities and schools to promote asthma awareness and improve lives? My advice for respiratory therapists is to gather data on asthma prevalence, ER visits, and hospitalizations within the area they are targeting. School attendance is tracked, but the reason for absenteeism is not, so you may not get absenteeism due to asthma data. Any school nurse will tell you her day is filled with asthmarelated issues, yet that is not always communicated to those in power to make decisions. Schools are under severe funding issues, so an RT who gets the ear of someone who makes decisions and implements policy must point out the non-obvious costs associated with asthma as well as the added revenues the district will receive if asthma awareness education takes place. If you are approaching a school district, get acquainted with the Environmental Protection Agency s (EPA s) Tools for Schools program. It will give you valuable information on some of the issues school districts face plus will be a resource of school districts that are already on board and understand the need for improved indoor air quality (IAQ). Now this is key: IAQ and asthma go hand in hand; administrators who may not be familiar with asthma have heard the horror stories of school districts that have experienced an IAQ crisis and the media frenzy that follows. Maintenance and operations funding for school facilities is limited, which can lead to increased IAQ issues, resulting in increased absenteeism of all students, not just those with asthma. By creating an asthma program, you are addressing IAQ at the same time. This is why our program is in the Department of Environmental Health and is organized under the NEISD Division of Operations under Facilities Maintenance and Support Services. bgo to page 73 for more information on Peak Performance USA. 8 AARC Times April 2010

5 So you are suggesting RTs target issues that are important to administrators? Yes. Once a school district realizes what asthma is costing them in terms of average daily attendance and performance measures, it will make more sense to take action and develop an asthma program. For example, with our current state funding system, a school district our size receives $3.4 million in state revenue for each 1% increase in average daily attendance. In our district, 11% of our student population has asthma, with some campuses as high as 16%, and asthma is known as the most frequent reason why students miss school. Put those two together and respiratory therapists can really present a great argument on the need for asthma awareness to someone in an administrative position who can effect change. Since the inception of our program three years ago, NEISD attendance rates have increased and our asthma symptom-related visits to the school nurse have declined. Although difficult to directly measure, academic performance is another important aspect. Asthmatic students whose asthma is not in control will frequently be in the clinic for medication and thus will miss important instructional time and not achieve their true academic potential. Students with uncontrolled asthma may not participate or limit themselves in desired sports or extracurricular activities. All of these increase the chances that a student will feel socially disconnected and therefore be at a higher risk for dropping out and not graduating. What has helped you in your efforts to get involved in asthma awareness and education? The AARC has helped me through education and communication. The AARC s Asthma Educator Course is vital for any respiratory therapist wanting to create, implement, and/or develop an asthma program. It offers a better understanding of the need for asthma education and the barriers asthmatics face and focuses on environmental trigger awareness that RTs need to know. The AARC also has a relationship with the EPA and offers a course on triggers to reinforce that much-needed education. The AARC has been a valuable resource in the formation of the NEISD Asthma Awareness Education Program. Being able to share the program with the respiratory therapy profession through this interview is exciting. By telling my story I am hoping that more RTs will step outside the box and lead implementation programs similar to ours in school districts across our nation. There are still too many children living with uncontrolled asthma and too many parents who don t understand what asthma control really means. It is up to respiratory therapists to educate and not only raise parents expectations but, most importantly, to improve the quality of life of our asthmatic children. From a school district s perspective, that means stopping missed school days and class time due to asthma-related symptoms, which directly affects how a school district is funded and evaluated. It s a win-win for everyone. RESOURCES EPA s Indoor Air Quality Tools for Schools: AARC s Peak Performance USA Program: AARC s Asthma Educator Certification Preparation Course: EPA/ARCF s Asthma Triggers and the Respiratory Therapist: 10 AARC Times April 2010