You must work closely with teachers, the nurse,
administration and other parents to ensure
that your school's policies and practices provide
a safe environment for your child. Schools vary
in the appropriateness of their policies and
commitment to health planning, the physical
conditions in the school building, the accessibility
of a certified school nurse, and the level of
teacher knowledge about asthma.
sections listed below were taken from "Asthma
at School" in Dr. Tom Plaut's Asthma Guide for People
of All Ages. The Asthma Emergency Guides are
single page documents that may be copied without
charge by a school nurse or school district
for posting in the classroom.
Guidelines for Teachers
and School Staff
Legal Aspects of Asthma at
Indoor Air Quality
Health Problems Related
to Indoor Air Quality
Air Quality in Schools
How Asthma-Friendly Is
Individualized Health Plan (IHP)
The Individuals with Disabilities
Education Act (IDEA).
Act (IDEA), Section 504 of the Rehabilitation
Act of 1973
Americans with Disabilities Act
(ADA) of 1990
Typical Sources of Indoor
Emergency Guide for Schools
Emergency Guide for Pre-schools
The Asthma Learning Tool for Teachers
Asthma Education for Childcare and Preschool Staff
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School health professionals have developed a
framework for health planning known as the Individualized
Health Plan (IHP). An IHP is a written
record of a school’s comprehensive health
management plan for meeting a particular child’s
special health needs. Creating an IHP involves
a series of steps to identify those needs, develop
strategies to meet them and provide for scheduled
evaluation of how well the plan is working.
The plan should specifically address the areas
of medication, environmental safeguards, physical
education, teacher and staff planning and emergencies.
Before your child enters school, notify the
administration in writing about her asthma.
Ask your child’s doctor to send a formal
letter including the diagnosis and medicine
needs, and recommending environmental safeguards
and guidelines for exercise and emergencies.
Request a planning meeting with all school staff
who play a role in your child’s well-being.
A school nurse should coordinate the health
management team. Other participating staff might
include the principal or director of student
services, teachers, teacher’s aides and
In this meeting, consider the physician’s
recommendations in the specific context of the
school and the classrooms your child will attend.
Give the school the written authorizations it
will need to carry out your doctor’s instructions
and sign forms allowing designated school staff
to discuss confidential information about your
child with your doctor.
Several resources include sample IHP forms that
can guide your child’s planning team by
helping you ask important questions and providing
a framework for answering them. Consult The
School Nurse’s Source Book of Individualized
Health Care Plans, Serving Students with Special
Health Care Needs, Massachusetts Comprehensive
School Health Manual, and Guidelines for Serving
Students with Special Health Care Needs. In
addition, check with your state’s Department
of Education and Department of Public Health
for guidelines for developing an Individualized
Health Plan. The NHLBI produces “Managing
Asthma: A Guide for Schools,” which offers
guidelines for administrators, teachers, coaches,
and students, although not within the specific
framework of an IHP.
IF THERE IS NO SCHOOL NURSE?
The development and implementation of an asthma
management plan depends heavily upon the school
nurse. However, many districts do not have full-time
nurses, or they have nurses who provide
services to many students, sometimes in different
buildings. Since asthma problems do arise
when no school nurse is available, the school
administration needs to plan for safe delegation
of health tasks. State medical practice acts
regulate procedures for safe delegation. Contact
the school health unit of your state’s
Department of Public Health for a copy of the
regulations that apply to schools. Simply delegating
a health task to an untrained person who is
willing to perform it is not safe.
If you are concerned about inadequate staffing
at your child’s school, make your concerns
known in writing to school administration and
the school board.
POLICY AND STUDENT NEEDS
Your child’s medicine routine is guided
by your Asthma Action Plan. Ask your doctor
to keep the plan as simple as possible and schedule
use of controller medicine outside of school
hours. The school nurse should concentrate on
more essential tasks. Your child may need to
take a quick relief medicine during the school
day to prevent symptoms of exercise induced
asthma or to treat an episode.
According to a ruling by the U.S. Department
of Education, Office of Civil Rights, schools
are responsible for providing students with
reliable access to their prescribed medicines.
“Reliable” in this case means that
the child can quickly, conveniently, and safely
get to his medicine and that school staff is
sufficiently knowledgeable about asthma to care
for the child’s health and safety.
Eliminating and avoiding asthma triggers can
protect the lungs from sources of inflammation
and reduce the amount of medicine needed to
keep asthma under control. Once triggers at
school are identified they can be removed or
exposure to them reduced.
Because schools are complex facilities, you
may want to take an environmental “walk-through”
with school staff to help identify conditions
that are sources of air quality problems. It
is best if known or likely triggers are dealt
with before students encounter them. Because
asthma is provoked and aggravated by environmental
exposure, environmental safeguards should be
written into the asthma management plan (or
Some activities or rooms in the school may cause
special problems for children with asthma. Field
trips may bring a student into contact with
an unexpected trigger. Sometimes a one-time
exposure to an asthma trigger can cause a problem.
When my patient, Robby, was assigned to a study
hall in the wood shop, he told the teacher that
this would cause him to have asthma symptoms.
The teacher didn't believe Robby and
made no change. After he spent one hour in the
wood shop Robby missed seven days of school
due to asthma and associated problems. I had
to double some of his medicines and add an additional
one in order to bring his asthma under control.
I wrote the following letter to the principal
to prevent a repeat incident:
be advised that Robby should not be in the wood
shop, the metal shop, or any other place where
he is likely to be subjected to dirty air. Although
he is only 13, Robby is a good judge of his
condition. If he says he should not take gym,
the school staff should respect that. His mother
and I will follow up to confirm that he’s
not just trying to avoid gym. I look forward
to working together with you to see that Robby
gets the education he needs in an environment
that will be safe for him.”
The planning tools available through the Individualized
Health Plan process would have anticipated the
wood shop problem, avoided placing Robby in
a risky environment, and informed teachers that
Robby was a good judge of his asthma needs.
Robby would have stayed healthy and continued
his learning without interruption.
FOR TEACHERS AND SCHOOL STAFF
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Your child’s teachers may have little
or no experience with asthma. The Individualized
Health Plan offers an opportunity to provide
guidelines and training for them. Using the
booklet, One Minute Asthma: What You Need to
Know, they can learn the basics of asthma and
the medicines used to treat it in about thirty
minutes. Make this resource a part of staff training and
include it in your child’s asthma management
plan. Teachers who have learned about asthma
will plan classroom activities and choose materials
so every child can participate safely.
Part of the documentation you and your child’s
doctor provide to the school should include
guidelines for avoiding exposure to asthma triggers.
Teachers can integrate these guidelines into
their lesson planning. For example, they will
know to avoid bringing a guinea pig or rabbit
into the classroom because it can provoke inflammation
and asthma symptoms. They will know to provide
alternative recess activities during cold weather
or pollen season. Teachers also need guidelines
to plan field trips and other activities outside
the school building and instruction in how to
handle asthma-related emergencies that occur
outside of school. Good planning and communication
help put teachers in an informed and comfortable
position, able to consider the needs of all
Some materials used in classroom activities
are not healthy for any student. The Artist’s
Complete Health and Safety Guide discusses classroom
hazards created by the use of some art products
and identifies safe school supplies. Although
the book focuses on products used in art classrooms,
many of the same products are used in regular
classrooms as well.
Does your child’s school use pesticides?
When are they applied? Are physical education
and other teachers informed? Do students use
areas that have been sprayed recently? Are applications
on school grounds clearly posted? Are parents
notified about pesticide applications? What
is the school policy about using pesticides
inside the school to control mold, insects,
Pesticides present special health hazards for
children, whose small body sizes make them more
vulnerable to toxic chemicals and whose activities
may bring them into closer contact with areas
where pesticides are used. Classrooms are often
treated with pesticides, and playgrounds and
sports fields may be treated with chemicals
(including turf treatments like insecticides,
fertilizer, lime, and other supplements) which
can irritate the lungs. Integrated Pest Management
(IPM) is an approach to building and landscape
management that corrects and prevents conditions
where pests can thrive. These practices can
greatly reduce the need for chemicals, protect
student and staff health, and often save money.
Having students with asthma in a class offers
a learning opportunity for everyone. These children
are learning life skills that are important
to all students: self-monitoring, communicating
their needs and taking medicines safely. Health
management skills are part of many comprehensive
health curricula. In addition, learning about
the lungs, triggers, and the asthma reaction
is well-suited to a health curriculum and can
be integrated into many subjects.
The National Heart, Lung and Blood Institute
has produced an asthma curriculum, Asthma Awareness,
for elementary students, and a short video for
school staff (kindergarten through eighth grade),
Making A Difference: Asthma Management in the
Students whose asthma is well controlled will
miss no more than one day of school due to asthma
EDUCATION AND EXERCISE
The goal of physical education is to help students
build skills for lifelong fitness and health.
Exercise commonly triggers asthma symptoms,
but students with asthma should not avoid it.
Physical education teachers may unnecessarily
limit students with asthma, or they may push
them too hard and thereby put them at risk for
an asthma episode. Well-informed and thoughtful
teachers can help these students perform at
their best and gain confidence about physical
Good communication and planning can help your
child have a positive and safe experience during
physical education class. The pamphlet Asthma
& Physical Activity in the School: Making
A Difference, developed by the NHLBI, provides
an excellent framework for this planning. Its
“Safety Guidelines for Physical Education
Teachers” state that safe physical activity
activities that match a student’s changing
asthma status and take into account environmental
conditions (outdoor temperature, presence of
• proper use of medicines before exercise,
• prompt use of quick relief medicines
• reliable access to medicines during
A physical education teacher can adjust the
type, pace, or intensity of an activity when
a student’s peak flow scores drop, symptoms
are present, or the student expresses a need
for reduced activity. Because exercise is a
common trigger for people with asthma, physical
education teachers and peers need to be able
to recognize the early signs of an asthma episode
and know what action to take. Students whose
asthma is under excellent control should also
be able to play any sport they choose.
A School Emergency Guide should be in place
as part of the school’s overall asthma
management plan or IHP. The plan should define
emergency situations and outline sequential
action steps to be taken by designated staff
members. Anyone who is responsible for your
child during the school day needs instruction
in how to identify an asthma emergency.
A peak flow score that is stuck in the child’s
red zone is an emergency. “Stuck”
means that the peak flow score fails to improve
into the low yellow zone within ten minutes
after the child inhales 4 puffs of a quick relief
medicine. Once the nurse or staff delegate determines
that the child is stuck in the red zone, the
child must be taken to a medical facility (emergency
room or doctor’s office) without delay.
extreme asthma emergency exists if a child can
barely move the marker on the peak flow meter
or if he shows any one of the following signs:
gray or bluish lips or fingernails
• difficulty talking or walking
• difficulty breathing, with any of the
- chest and neck skin pulled in (retractions)
- breathing hunched over
- struggling to breathe
the case of an extreme emergency, the child
must be transferred to medical care within minutes.
Teachers and school staff must be able to identify
an emergency and know that it calls for immediate
action. A good emergency plan will apply to
all children with asthma and specify exactly
what a teacher should do and who is responsible
for carrying out each step of getting your child
to medical care. The specific emergency plan
itself will depend on the child’s situation,
the school, the personnel, the rescue service
available, and many other factors.
are some questions to consider as you work with
the school to develop the steps in an emergency
Who gives medicine if a nurse is not available?
• Where are medicines kept?
• How do teachers and staff communicate
with the nurse, principal, and people outside
• Are teachers and other staff authorized
to call for emergency service?
• What is the emergency phone procedure?
• Do staff members who may be responsible
for your child all have a copy of the emergency
plan and understand it?
• Do teachers and other staff know the
signs of an asthma emergency?
• Where is the emergency plan posted?
• How should staff deal with emergencies
that happen outside the classroom?
• How is a substitute teacher informed
of the plan?
• Has the staff rehearsed a health emergency?
• Does the rescue team include an emergency
medical technician (EMT)? Can team members administer
oxygen and albuterol? How close are they? What
happens if they are unavailable?
• If the student goes to the hospital
in an ambulance, who accompanies the child?
• What are the procedures for contacting
parents? What is done if parents cannot be reached?
ASPECTS OF ASTHMA AT SCHOOL
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The rights of students with disabilities are
defined under three federal laws: the Individuals
with Disabilities Education Act (IDEA), Section
504 of the Rehabilitation Act of 1973, and the
Americans with Disabilities Act (ADA) of 1990,
as well as state statues and regulations. Federal
rulings on specific cases continue to clarify
what these laws mean for students with asthma.
Your child does not have to be classified as
“special needs” to qualify for accommodation
or special planning, such as an Individualized
The three sections that follow were taken from
the works of Ellie Goldberg, M. Ed., an educational
rights specialist. (see “Resource Section).
SCHOOL’S DUTY TO CARE
Schools have a “duty to care” that
is shared by all staff members. This duty arises
because students are required to be at school,
away from their usual sources of protection
(parents). Schools have a duty to exercise “special
care” for students known to have physical
handicaps, injuries, or impairments. This duty
may require administering medication, monitoring
health status, providing specialized staffing
or training to teachers, and protecting students
from emotional distress caused by teasing, neglect,
or abuse. Parents cannot waive a child’s
right to proper care nor release a school from
its obligation to protect a student from harm.
When efforts to work with school officials do
not result in appropriate cooperation and supports
for your child, you should exercise your due
process rights. Federal laws require states
to establish a system for working out parent-school
disagreements, such as arbitration, mediation,
and/or a hearing process. Both IDEA and Section
504 oblige schools to inform parents how to
file complaints and seek remedies when they
disagree with a school’s decisions or
Every school system should have a “parents’
rights” document explaining its problem-resolution
process and naming the person to contact to
officially request consideration for a child’s
needs or to remedy a situation. If your school
handbook or school office does not supply this
information, call the district’s director
of pupil services, director of special education,
or Section 504 coordinator. If you cannot find
the appropriate official, call your state’s
Department of Education.
ARE CONCERNED ABOUT LIABILITY
Schools sometimes assume that informal arrangements
reduce their liability better than clear written
documents that describe procedures, roles, and
responsibilities. Many schools do not document
accidents, injuries, and medication administration,
mistakenly thinking that writing things down
somehow exposes staff to liability that they
might otherwise avoid. In fact, a school’s
best protection against liability is having
an ongoing risk-management process that carefully
records assigned tasks, responsible parties,
and ensures that proper procedures are followed.
An accurate reporting system is essential to
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The U.S. Environmental Protection Agency has
ranked indoor air pollution among the top five
environmental health risks. (see Typical Sources
of Indoor Air Pollution) Inadequate ventilation
and poor maintenance can make the inside of
buildings two to five times more polluted than
the outdoors. Poor air quality in school can
cause a wide range of health problems for occupants,
especially for people with asthma.
People who have not been affected previously
by allergies or asthma may become sensitized
by repeated exposure to a substance or even
by a single exposure. To avoid this problem
you can create an indoor air quality team that
works to promote safe practices, good maintenance,
and control of pollutant sources, and promptly
reports health symptoms, poor conditions, or
hazards. Keeping in-house records of the nature,
location, and timing of health symptoms in the
school is a reliable and inexpensive way to
identify air quality problems.
Construction and remodeling can be major sources
of pollution. The work area must be walled off
physically and air from the site vented out
of the building.
This section discusses the basics of indoor
air quality so you can identify potential or
existing problems and work to resolve them.
The U.S. Environmental Protection Agency recommends
measurement of air temperature, relative humidity,
air movement, and volume of airflow. Schools
should have the basic equipment for measuring
these parameters as well as carbon dioxide.
This information is more useful than sampling
for specific pollutants, and cost much less.
PROBLEMS RELATED TO INDOOR AIR QUALITY
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For a student or school staff member with asthma,
poor air quality can cause an increase in the
frequency or intensity of asthma symptoms. A
school occupant who does not have asthma may
experience problems as well. However, people
often do not recognize that their symptoms are
caused by something in the air. When only a
few individuals are affected, their symptoms
may not be taken seriously. Even when symptoms
are widespread, they may be nonspecific and
not easily linked to poor air quality. Symptoms
commonly associated with poor indoor air quality
coughing and shortness of breath
• sinus congestion and sneezing
• eye, nose, throat, and skin irritation
• headache, dizziness, nausea, and fatigue
related to air quality often begin or intensify
after a person has entered the school building
and diminish or disappear entirely in the evening,
over weekends, or during school vacations. A
peak flow diary often can reveal a pattern that
identifies a trigger in the school as the cause.
A mother brought her son to see me because he
coughed every day he went to school, yet he
was fine over the weekend. She thought he was
allergic to the gerbil in his second grade classroom
but had been unable to convince the teacher
of this. I suggested that she check his peak
flow Monday morning at the school door and then
after an hour of class. His peak flow dropped
thirty percent, proving that she was right.
Once the gerbil was removed from the room her
son’s cough disappeared.
School-wide data collection of symptoms is an
excellent way to track down indoor contaminants
and ventilation problems. A health log should
record the nature, time, and location of health
symptoms. These records may reveal certain types
of symptoms that are typically caused by specific
contaminants. The pattern of symptoms in a building
can identify particular areas or activities
for closer investigation. For example, when
health complaints are clumped in one or two
classrooms, the office area, or the gym, the
air handling system and activities in these
areas may be at fault.
When I was on the Board of health in Amherst
Massachusetts, teachers and students complained
of respiratory and other health problems. The
teachers had logged their complaints in the
principal’s office over a period of months.
When we mapped these complaints on a floor plan
of the building we found that they were concentrated
in four areas. A walk-through inspection identified
the cause of the problem in each area: a large
classroom had been divided into four rooms,
depriving three of them of proper circulation,
a univent air handling device had been turned
off to conserve heat, air filters were clogged
and a fan belt was inoperative.
INDOOR AIR QUALITY IN SCHOOLS
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The air quality inside a school building is
the result of interactions among many factors:
the site and climate, building structures and
construction techniques (including any modifications),
the mechanical systems in place to handle ventilation,
and the activities of the occupants who may
introduce pollutants. Good indoor air quality
management requires control of pollution sources,
introduction and circulation of sufficient outdoor
air, and maintenance of an acceptable temperature
Understanding these components is a challenging
task. However, you and other concerned parents,
staff, students, and administrators can learn
what you need to know to participate in indoor
air quality management and promote responsible
practices. The U.S. Environmental Protection
Agency has produced two excellent resources
to help you: Building Air Quality: A Guide for
Building Owners and Facility Managers and Indoor
Air Quality: Tools for Schools. These documents
are essential guides for learning about air
quality, creating a proactive management team,
and dealing with problems that arise. The information
below is taken largely from these documents.
AIR HANDLING SYSTEMS
The Heating, Ventilating and Air Conditioning
(HVAC) system in a school includes boilers,
furnaces, chillers, cooling towers, air handling
units, exhaust fans, ductwork, and filters.
If it is well designed and maintained and functioning
properly, the system should control temperature
and relative humidity in the building, distribute
adequate amounts of outdoor air, and isolate
and remove indoor pollutants through air pressure
control, filtration, and exhaust fans.
However, the HVAC system in your child’s
school may not have been designed to perform
all these functions, or lack of maintenance
may have compromised its effectiveness. Depending
on a building’s age, design, modifications,
changes in use, and quality of maintenance,
the system may not perform its job to acceptable
Ventilation rates specified by building codes
may have been much lower at the time your child’s
school was constructed than they are now. The
energy crisis of the 1970s encouraged tight
construction with low air exchange rates to
reduce heating costs. The American Society of
Heating, Refrigerating, and Air-Conditioning
Engineers (ASHRAE) sets air exchange standards
that are the basis for most building ventilation
codes. The 1989 standard (Standard 62-1989)
calls for the introduction of 15 to 20 cubic
feet of fresh air per minute (CFM) for each
person in an area served by the ventilation
system. Many schools were constructed at a time
when standards called for only 5 CFM, far lower
than the present recommendation.
School personnel often impair the operation
of the HVAC system. In a carefully engineered
system, opening a window will improve conditions
in one room but, by changing air pressure relationships,
may impair ventilation throughout the rest of
Current ventilation standards (15 to 20 CFM)
are not adequate for spaces with certain kinds
of indoor contaminants. Toxic airborne substances
must be exhausted to the outside directly from
the source. For example, a metal shop should
have a local exhaust system in place to vent
welding fumes away from students, out of the
building, away from air-intake areas. The same
applies to construction or remodeling work being
done to the school building.
Unfortunately, not all harmful materials are
easy to recognize as toxic airborne contaminants.
Schools are filled with materials, furnishings,
supplies, and activities that can create airborne
hazards. Students or staff with asthma are particularly
sensitive to these inhaled triggers and may
become more sensitive if the exposure continues.
Although individual concentrations of specific
contaminants may be low, the combined effect
of multiple pollutants may be much greater due
to interactions among them. Therefore, achieving
and maintaining good indoor air quality requires
your school to remove sources of indoor contaminants
from construction, furnishings, cleaning, and
daily activities. No ventilation system is as
effective as avoiding the hazard in the first
SOURCES OF INDOOR POLLUTION
Many potential sources of indoor air pollution
exist in a school. Some Typical Sources of Indoor
Air Pollutants include exhaust from idling buses
and cars. I will discuss several categories
of contaminants here and refer you to the resources
mentioned previously. Manufacturer’s Safety
Data Sheets (MSDSs) for individual products
provide safety information and should be available
from your school’s vendors. A committee
of parents, staff, and other concerned citizens
can establish purchasing criteria for all supplies
and materials used by the school district. This
committee, or an indoor air quality team, can
also make sure that storage, handling, use,
and disposal conform with manufacturer recommendations.
Good housekeeping is part of good maintenance.
Regular and thorough cleaning of the school
reduces the amount of dust and other particles
that can become airborne. In addition to causing
trouble for people with asthma, dust, lint,
and other particles can clog filters in the
air-handling system and decrease their effectiveness.
Schools can improve house cleaning by damp dusting,
using high-efficiency vacuum cleaners, upgrading
filters in ventilation systems, and changing
filters frequently. Carpeting poses special
difficulty, as it is a breeding ground for dust
mites, mold, and bacteria. It usually harbors
dust, moisture, allergens or irritants.
To avoid creating health problems, schools should
not have carpeting at all. However, if your
child’s school does have carpeting, daily
vacuuming using double-thickness vacuum bags
can remove allergens and irritants without exhausting
them into the air. Removal of carpeting can
provide a safer school environment in the long
term, but removal itself may be hazardous. It
should be done under strict guidelines for contaminant
control. After carpet is removed, be alert to
the need for more frequent air filter changes
to keep small particles, previously trapped
in the carpet, out of circulation.
Cleaning can introduce a range of chemical products
into the school that may be sources of indoor
air pollution. Solvent-based cleaners are hazardous.
Fumes and vapors remain in the building long
after cleaning is complete and may be present
during after-hours activities.
Find out what materials are used for cleaning
and how they are stored in your child’s
school. You should have access to labels and
Manufacturer’s Safety Data Sheets (MSDSs)
for these materials. Select materials carefully
and be aware that “natural” or “nontoxic”
materials are not necessarily safe. Judge them
by the same criteria you develop for any cleaning
material. Some preliminary recommendations include:
Avoid solvents and volatile organic compounds
• Find out about inert ingredients that
are not fully disclosed on package labels; though
“inert,” these chemicals may pollute
• Avoid vinyl, products with formaldehyde,
and other products that off-gas.
• Remember that “environmentally
friendly” does not mean that a product
is safe for people.
states and organizations are developing purchasing
guidelines based on human health and environmental
A volatile organic chemical is any carbon-containing
substance that becomes airborne when it is used
or that off-gasses from a product over time.
Such products and substances include paint,
cleaners, glues, varnishes, pesticides, formaldehyde,
laminators, copier toners, and chemicals used
in science, industrial arts, welding, auto shop,
or other vocational classes. Any area that uses
volatile chemicals routinely, such as a science
lab or art room, should have a special ventilation
system that keeps fumes out of a student’s
breathing zone. Depending on the material, exhaust
fans or local exhaust hoods may be necessary.
Formaldehyde, a colorless gas and volatile organic
compound, is released from many building products
(like plywood or particleboard), wood furniture,
carpeting, and some consumer products. This
gas has a pungent odor, irritates the lining
of the nose and respiratory tract, is considered
a sensitizer, and can cause cancer. Find out
if formaldehyde is present in construction materials,
new furnishings, computers, and other products
the school wants to purchase.
Carbon dioxide is not itself a toxic gas, although
a concentration of 15,000 ppm does cause symptoms
of asphyxia including reduced mental acuity.
Carbon dioxide is a natural byproduct of human
metabolism, so the concentration of carbon dioxide
in a room is one indicator of how well the ventilation
is working. The ASHRAE standards recommend 1,000
ppm as the upper limit of carbon dioxide for
comfort reasons. An elevated level indicates
that ventilation is inadequate or that there
is contamination from a furnace, vehicle, or
other combustion source.
Biological sources of indoor pollution include
bacteria, fungi (mold or mildew), pollens, insect
parts, and other allergens. Harmful bacteria
and fungi flourish in warm, moist environments,
such as damp carpets, moist insulation, or leaky
roofs and walls. Contaminants that grow in the
ducts, cooling pans, or other air-handling system
components can be circulated throughout the
building. Outdoor pollen and allergens can also
be drawn in through open windows and doors.
Second-hand tobacco smoke, also called environmental
tobacco smoke is a common trigger of asthma
symptoms. Even in people who do not have asthma,
it can cause irritation of the eyes, nose, throat
and lungs. Secondhand smoke has been strongly
implicated in thousands of cancer deaths each
year. People who are chronically exposed to
secondary smoke are at increased risk of developing
asthma and experience greater severity of asthma
problems. Many communities have banned smoking
in school buildings and on school grounds. Effective
implementation of this policy protects the health
of all school occupants, especially students
and staff with asthma.
RENOVATION AND REPAIR
Construction creates dust from all kinds of
materials, ranging from irritants to known carcinogens.
In addition, glues, varnish, stripping chemicals
and cleaners used in construction present potential
health hazards. These contaminants can provoke
airway inflammation and symptoms in an individual
with asthma who is sensitive to them, and can
sensitize individuals who were not previously
affected. Any construction, repair or renovation
work done to the school must be sealed off and
vented outside and away from the renovation
site. If students or staff can see dust in spaces
they are using, it means that they are being
exposed to small particles that can be inhaled
into the lungs. Demolition, renovation, and
new construction are hazardous activities and
should be handled as such.
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You can work with your child’s school
to promote policies and practices that make
it a safe and healthy environment for all children.
As a concerned parent, you share many goals
with other parents and school staff. Seek out
your allies; you can’t do the job alone.
Build a team approach that deals with problems
throughout the school, not only in your child’s
classroom. No student should be denied medicine
because the school administration has not worked
out a responsive and responsible policy. No
student should have to take extra medicine because
a building is poorly ventilated.
is Your School?
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1. Is your school free of tobacco smoke all
of the time, including during “after-hours”
2. Does the school maintain good indoor air
quality? Does it reduce or eliminate allergens
and irritants that can make asthma worse?
3. Is there a school nurse in your school all
day, every day? If not, is a nurse regularly
available to the school to help write plans
and give students with asthma guidance about
medicines, physical education, and field trips?
4. May children take medicines at school as
recommended by their doctor and parents? May
children carry their own asthma medicines?
5. Does your school have an emergency plan for
taking care of a child with a severe asthma
episode? Does it state clearly what to do? Whom
to call? When to call?
6. Does someone teach school staff about asthma,
asthma management plans, and asthma medicines?
Does someone teach all students about asthma
and how to help a classmate who has it?
7. Do students with asthma have good options
for fully and safely participating in physical
education class and recess? (For example, do
students have access to their medicines before
exercise? Can they choose modified or alternate
activities when medically necessary?)
the answer to any question is no, a student
may be facing obstacles to asthma control. Asthma
that is out of control can hinder a student’s
attendance, participation, and learning. Contact
the organizations in the Resource Section for
information about asthma and for ideas to help
make school policies and practices more asthma-friendly.
Federal and state laws exist to help children
Adapted from the National Heart, Lung and Blood
Institute, National Asthma Education and Prevention
Individualized Health Plan (IHP) provides for:
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• opportunities for collaborative planning
and problem-solving among staff and parents.
• timely and convenient access to medication
at all times.
• the achievement of personal fitness
goals and safe participation in physical education
and sports, field trips, and other special events.
• environmental controls and safeguards
(maintaining air quality, eliminating irritants,
allergens, pesticides, and other toxic hazards).
• coordination of physical, social, emotional,
and academic goals.
• staff training and peer sensitization.
• academic and social continuity during
periods of disrupted attendance.
• individualized crisis and emergency
The asthma plan for your child should include
instructions that define the situations when
modification of exercise is necessary. This
will avoid the need for your child to negotiate
with the physical education teacher.
Goldberg, E., “Individual Health Plans:
A Strategy for Achieving Educational Equity,”
laws protecting students with disabilities
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The Individuals with Disabilities Education
Act (IDEA). Students are eligible for special
education services if they have one or more
of thirteen disabling conditions. An individual
education plan (IEP) is designed for each student
by an IEP team in which parents and school staff
are equal partners in the process of identifying
the student’s needs and the school’s
options for meeting those needs. The IEP describes
the student’s learning objectives, and
the instructional strategies and related services
the school will provide to ensure that the student
receives a free and appropriate public education
in the least restrictive environment. A student
eligible for services under IDEA is also protected
by Section 504 (below). However, not every student
covered by Section 504 is eligible under IDEA.
504 of the Rehabilitation Act of 1973
is a civil rights law that prohibits discrimination
against individuals with disabilities in education
or employment programs that receive federal
funds. Schools are required to modify programs,
policies or practices and provide related aids
and services for any student who has a physical
or mental impairment that limits one or more
of the student’s major life activities,
such as breathing. This is a “functional”
definition of disability, as compared with the
“categorical” definition under IDEA.
A “504 plan” serves to remove barriers
to a student’s meaningful access to academic
and non-academic programs or extracurricular
activities. Asthma may be covered under Section
504 but is not typically covered under IDEA.
Americans with Disabilities
Act (ADA) incorporates and extends
the rights and responsibilities of Section 504
to include public services and places of public
accommodation, such as preschools, day care
centers, and private schools.
Adapted from Goldberg, E., “Integrating
Students with Chronic Illness,” 1996.
Sources of Indoor Air Pollutants
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• Polluted Outdoor Air: pollen, dust,
fungal spores, industrial emissions, emissions
from school buses and other vehicles.
• Nearby Sources: loading docks, odors
from dumpsters, unsanitary debris, building
exhausts near outdoor air intakes
• Underground Sources: radon, pesticides,
leakage from underground storage tanks
• HVAC Equipment: microbe growth in drip
pans, ductwork, coils, and humidifiers; improper
venting of combustion products; dust or debris
• Non-HVAC Equipment: emissions from office
equipment (volatile organic compounds, ozone);
emissions from shops, labs, cleaning processes
• Components: microbe growth on soiled
or water-damaged materials, dry traps that allow
the passage of sewer gas, materials containing
volatile organic compounds, or damaged asbestos
materials that produce particles (dust)
• Furnishings: emissions from new furnishings
and floorings, microbe growth on or in soiled
or water-damaged furnishings
Other Indoor Sources
• Science laboratories; vocational arts
areas; copy/print areas; food prep areas; smoking
lounges; cleaning materials; emissions from
trash; pesticides; odors; volatile organic compounds
from paint, caulk, and adhesives; occupants
with communicable diseases; dry-erase markers
and similar pens; insects and other pests; personal
Adapted from United States Environmental Protection
Agency, Indoor Air Quality: Tools for Schools,