New York State Center for School Health / …



NYSCSH Resource Toolkit for Asthma Management?during?COVID-19Students with asthma are protected by the Americans with Disabilities Act and should be provided with accommodations necessary in order for them to fully participate in school. Educating students and families on proper asthma management (e.g. proper use of controller medications and avoiding asthma triggers etc.) can help reduce the need for rescue asthma medication. A student may need a bronchodilator treatment before being sent home or before an ambulance arrives. While?it is uncertain whether aerosols generated by nebulizer treatments are potentially infectious1?, during this COVID-19 pandemic, nebulizer treatments at school should be reserved for those who cannot use an inhaler (with or without spacer or face mask).?Based on limited data, use of asthma inhalers (with or without spacers or face masks) is not considered to be an aerosol-generating procedure.?The CDC, professional health organizations such as the American Lung Association (ALA), Allergy and Asthma Network, and the Asthma and Allergy Foundation (AAFA) recommend that?asthma treatments using inhalers with spacers?(with or without face mask,?according to each student’s individualized treatment plan) are preferred over nebulizer treatments whenever possible.According to the CDC, the COVID-19 pandemic has caused PPE shortages. The CDC’s strategies to optimize personal protective equipment (PPE) can help schools determine requirements. Schools should obtain and provide the appropriate personal protective equipment (PPE) for staff. The CDC webpage on?Using Personal Protective Equipment (PPE) provides resources on when to use PPE, what PPE is necessary, how to store, don, doff, and dispose of used PPE. The CDC recommends the following PPE when administering Aerosol Generating Procedures (AGP): Gloves; N95 or surgical facemask; In lieu of N95 - a surgical mask with face shield; Eye protection; and; gown (if necessary). The NYSED Re-Opening Guidance states that treatments such as nebulized medication treatments and oral or tracheostomy suctioning should be conducted in a room separate from others with nursing personnel wearing appropriate PPE. The number of people present in the room should be limited to the student and the staff member administering the treatment. If appropriate based on the student’s age and level of maturity, the staff member could leave the room and return when the nebulizer treatment is finished. After the nebulizer treatment the room should undergo routine cleaning and disinfection between uses. Cleaning of the equipment should be done following manufacturer’s instructions after each use. Resources on how to clean and disinfect?and?prevent asthma attacks triggered by cleaning and disinfecting?activities are provided in the resources below.?It is highly recommended every nurse watch the NYSCSH?Asthma Management in Schools webinar which provides information on asthma medication including the use of valved holding chambers. The NYS Center for School Health (NYSCSH) , in collaboration with the NYSED Student Support Services?has created resources to educate staff, families, and students on safe management and administration of asthma medications during COVID-19.?The resources may be customized for your needs with review and approval of the School Medical Director. ??6134100793751?Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J (2012) Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review.?PLoS?ONE 7(4)??5 Centers for Disease Control and Prevention- Healthcare Infection Prevention and Control FAQs for COVID-19 Accessed 6/20/2020. This resource is available on the NYS Center for School Health Website at 9/2020NYSCSH Sample Letter to Families about Metered Dose Inhalers, Spacers and Nebulizers Dear Parents and Guardians,Our records show that your student has a previous or current order for a nebulizer treatment related to their asthma. Due to the COVID-19 pandemic, the CDC recommends students use a metered dose inhaler (MDI) also called an inhaler of puffer with a spacer or valved holding chamber instead of a nebulizer for asthma treatments if possible. This is because they don’t know if using a nebulizer can spread the virus.For this school year, we are asking families to talk with their health care providers about using a rescue inhaler with a valved-holding chamber or spacer instead of using a nebulizer. A spacer is not needed if your child uses a dry powder inhaler.Asthma spacers and valved-holding chambers make it easier to take asthma medication from an inhaler. They help the medicine get into the lungs, with less medicine ending up in the mouth and throat. We strongly recommend students also have a written Asthma Action Plan that gives us direction on which medicines your child takes and how to take care of their symptoms. I have attached an Asthma Action Plan for your child’s healthcare provider to fill out.Here is a list of what to ask your child’s healthcare provider for this school year to help us take care of your child’s asthma at school.An up to date written Asthma Action PlanA rescue inhaler for school A spacer or valved holding chamber for school. Check with your healthcare provider or insurance company to make sure they will pay for two devices: one for home and one for school.Please contact us if you need more information or help.Contact Name:Contact Phone:Contact Email:This resource is available on the NYS Center for School Health Website at 9/2020School District LetterheadProvider and Parent/Guardian Permission for Use of School Provided Spacer/Valved-Holding Chamber to Deliver Asthma Medications at School/School Sponsored EventsAsthma spacers and valved-holding chambers make it easier to take asthma medication from an MDI (metered dose inhaler) also called an inhaler or puffer. They help the medicine get into the lungs, with less medicine ending up in the mouth and throat. If your child’s spacer/valved-holding chamber is not available, our school would like to provide one for use at school and school events. Please provide healthcare provider and your permission to allow the school to provide a spacer/valved-holding chamber for your child. Please have your health-care provider sign this form.The school supplied type of ? spacer or ? valved-holding chamber is ___________________________.To Be Completed By Parent/GuardianStudent Name: __________ _________________ DOB: ___________________ Grade: _____ Teacher/HR: _______________________________ School: ________________________ Parent/Guardian Name: _________________________________________ Date: _____________________Signature: _________________________________________ Phone: ____________________________ I allow my child to use the school provided spacer/valved- holding chamber listed above when using their asthma medication prescribed by their healthcare provider.To be completed by Health Care Provider- Valid for 1 Year4262327829900The above-named student may use the school provided STAMP Spacer/Valved-holding chamber listed above when using their prescribed asthma MDI at school and school sponsored events. ____________________________________ ________________ Name/Title of Prescriber (Please Print) Date ____________________________________ ________________ Prescriber’s Signature Phone Return to: School Nurse: _________________________________ School: __________________________________School Address: ________________________________________________________________________Phone: ( ) _______________________________ Fax: ( ) ______________________________ Email _______________________________________________________This sample resource is located at the NYS Center for School Health at 9/2020Sample Medication Delivery Information for ParentsDear Parent or Guardian,Date: __________Health care provider and parent permission is needed for both prescription and over the counter (OTC) medications used at school or school-sponsored activities. Please bring medications in their original labeled prescription or over the counter bottles/packaging, Medication forms are available on our district web site [link] or may be obtained from the School Health Office. Self-Carry and Use of MedicationsIf your child’s healthcare provider decides your child can carry and use their diabetes, asthma, or epinephrine auto-injector medication independently they must put in writing (attest) that your child can do so safely. Your permission is also required. We can provide the attestation form upon request.Asthma MedicinesIf your child uses a nebulizer, please ask your healthcare provider about ordering metered-dose inhaler (MDI) and a valved-holding chamber (spacer) which helps all the asthma medicine get into the lungs for use at school. For many people MDI’s and valved-holding chambers work as well as nebulizers and are portable for use wherever a student needs them. For children under age 5 years, a mask can be attached to help the child use the spacer or chamber correctly. Collapsible models are available and may be easier to fit and carry in a handbag or backpack.[Optional: Remove If Your District Does Not Supply a Back-Up Valved-Holding Chamber] Your child’s health care provider may allow the school to supply a valved-holding chamber in the event the one you supply is not available by completing the attached form.Emergency Care Plans and Asthma Action Plans (ECP’s) Emergency Care Plans help school staff safely care for your children. If your health care provider writes medication orders for life-threatening allergies, asthma, and seizure disorders on the ECP a separate medication form is not needed.Medication Drop OffAn adult should bring the medications to school unless your student has a health care provider attestation to carry and use their medication independently. If you need to make special arrangements to drop off medication, please call the school health office.Thank you in advance for your cooperation.Return to: School Nurse: _________________________________ School: __________________________________School Address: ________________________________________________________________________Phone: ( ) _______________________________ Fax: ( ) ______________________________ Email _______________________________________________________This sample resource is located at the NYS Center for School Health at 9/2020AAFA: IS IT COVID-19, THE FLU, A COLD, ALLERGIES or Asthma?611505084455Permission for use of this chart was provided by Asthma and Allergy Foundation of America.This chart is part of the AAFA COVID-19 Asthma Toolkit for Schools. It is also available in SpanishThis resource is available on the NYS Center for School Health Website at 9/2020Allergy & Asthma: Asthma Care at School Post COVID-19 Outbreak61626753907790Permission for use of this chart was provided by Allergy and Asthma Network. This chart is part of the Allergy and Asthma Network COVID-19 Asthma Toolkit for Schools. This resource is available on the NYS Center for School Health Website at 9/2020NYSCSH Website Resources for School Nurses and FamiliesAllergy & Asthma Network provides education, advocacy, and resources for schools and families. They have added resources specific to COVID and managing asthma, which includes webinars and downloadable posters. American Academy of Allergy, Asthma & Immunology (AAAAI) is composed of?allergist/immunologists, other medical specialists and allied health healthcare professionals?dedicated to the practice of allergy, asthma, and immunology. They have specific resources related to COVID-19.American Association for Respiratory Care Guide to Aerosol Delivery Devices 4th Edition?This guide contains information on?different aerosol delivery technologies and aerosol. (2017) American Lung Association provides resources for students, families, and schools including Asthma Basics, Asthma Medication in Schools, Back to School with Asthma, letters to health care providers and Parents you suggested regarding medications (MDIs with spacers vs Nebs) and follow up technical assistance regarding Stock Medication programs (and the ALA’s Model Policy).American Lung Association- How to use a metered dose asthma inhaler with a spacer or valved holding chamber (video 1:18 minutes) and How to Clean a Nebulizer (video 2:10 minutes)Asthma and Allergy Foundation of America COIVD19 and Asthma Toolkit for SchoolsAsthma and Allergy Foundation of America?Provides an Asthma Toolkit with information on required and/or suggested facemasks or coverings, physical distancing, schedule changes, and new cleaning practices.CDC Guidance?K-12 Schools and Child Care Programs FAQs for Administrators, Teachers, and Parents?webpage.CDC: Strategies to Optimize Personal Protective Equipment (PPE)CDC: Using Personal Protective Equipment (PPE)NYSCSH Asthma Resource Webpage provides multiple resources and guidelines on medication, devices, and management.Customizable Resources available on the NYSCSH Samples and Forms webpageSample Letter to Families About Metered Dose Inhalers and Nebulizers (9/2020)Sample Medication Delivery Information for Parents (7/2020)Sample Provider and Parent Guardian Permission for the use of School Provided Spacer/Valved Holding Chamber (7/2020)ReferencesAerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review.?Tran, K., Cimon, K., Severn, M., Pessoa-Silva, C. L., & Conly, J. (2012). PloS one,?7(4), e35797 Spacers versus Nebulizers in Treatment of Acute Asthma - A Prospective Randomized Study in Preschool Children American Academy of PediatricsMetered-Dose Inhalers vs. Nebulizers in Treating Asthma American Family Physician.?2002, Oct?1:66 (7):1311. American Academy of Family Physicians624903546164500 HYPERLINK "" Practical strategies for a safe and effective delivery of aerosolized medications to patients with COVID-19 Respir Med. 2020 Jun; 167: 105987.Published online 2020 Apr 21.? This resource is available on the NYS Center for School Health Website at /2020 ................
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