asthma compliance/management

[Graciehope]

I have two asthmatics (not siblings) who I see almost everyday for wheezing/cough, SOB, after outdoor recess. They come in red faced, coughing and stating they can't breath. After doing quick thorough assessments, I always give them their inhalers. I always send home a note stating why they came to the nurse, what my assessment and findings were and my intervention. I tell them that if the student requires rescue inhaler more than 2 times a week, they should consult pediatrician/whomever they see for asthma care, for better asthma control. I have spoken to both sets of parents and expressed my concerns that the students' asthma may not be as well controlled as it could be. The parents did not even know what Peak Flows meant.

In speaking with the students, they tell me that their parents sometimes forget to give them their asthma maintenance meds. They said they have not seen their Dr.'s for their asthma for a while now.

I feel so strongly that these boys could be in a better place in regards to their asthma. I don't know what else to do. I feel like calling their Dr.'s myself but I know I can't and besides do I really think their Dr is going to call the parents and ask them about their asthma, of course not.

[BahoRN]

If you are a RN, see if you can schedule time, in person, with each parent to assess their knowledge and teach them again if necessary. Maybe they weren't properly taught in the first place.

You can also assess the children's knowledge and determine if their ready for enhanced teaching regarding their own illness as well. Good luck!

[coughdrop.2.go, BSN, RN]

Is there a local Asthma Coalition or County/State resources you can use? We have a County Asthma group that will go out to the home, do an assessment, provide support/resources/whatever the child may need. Also consult with your local School Nurses Association.

[Graciehope]

I am an RN. BTW both boys are in second grade.

The parents both seem knowledgeable (besides not knowing what Peak flows are), however I think they do not realize the consequences of continued uncontrolled asthma. The one mom is head of the PTO here and I've spoken to her several times regarding her son's asthma. In the past she has taken him a few times to the pediatrician when I have asked her to and he would be put on steroids. I have done extensive teaching with the boys and even made up a laminated picture with reminder to do his flovent as prescribed before bed (of course he told me its still in his mom's car). The boys get it but they are young and it is still up to the parents to make sure they are getting their maintenance meds or have their maintenance meds adjusted as needed. These parents would refuse external resources. They both have a very relaxed attitude about their child's asthma. I will however attempt again to find the local Asthma Coalition and see what they can do. Thank you for that suggestion.

My daughter has asthma and as soon as I see her needing her inhaler more than once a week, I immediately take action. I guess I can't expect all parents to do what I would do.

[OldDude]

Do they have wheezing/coughing issues not associated with exercise/increased activity?

[Wave Watcher]

I have to be proactive and not reactive with one of my asthmatics. It is high allergy season here and he has hit a rough patch with his wheezing. I give his inhaler 15 min before recess or gym. I only give it once a day. I will call mom on Monday and talk with her about backing off the inhaler this coming week. If she feels the child still needs it then I will recommend a visit to his pediatrician. I always send home a note letting her know what time I gave his inhaler so she is aware. Seems to be working well right now.

[JenTheSchoolRN, BSN, RN]

Do they have wheezing/coughing issues not associated with exercise/increased activity?

This is the same question I have. If is consistent with exercise, perhaps you could look at a proactive approach and give the inhaler before recess. I do this with several of my asthmatics, especially at the change of seasons - it has been terrible in my neck of the woods this year already with the pollen.

Medication regimens at home are tough - you can't police those, unfortunately. For a couple of my students that are inconsistent with any morning medications, I reach out to parents and offer a chance to give them during student's homeroom instead (with doctor's orders, of course). You would be surprised how much appreciation I got from the gesture! Turns out parent worked night shift and was so tired that making sure med was given before getting them to school was tricky.

[Graciehope]

Update - The mother of one of the students came in this morning as she was bringing her son in late. She informed me that her son never has had to use inhaler before with such frequency like he has had in this school year. She said his pediatrician prescribed it when he was a toddler and had RAD. She has not spoken with the pediatrician to say that his RAD is now worse. I advised her to see an Asthma Specialist as soon as possible. I printed out his visits for the last month describing my assessment and interventions which include his Peak Flows I had done. She was very appreciative and I believe she now "gets it". I guess my previous conversations and letter home to her did not sink in at that time.

Now if I can only get the other parent to call me back.