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One way that asthma influences students' academic Asthma symptoms.

Naude and Pretorius (2003) completed a study on the cognitive and psychosocial effects of asthma medication on primary school children. They studied 6 to 13 year old children in a South Africa primary school. The study found that the children with asthma were more likely than other children to have concentration deficits and be inattentive (Naude & Pretorius, 2003). In addition, the children with asthma demonstrated impaired short-term memory, poor time management, sudden mood changes, symptoms associated with allergic-tension-fatigue syndrome, and functional impairment of academic and psychosocial functioning (Naude & Pretorius, 2003). In addition to having primary effects on children's behaviors and academics, the study found that the side effects of asthma medications also caused students with asthma to have many more absences than students without asthma (Naude and Pretorius, 2003). Therefore, asthma medications seem to cause a number of negative school related outcomes.

Other studies have also found negative effects related to asthma medication. For instance, Brown, Sherwood, Khan, and Njtek (1999, as cited in Naude & Pretorius, 2003) studied the effect of corticosteroids.
Corticosteroids are a type of medication commonly prescribed to treat asthma. In fact, corticosteroids are described as the "...most potent anti-inflammatory drugs in our therapeutic arsenal and are by far the most effective agents for the management of asthma," (Lieberman, 1999, p.65). Brown et al. (1999) found that corticosteroids increased risk for developing psychiatric symptoms including, "...depression (sad mood and suicidal ideation); lability (unstable mood or mood swings); mania or hypomania (elevated or unstable mood); increased energy, decreased sleep, agitation, rapid speech; psychosis (hallucinations); delusional beliefs and disorganized though processes," (as cited in Naude & Pretorius, 2003, p.700). Because corticosteroids provide the most effective treatment for the management of asthma, it is worrisome that they can cause such severe side effects. It is important for teachers and school psychologists to know of such side effects if students are taking corticosteroids to treat their asthma

Beyond the side effects of medication, another reason asthma impacts school performance is through children's sleeping patterns. Children with asthma often experience disturbances of sleep due to increased nighttime coughing and a feeling of being unable to breathe (Celano & Gellar, 1993, as cited in Naude & Pretorius, 2003). This sleeping difficulty leads to children being passive and tired in the classroom, resulting in poor listening skills. It has been found that these poor listening skills in children with asthma are often erroneously diagnosed as attention deficit hyperactivity disorder (Celano & Gellar, 1993, as cited in Naude & Pretorius, 2003). Again, symptoms such as poor listening skills need to be examined to determine what the true cause of these problems may be. In addition, teachers should be aware of the sleeping difficulties that children with asthma often experience to be able to better understand their unique needs.

As has been discussed, asthma can have a number of negative effects on school performance. To make this issue more complex, Fowler et al. (1992) found that the negative effects of asthma on school performance may be mediated by socioeconomic status. The study found that children with asthma who were from families with incomes of $20,000 or more were no more likely to fail a grade than children without asthma from comparable backgrounds (Fowler et al., 1992). In contrast, children with asthma who were from families with incomes of less than $20,000 had a risk of grade failure that was twice as high than children without asthma in this same income group (Fowler et al., 1992). These results suggest that having both medical and economic stressors decreases students' ability to cope and perform well at school. In conclusion, children experience a number of academic difficulties due to asthma symptoms and medication.


How Asthma Influences Psychological Functioning
Asthma seems to have some connection to emotions. For instance, asthma symptoms tend to get worse under stress (Bray et al., 2004). In addition, psychologically based interventions have helped to improve lung function.
This asthma-emotion connection is important for school psychologists to understand, especially since asthma is not popularly thought of as a "psychological" disorder. Bray et al. (2004) offer advice on this issue, stating, "...school psychologists may treat students with asthma, particularly those students' whose asthmatic attacks are triggered by psychological events, with interventions that globally address the students' subjective well-being," (p. 98).

As stated, there have been a number of psychologically based interventions that have been shown to increase the lung functioning of individuals with asthma. One psychological intervention that has been used is written emotional expression. Written emotional expression is a therapeutic technique that requires individuals to write about their stressful or traumatic experiences (Symth et al., 1996, as cited in Bray et al., 2004). Symth et al. (1996, as cited in Bray et al., 2004) completed a study on written emotional expression, finding that adults with asthma who were assigned to write about their stressful and traumatic experiences showed significant improvement in their lung function as compared to a control group who were assigned to write about neutral events. Although not tested, this technique may have the ability to help school children with asthma deal with their stressful life experiences, while also increasing lung function. In addition to therapeutic written expression, having children with asthma relax using biofeedback techniques has also shown to reduce asthma symptomology (Kern-Buell, McGrady, Conran, & Nelson, 2000, as cited in Bray, 2004). Relaxation without the use of biofeedback also seems to improve lung function. For instance, Peck (2001, as cited in Bray et al., 2004) studied the effects of relaxation with guided imagery on improving children's lung function, finding that it produced significantly increased lung function and reduced anxiety. This study suggests that children with asthma may be helped by being taught and guided through relaxation techniques. Overall, the research suggests that asthma may be strongly related to emotions, meaning that asthmatic children may need to be treated not only with medication, but with psychological interventions as well.

How Asthma Influences Students' School Experiences
Along with inhibiting academics, asthma also seems to have social and emotional effects on students' personal school experiences. Ayala et al. (2006) completed a study of
middle school students with asthma to learn about their experiences of living with asthma. Fifty students in sixth, seventh, and eighth grade took part in this study, which consisted of grade specific focus groups at which students discussed their asthma. Ayala et al. (2006) found that students across grades gave reasons for why youth are poor managers of asthma. Students stated that asthma control is "time consuming" and "annoying," (Ayala et al., 2006). In addition, it was found that there were differences between the views of sixth graders and those of seventh and eighth graders. Sixth grade students reported being scarred about their asthma and not liking that they were different from and/or teased by their peers. Seventh and eighth grade students stated that asthma management was not needed because they had "outgrown" their asthma (Ayala et al., 2006).

Students across grade levels also reported a number of reasons for why they did not take their asthma medication (Ayala et al., 2006). For one, they stated that medications tasted badly, were complicated to use, and were costly. In addition, the students reported that they often forgot about taking medication with them to school or when they went to a friend's house. Surprisingly, many students also stated that they were reluctant to report asthma attacks while they were at school. This reluctance to report attacks came from the fact that many students had been accused by teachers and coaches of faking asthma attacks to get out of completing work (Ayala et al., 2006). This finding suggests that teachers and other school personnel need to be trained in asthma symptoms, such that they come to understand the severity of the condition.

Peer relationships were also mentioned by the students with asthma (Ayala et al., 2006). For instance, some students reported that they did not like to have to turn down offers to play basketball when pollen counts were high. Other students reported that they would do things that their friends were doing, even if they knew it would cause an asthma attack (Ayala et al., 2006). In addition, students discussed their frustration over middle school physical education classes, which required more physical activity than in elementary school. Students were therefore more likely to experience breathing problems in class and in front of their peers.

As part of their study, Ayala et al. (2006) also had the students with asthma come up with interventions or education programs to teach others about asthma. Interestingly, sixth grade students were more concerned about
how they were perceived among their peers, designing an education program for middle school students. Seventh and eighth grade students discussed the lack of media attention about asthma, designing more universal programs to let more people know about the condition. This finding suggests that younger students may be more concerned about how peers will perceive them because they have asthma. As students get older, they may reach a point at which they come to accept their asthma and/or have already formed a peer group that is accepting of their condition. Overall, it seems that students with asthma have a number of concerns related to asthma control, medication, and how their peers perceive them.

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<<Asthma Information >>

Asthma symptoms, What causes Asthma

 
Source: Idaho Department of Health and Welfare
Topics: Health and Wellness for Children , Childhood Medical Problems, Childhood Asthma , Childhood Lung and Respiratory System
When You Can’t Breathe, Nothing Else Matters®
Asthma is the most common chronic illness among children. More than five million children have asthma. Since 1980, asthma prevalence in children has more than doubled. The most rapid increase in prevalence has occurred in children under the age of 5 with that rate increasing more than 160 percent. For reasons not yet clear, studies show a strong correlation between poverty and asthma prevalence.

What is asthma?
Asthma is a chronic inflammatory disease of the respiratory tract. The airways of individuals with asthma are sensitive to substances that are common in the environment. When a person with asthma is exposed to one of these substances, it triggers a cascade of events. The inside walls of the bronchial tubes become inflamed and swell. Muscles that surround the bronchi contract, squeezing them even tighter. And mucus is produced in greater amounts within the bronchi, adding to the obstruction. Out of control, asthma can lead to permanent lung damage and even death.
Symptoms of Asthma in Children
•An audible whistling or wheezing when your child exhales
•Coughing, especially if the cough is frequent and occurs in spasms
•Waking at night with coughing or wheezing
•Shortness of breath, which may or may not occur when your child exercises
•A tight feeling in your child's chest
From "What is Asthma," MayoClinic.com. (Not available in Spanish)

The “A, B, C’s” of Asthma Challenges
One reason your child may not be able to meet the challenges of school is that he/she simply can’t breathe. For asthmatic children, asthma presents learning challenges. If a child is having difficulty breathing, the focus of the child’s energies will be on breathing and not on the lessons at hand. It is estimated that nationally, approximately 10 percent of schoolchildren may have asthma. One study reported the absence rate is three times higher among children diagnosed with asthma.

“A” is for Attendance — A basic necessity of learning starts with “A” as in attendance. The American Academy of Allergy and Immunology states that, “Going to school with asthma introduces two sometimes opposing realities. The first reality is that uninterrupted daily attendance at school maximizes a child’s chances to learn and provides the student with the continuity of instruction necessary to reach his or her potential. The second reality is that asthma is a largely unpredictable disease, and it often interrupts learning by distracting [the child] or keeping children away from school.”

“B” is for Behavior — Asthma has an impact on the social and emotional, as well as, the physical health of a child. A child may feel “different” because he/she has to sit down during playtime, or avoid touching the classroom pet because it may trigger an asthma attack. Or the child may feel embarrassment over having to take his/her medication in front of peers. Anxiety is also common among children who may be experiencing difficulty breathing. Children who are being emotionally challenged are less likely to engage actively in the learning process.

A child's participation in the learning process will be impacted if they are having difficulty breathing. The medications prescribed to assist the child’s breathing also may cause behaviors that can limit a child’s participation in the learning process. Fatigue or drowsiness simply can be the result of a sleepless night caused by coughing. Asthma medications can cause side effects such as nervousness, nausea, jitteriness, hyperactivity, and inability to concentrate. Any one of these issues can pose a significant barrier to learning. There is, however, some good news.

“C” is for Control, but not Cure — At this time, there is no cure for asthma. Fortunately, new ways of controlling asthma and managing it long-term are available. It is possible to reduce asthma’s personal, social, and economic burdens. Children with asthma can live normal lives in which the disease has a minimal impact on their daily activities and learning progress. Children with asthma need proper support in their learning environment to keep their asthma under control and be fully active. Head Start, schools or child care staff, health professionals, and parents can work together to remove obstacles and to promote students’ health and education.
 Asthma and Learning Readiness (continued)
by Jean Woodward
Source: Idaho Department of Health and Welfare
Topics: Health and Wellness for Children , Childhood Medical Problems, Childhood Asthma , Childhood Lung and Respiratory System
Components of Asthma Management
There are four components of a school-based asthma management program:

Asthma-friendly policies include providing access to a school nurse. Another asthma-friendly policy is that every child with asthma will have a written, physician-directed asthma management plan on file. This plan should include a strategy to manage chronic and worsening symptoms, a list of medications to be taken and instruction on when and how to take them, measures to prevent exercise-induced asthma attacks, and a list of known asthma triggers. The third asthma-friendly policy is that every school/child care would have an asthma action plan. This plan is different than the asthma management plan in that it directs staff action in an asthma emergency. An asthma attack can be a life-threatening event. Anyone who may have to care for a child under these circumstances needs to know what the policies require. Does staff know what to do? Who to call? When to call, etc.? Some of these answers can come through a staff asthma management training program.

Healthy Environment — Since children spend most of their time in school, child care facilities, or at home, it is important to reduce their exposure to environmental asthma triggers as much as possible in each of these environments. Many indoor air quality problems in schools can impact the health of students and staff, including those with asthma. Follow the link to the right for more information.

Asthma Education — Schools/child cares have a “duty to care" that is shared by all staff members. This duty arises because children need to be at school (or in a child care setting), away from their usual sources of protection (parents). This duty may require administering medication, monitoring health status, providing specialized staffing or training to staff, and protecting students from emotional distress. As a result, all faculty and staff should, as a matter of policy, participate in asthma management training. Of course, every child who has asthma should know about his/her condition and how to manage it (the level of knowledge, of course, will vary depending on the age of the child). In addition, other children in the school (or child care) should know something about asthma.

Communication — The final component of an asthma management program is perhaps the most important, communication. The asthma management team includes the child, parents, Head Start/school/child care staff, and the child’s physician. Parents and staff should monitor the child’s learning, absenteeism, and the facility environment. Any changes in the child’s symptoms or behavior should be communicated to the other team members. If all members of the asthma management team are monitoring the child’s behavior and communicating with the other team members, we can achieve optimal asthma control and enhance the child’s learning opportunities.

In summary, asthma problems can’t be solved in the school/child care environment alone, but together, we can make a difference. Successful asthma management means that children with asthma can live active, healthy lives. There is a clear connection between health interventions and student success.



Healthy Children Project Monthly e-News
This e-newsletter is a publication of the Learning Disabilities Association of Michigan's Healthy Children Project (HCP). Its purpose is to select and summarize the most pertinent, current information about environmental factors that impact developing fetuses, the newborn or young children and the actions we can take to minimize or eliminate those factors. Michigan's Healthy Children Project e-newsletter will be published every month. Feel free to let your friends, family and colleagues know about this valuable new resource. Instructions to subscribe or unsubscribe are at the end of this e-newsletter.
 
Articles Related to Chemicals, Toxins & Pesticides
Weak Rules on Toxins and Safety
http://www.nytimes.com/2010/03/31/business/economy/31leonhardt.html
For 14 years until just last month, GlaxoSmithKline sold a denture cream called Super Poligrip that contained high levels of zinc. The zinc helped with adhesion and was probably safe so long as people used moderate amounts of cream. Indeed, the human body needs small amounts of zinc to function. But some people ended up using much larger amounts, and they began to develop the kind of nerve damage associated with excess zinc.

Pharmaceuticals in Water – An Interdisciplinary Approach to a Public Health Challenge
http://ehsehplp03.niehs.nih.gov/article/info%3Adoi%2F10.1289%2Fehp.0901532
The presence of pharmaceuticals in aquatic environments and drinking waters has prompted significant public interest regarding potential adverse ecological effects and risks to human health.
 
Bad Chemistry: The Poison in the Plastic That Surrounds Us
http://www.independent.co.uk/life-style/health-and-families/features/bad-chemistry-the-poison-in-the-plastic-that-surrounds-us-1931462.html
Could a ubiquitous chemical, found in everything from food cans to baby bottles, be killing us? In a special investigation, this article examines the horrifying evidence dividing scientists and big business.

EPA to Intensify its Study of BPA
http://www.jsonline.com/watchdog/watchdogreports/89485472.html
The Environmental Protection Agency announced that it is intensifying its look at how BPA affects the nation's wildlife and water supply and will designate the compound as a "chemical of concern." The action plan is part of a growing effort by federal regulators to more carefully scrutinize the effects of the chemical. Bisphenol A is found in the lining of most food and beverage cans. The move by the EPA comes after a three-year investigation found that government agencies relied heavily on industry scientists to assess BPA's safety, ignoring hundreds of independent studies that found the chemical caused harm.

In the UK, Parents' Smoking Gives 15,000 Children a Year Asthma, Doctors Warn
http://www.guardian.co.uk/lifeandstyle/2010/mar/24/smoking-asthma-children-health
Tens of thousands of children in the UK every year get asthma, chest infections and ear problems because they are exposed to smoke from their parents' cigarettes, doctors reveal today. Secondhand smoke causes 15,400 children between three and 16 to develop asthma, gives 20,500 two or under a chest infection and 121,400 under-16s an infected middle ear, a report from the Royal College of Physicians warns. Another 600 under-16s get meningitis, 7,200 babies start wheezing and 40 children die of sudden infant death syndrome owing to passive smoking, the study says.

GAO Report Scolds EPA on Inaction Regarding Children and Toxics
http://www.usatoday.com/news/washington/2010-03-17-epa-children-pollution_N.htm
During the past decade, the Environmental Protection Agency's commitment to keeping children safe from toxic chemicals has lapsed, and top officials routinely ignored scores of recommendations by the agency's own children's health advisory committee, according to a report released Wednesday by the Government Accountability Office. The consequences are substantial, health experts told lawmakers Wednesday, during a hearing of the Senate Environment and Public Works Committee. Download the full GAO report at http://www.gao.gov/products/GAO-10-545T.

Learn About the Children's Safe Products Act
http://www.mnceh.org/campaigns.lead.php
Exposure to even small amounts of a toxic chemical can impact a child's ability to reach his or her full potential. The Children's Safe Products Act would help protect children and by informing parents and other consumers about chemicals of highest concern in toys and other children's products. Take action at http://salsa.democracyinaction.org/o/1421/p/dia/action/public/?action_KEY=1857.
 
Download the Brochure: Mental Health Effects Arising from Pesticide Exposure: A Guide for Healthcare Providers and Mental Health Practitioners
http://www.healthandenvironment.org/?module=uploads&func=download&fileId=816
This document was prepared by the Mental Health and Environment Working Group of the Collaborative on Health and the Environment.

A Connection Between Personal Care Products and ADHD?
http://www.environmentreport.org/story.php?story_id=4941
There’s been a rise in reports of behavioral disorders in kids over the past decade or so. Some researchers say genetics, lack of sleep, and chaotic households all contribute to things like ADHD. Now researchers say another cause could be personal care products. Read the study: http://ehp03.niehs.nih.gov/article/fetchArticle.action?articleURI=info%3Adoi%2F10.1289%2Fehp.0901470#Ahead%20of%20Print%20%28AOP%29 and read and article from Environmental Health News: http://www.environmentalhealthnews.org/ehs/news/phthalates-and-attention-deficits
 
Take Action: Tell Congress to Phase Out Persistent, Bioaccumulative Toxins (PBTs)
http://salsa.democracyinaction.org/o/1421/p/dia/action/public/?action_KEY=2414
Protect Michigan's Children and the Great Lakes from Persistent, Bioaccumulative Toxins (PBTs). Some of the most notorious chemicals ever studied - lead, PCBs, mercury, DDT, Dioxin, and cadmium - are PBTs. Ask Congress to reform our broken chemicals regulatory system and phase out the use of PBTs.

Toxic Air and America's Schools
http://content.usatoday.com/news/nation/environment/smokestack/index
USA Today used an EPA model to track the path of industrial pollution and mapped the locations to almost 128,000 schools to determine the levels of toxic chemicals outside. The potential problems that emerged were widespread, insidious and largely unaddressed. Visit this website to see how the schools in your town/state rank.
 
Autism and Toxins
http://www.loe.org/shows/shows.htm?programID=10-P13-00011#feature2
Read or listen to an interview of Dr. Phillip Landrigan of Mount Sinai School of Medicine as he talks about possible environmental links to autism and the effects of chemical exposure on a developing brain.

CHE Launches New Working Group on Autism
http://www.healthandenvironment.org/working_groups/autism_group
CHE's new working group on Autism is dedicated to exploring the new paradigm of autism research and treatment in Autistic Spectrum Disorders. To join CHE Autism contact info@healthandenvironment.org

Environmental Working Group's Green Cleaning Tips for Your Home
http://www.ewg.org/healthyhometips/greencleaning
Cleaning might be a chore, but it doesn't have to be toxic, too! Safer products and practices are available and easy. Why not go green when you clean? Your family's health is (naturally) worth it.
 
Lead Testing Recommended for Detroit Gardens
http://michiganmessenger.com/35933/lead-testing-recommended-for-detroit-gardens
An estimated 4,000 gardens will be planted in the city of Detroit this summer. However, many of its residents are unaware that the city's soils are contaminated with lead from paint chips, industrial emissions, and dust from lead-based gasoline combustion. A service for home gardeners provided by the MSU Extension does not provide lead testing. The city is being called on to provide lead testing for these gardens.
 
Cumulative List of Biomonitoring Reports from CHE
http://www.healthandenvironment.org/working_groups/learning/r/reports
 
Use of Acetaminophen in Pregnancy Associated with Increased Asthma Symptoms in Children
http://www.ccceh.org/pressreleases/press020410.html
Children who were exposed to acetaminophen prenatally were more likely to have asthma symptoms at age five in a study of 300 African-American and Dominican Republic children living in New York City. Building on prior research showing an association between both prenatal and postnatal acetaminophen and asthma, this is the first study to demonstrate a direct link between asthma and an ability to detoxify foreign substances in the body. The findings were published this week in the journal Thorax.

Pamphlet for Expecting Moms Explains Environmental Risks
The American Association on Intellectual and Developmental Disabilities (AAIDD) has developed a color, folded, cross-cultural pamphlet to be given to women at Ob-Gyn appointments. This educational pamphlet for expecting moms explains environmental risks at home, in the workplace, and outdoors and is intended for use in clinics and doctors offices around the country. Contributing partners include the Learning Disabilities Association of America (LDA), American College of Nurse Midwives, and the V.A. women's health program, with funding from the John Merck Fund.
Download the pamphlet - English: http://www.aaidd.org/ehi/content_336.cfm?navID=113
Download the pamphlet - Spanish: http://www.aaidd.org/ehi/content_3339.cfm?navID=295