States lack policies to curb classroom burden of asthma and severe allergies

Nov 5 2011

For over 7 million children with asthma, and 13 million with food allergy or other severe allergies, going to school is a daily risk affecting how well they can – or can't – manage their diseases.  Now for the fourth year, the Asthma and Allergy Foundation of America (AAFA) has released its annual report assessing all 50 states and the District of Columbia on their leadership and progress on school-based policies that address student asthma and allergy health in more than 100,000 elementary, middle and high schools across the U.S.  

The result: most states still don't make the grade.

Signs of Leadership

Each year, the Foundation's report, the "State Honor Roll™ of Asthma and Allergy Policies for Schools," outlines 18 school-related core policies proven to affect positive healthy school environments, then assesses each state on how many of these policies they have adopted.  If a state has enacted at least 15 of the policies, it is listed on the Foundation's "Honor Roll."  This year, six states achieved this distinction:

• Connecticut
• Massachusetts
• New Jersey
• Rhode Island
• Vermont
• Washington

AAFA is announcing the results of the study at an international medical conference in Boston this weekend.  Full results, including detailed state profiles and charts, are available at www.StateHonorRoll.org.  The report Web site also has several links to free resources for parents, advocates, schools and policymakers.

"New England has been committed to student health, and public health overall, for decades," says Judi McAuliffe, RN, a school nurse in the Pembroke, Massachusetts, school district.  "I'm not really surprised that we continue to lead the rest of the country on asthma and allergy health, I just wish others would follow," says McAuliffe.  According to the Foundation, these 6 Honor Roll states demonstrate leadership on asthma and allergy school health.  "They provide a blueprint for parents and patient advocates around the country," says Tom Flanagan, Chair of AAFA's national Board of Directors, and a parent of a child with severe allergies," but there has been limited progress in too few places for such a huge public health problem." 

The Burden on Schools

In the United States, asthma and allergies have a major and growing affect on schools.  About 10 percent of kids (7.1 million children) have asthma.  It is the #2 chronic disease among children (behind obesity) and the #1 chronic cause of student absenteeism (10.5 million school days missed annually due to asthma in 2008).  Last year, 185 children died because of asthma.  In addition, severe allergies and anaphylaxis – the most severe type of allergic reaction – are on the rise nationwide, particularly food allergies among children, forcing schools to prepare, manage and react to the problem.  Plus, millions of adult teachers and staff in schools have asthma and allergies, as well.

With so many people affected in the school setting, these diseases create a burden on schools and communities, requiring improvements to indoor air quality (IAQ), emergency procedures and prevention training for food allergies, individual health plans for students, notifying parents of pesticide spraying, student access to medications such as epinephrine auto-injectors or albuterol inhalers, campus smoking bans and cessation programs, and more.

Many States Have Few Protections

While thousands of local schools and districts may show innovation and leadership in support of students and staff with asthma and allergies, strong state-wide policies are lacking throughout the U.S., with some rare bright spots.  "Four New England states, New Jersey and Washington State have been on our Honor Roll for 4 years," says Charlotte Collins, JD, AAFA's Vice President of Policy and Programs, "but the gap from coast to coast is wide, with most states simply falling short.  In fact, twelve states failed to achieve even half of the core policy standards," says Collins.

Even though broad improvements in the states has not yet been seen, AAFA found that overall, most states are at least taking a few steps each to address the needs of students with asthma and allergies in the school setting.  For example, most states now protect student access to their own medications, document chronic diseases, and prohibit smoking at school and on school buses.  Currently, about half of the states fail to require schools to develop emergency protocols for asthma and anaphylaxis emergencies, and only five recommend that schools provide at least one nurse per 750 students. 

Anaphylaxis on the Policy Frontier

"One major positive finding in this year's report is that nearly every state in the U.S. now has a law allowing students to carry and self-administer their epinephrine auto-injectors for allergic emergencies," says Flanagan.  This is a major development compared to just 10 years ago when few states allowed – and in fact prohibited – such access.  Wisconsin and New York still don't have this law but their legislatures are considering policies, "so those states are behind on this right now while all the other states are leading the way," says Flanagan.

Now that student self-use of epinephrine has near nationwide acceptance, other access issues have emerged.  Surprisingly, states do not regulate emergency services consistently.  Depending on where you live, some emergency medical technicians (EMTs) may not have access to epinephrine, or may not be permitted to administer the medication, or only permitted to assist administering a patient's own epinephrine auto-injector device.  "This is a definite area of concern since school personnel rely on 911 services in these types of emergencies," says Collins.

SOURCE The Asthma and Allergy Foundation of America