Allegry and Asthma Health - New Asthma Assessment Guidelines Released by ATS/ERS

Preparing College-bound Students To Cope with Their Asthma

Diane Rhodes, BBA, RRT, AE-C

Going off to college can be an exciting time for both students and parents. However, if your child has a history of persistent asthma, it can be frightening and uncertain, as well. A student's academic success in college can depend on how well his asthma is under control, yet a study conducted by the Accreditation Association for Ambulatory Health Care pointed out that 72% of college students with asthma let their asthma symptoms worsen before seeking medical attention and/or taking their prescribed medications.

As students get ready to leave the close watch of parents, they should be empowered to assess their own disease and level of control, understand their medications and how to take them, and appreciate how their environment and triggers impact their asthma.

Assessment

There are four classifications of asthma severity: intermittent, mild persistent, moderate persistent, and severe persistent. But asthma is an always-changing disease, so the college student must be able to evaluate his level of asthma control and know when to seek medical care and increase therapy. Three awareness indicators can alert the student that her asthma is not in control and she should seek medical advice:

Use of reliever inhaler three or more times per week
Awakening with nighttime symptoms three or more times per month
Refilling reliever inhaler three or more times per year.

Students can also use the Asthma Control Test to assess their asthma. A score of 19 or less indicates that their asthma may not be in control. If any of these assessments reveal their asthma is not in control, they need to contact their physician.

Medication

All asthmatics should be familiar with reliever medications, also known as beta agonists. These medications are used to treat sudden symptoms. However, reliever medications do not address the underlying inflammation that causes asthma. Inhaled corticosteroids (ICS), also known as controller medications, target inflammation and are the preferred medication for persistent asthma.

These anti-inflammatory maintenance medications must be taken each day. Unfortunately, that daily routine is often neglected by college students when they feel symptom-free. It is crucial that the college student who is prescribed an ICS understand the importance of taking the medication daily, even during symptom-free days.

Before leaving for college, the student should have prescriptions refilled and establish contact with a physician in his new location. Medical records from home should be transferred to the new physician so the student can maintain his current asthma care plan while away from home. Medication compliance and inhaler technique must always be reviewed when asthma symptoms resurface.

Environment

When asthmatic students used to live at home, family members may have helped them maintain asthma control by reducing known triggers. A college dorm room/apartment that is carpet-free and utilizes limited upholstered furniture would be ideal, but not every student will have access to residential areas that are created with allergy-prone students in mind. Some college dorms/apartments will expose them to an ever-changing and potentially trigger-ridden environment. These triggers (allergens, irritants, and infection) may contribute to the inflammatory process and can increase symptoms and the need for quick-relief medications.
If the asthma patient has been evaluated and specific allergies have been identified, those allergens should obviously be avoided or reduced as much as possible. If the allergies are unknown, creating an asthma-friendly college room becomes more difficult. Some common triggers are:

House dust mites (often found in mattresses, carpets, and upholstered furniture)
Animal allergens (pet dander, urine, feces, saliva, feathers)
Cockroach allergens (common in urban, inner city environments)
Indoor molds (found in high humidity areas and buildings with dampness problems)
Outdoor allergens (tree, grass and weed pollen, and mold spores)
Household dust (avoid by using a damp dusting cloth and HEPA-filtered vacuum cleaner)
Tobacco smoke (worst irritant, whether self-inflicted or secondhand)
Other irritants (exhaust, cleaning agent fumes, perfumes, fragrances, and smog).

Since infection is a primary trigger for asthmatics as well, rhino viruses and respiratory viruses should be avoided by following good preventive hygiene practices and getting the seasonal and H1N1 flu vaccines as they become available in the campus community.

The U.S. Environmental Protection Agency has a resource document called the Asthma Home Environment Checklist that students can download to assess their "home away from home" for asthma triggers and learn about action steps to reduce them.

Talk to your doctor

Students should feel comfortable discussing all aspects of asthma with their doctor and/or respiratory therapist, including assessment, medication, and environment. Additionally, students should discuss any other conditions they have that may impede asthma management. If these conditions are treated appropriately, asthma control may improve. Incorporating and reinforcing asthma control measures into daily life can help asthmatic students maintain a healthy lifestyle during their college years.

Diane Rhodes is a Registered Respiratory Therapist and American Association for Respiratory Care member from San Antonio, TX, where she serves as director of asthma education for the North East Independent School District.

Resource

U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. Expert panel report 3: guidelines for the diagnosis and management of asthma, full report 2007. NIH Publication No. 07-4051.

A version of this article was published in the January 2010 issue of AARC Times, a publication of the American Association for Respiratory Care.