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Revised 2011

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ManagingAsthmainConnecticutChild

CareFacilities

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1. Purpose/Acknowledgments 2

 CaringforaChildwithAsthma:Checklist 3

3. AsthmaFacts 4

a. WhatisAsthma? 4

b. WhatCausesAsthma? 4

c. HowisAsthmaDiagnosedinYoungChildren? 5

d. SignsandSymptomsofAsthma 5

i. EarlywarningSigns 5

ii. Emergency

Signs 6

iii. WhatToDoforanAsthmaEmergency(“Asthma

Attack”)

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4. AsthmaControl 8

5. IndividualPlanofCare(IPC)canbeanAsthmaActionPlan 9

6. IdentifyingandAvoidingAsthmaTriggersandAllergens 10

a. AirwayIrritantsandTobaccoSmoke 10

b. PestControl 11

 CleaningProducts/Allergens 12

7. AsthmaMedication 15

a. Quick‐relief(Rescue)Medication 15

b. ControlMedication 16

c. HowtoAdministerAsthmaMedication 17

d. AsthmaMedicationsStorage 20

e. EmergencyAllergyReactions(Anaphylaxis) 21

8. DaycareRegulationsandStatutes 23

9. NurseConsultant/AsthmaEducator 26

10. HandoutsandForms

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11. Resources 28

12. GlossaryofTerms 31

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1. Acknowledgements & Purpose

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Theintentofthismanualistoprovideresourcesandguidanceforprogramsthatcareforchildrenintheirpre‐school

years.TheregulationscitedthroughoutthemanualareapplicabletofacilitieslicensedbytheConnecticut

DepartmentofPublicHealth(DPH).

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ProgramsinschoolsettingsnotlicensedbyDPHare

coveredbyfederalregulationsthatmayormaynotbethesame

astheregulationscontainedinthisdocument.Programsinthesesettingsmustbeawareofandcomplywiththe

applicableregulationsfortheagencythatprovidestheiroversightandcompliance.

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TheStateofConnecticutDPH,AsthmaProgramwouldlike

toacknowledgeandgivecredittothemanyindividuals

andagencieswhogavetheirtimeandsharedresourcestoupdateandrevisethisguideinordertoprovidea

comprehensivemanualtochildcareproviders.

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Disclaimer:

ThisguideisNOTAPOLICYMANDATE.

Instead,itisdesignedtoserveasa

resourcefordaycaresinmanagingasthmaanddoesnotsupersedeanyofthe

provisionsoftheRegulationsofConnecticutStateAgenciesSections19a‐79‐1athrough19a‐79‐13thatgovernchild

daycarecentersandgroupdaycarehomes.Furthermore,thisguideisnotintendedtoendorseany

particularbrand

ofproductdiscussedorshowninitspages.Picturesanddescriptionsofsuchproductsareforillustrativepurposes

only.Finally,thisguideisforeducationalpurposesonly.Itisnotintendedtoreplacethemedicaladviceorservicesof

alicensedhealthcareprovider.

ReneeD.Coleman‐Mitchell,M.P.H.EileenBoulay,B.S.N.,R.N.

SectionChief,HealthEducation,ProgramSupervisor,AsthmaProgram

Management&SurveillanceConnecticutDepartmentofPublicHealth

ConnecticutDepartmentofPublicHealth

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ElizabethD.Reynolds,B.S.N.,R.N.,NCSN  SalinaHargrove,B.S.

NurseConsultant,AsthmaProgramHealthProgramAssistant,AsthmaProgram

ConnecticutDepartmentof

PublicHealth   ConnecticutDepartmentofPublicHealth

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ValerieBryan,R.N.JoanSimpson,M.P.H.S.

DayCareLicensingEnvironmental&OccupationalHealthIndoorAirQuality

SupervisingNurseConsultantConnecticutDepartmentofPublicHealth

ConnecticutDepartmentofPublicHealth

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DevonConover,M.S.

DivisionofCommunityBasedRegulation

ConnecticutDepartmentofPublicHealth

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Permissionwasgrantedtoreprintand/oradaptcomponentsfromthefollowing:

AmericanAcademyofAllergy,AsthmaandImmunology AmericanCollegeofChestPhysicians

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CaliforniaChildcareHealthProgramCentersforDiseaseControlandPrevention

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2. CaringforaChildwithAsthma

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CHECKLIST

□Learnthebasicsaboutasthma

9 Whatisasthma?

9 Whatcausesasthma?

9 Signsandsymptoms

9 Howisitdiagnosed?

9 Asthmacontrol

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□Knowyourresponsibilitiesasachildcareprovider

9 Whichchildrenhaveasthma

9 Howyouhelpthemavoidthethingsthatmaketheirasthmaworse

9 Howyougivethemasthmamedicine

9 Howyouusetheirasthmaplans

9 Whatdoyoudoinanasthmaemergency

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□KnowtheConnecticutstatelawsandregulations

9 Medicationauthorizationsandadministration

9 Cleaninganddisinfectants

9 Environmentalrequirements

9 Illnessprocedures

9 Healthconsultants

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□Knowwhereelsetofindmoreinformationaboutasthmaandenvironmentalhealth

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3. AsthmaFacts

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WhatisAsthma?

Asthmaisaverycommonchroniclungdiseasethat

affectspeopleofallages.Asthmacausestheairway

passagesinthelungstobecomenarrow,makingit

hardertogetairinandoutofthelungs.Whenasthmais

notwellcontrolleditcausesepisodesofdayornighttime

coughing,breathlessness,chesttightness,andwheezing.

Theproblemthatmakesasthmaachronicdiseaseis:

• Inflammation(swelling)oftheliningofthe

airways(bronchusorbronchioles).

Whentheairwaysareinflameditmakesthemmore

sensitiveandlikelytohaveserioussymptomswhen

exposedtoasthmatriggerscausing:

• Tightening(constricting)ofthemusclesthatare

wrappedaroundtheairways

• Increasingmucusthatclogstheairways

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WhatCausesAsthma?

Asthmaisnotcontagious.Thereisnotonespecificthingthatcausessomeonetodevelopasthma.Whatwedoknow

isthattherearecertainriskfactorsthatmakeitmorelikelyforchildrentodevelopasthma,including:

• Ifanimmediatefamilymemberhasasthma(heredity)

• Ifthechildhashadeczema(dry,itchyskincondition)

• Ifthechildhasfoodorenvironmentalallergies

Somechildrenfirstdevelopasthmasymptomsafterarespiratorycoldvirus.Althoughcoldvirusesdon’tcause

asthma,theyareanimportanttriggerformostyoungchildrenthatcanresultinsomeone’sfirstorrecurringasthma

episodes.Anychildwhomightbeatriskfordevelopingasthmacanhavetheirasthmamadeworsebyexposureto

tobaccosmoke,anyotherformofairpollution,orenvironmentalallergens.

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HowisAsthmaDiagnosedinChildren?

Asthmacanbedifficulttodiagnoseinyoungchildren.Healthcareprovidersusenationalguidelinestoidentifyhealth

historyinformation,questionnaires,andphysicalexamfindingstoassistinthediagnosisofasthma.Recurringasthma

symptomssuchaswheezing,difficultybreathing,andexcessivecoughingareusedalongwiththechild’sfamilyand

medicalhistorytohelpmakethediagnosis.

Somechildrenundertheageof5yearsoldhaveahistoryofasthmathattheydoseemtooutgrow.Otherchildren

developasthmaatayoungageandhaveittherestoftheirlives.Childrenover5yearsoldmaybeabletoperforma

spirometrytestthatmeasureshowtheairflowsinandoutoftheirlungs.Thesetestsandassessmentsaredoneat

thechild’sPrimaryCareProvider(PCP)orapulmonaryorallergyspecialist.

AsthmaSignsandSymptoms

EarlyWarningSignsandSymptoms

VisibleSigns

• Breathingharderandfasterthanusual

• Excessiveoruncontrollablecoughing

o Whensleeping

o Whenawake

o Whenactive

 Exercising

 Laughing

 Crying

 Anyhardblowing

• Unusuallytired/notwantingtoplay

• Appearsworried,fearful,orirritable

VerbalStatements

Childrenhavedifferentwaysofdescribingwhattheir

asthmafeelslike.Somecommonphrasesare:

• “it’shardtobreathe”

• “ithurtstobreathe”

• “mychestfeelstight”

• “mythroathurtswhenIbreathe”

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Emergencysignsandsymptoms:“AsthmaAttack”

Whenasthmagetssobadthaturgentoremergencymedicalcareisneededitisoftenrefe rredtoasan“asthma

attack”.However,theterm“asthmaattack”canactuallybemisleadi ng. Most“asthmaattacks”canbeprevented

byfollowingachild’swrittenasthmaplan,stayingondailycontrolmedications,avoidingasthmatriggersand

allergens,recognizingtheearlysignsandsymptoms,andproperlyadministeringmedication.

Signsthatachildmaybehavinganemergencyasthma(orbreathing)probleminclude:

• Thechildisstrugglingtobreath(hardandfast),evenwhenresting

• Youcanhearthechildwheezingwithoutastethoscope

• Thechildishavingdifficultytalking,concentrating,orwalking

• Thechildcan’tseemtocatchhisorherbreath

• Thechild’slipsorfingernailsappearblueorgray

• Paleorsweatyskin

• Thechildappearsextremelyexhaustedorlethargic

• Thechild’schestorneckmusclesseemtobe“suckedin”witheachbreath

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Whattodoforachildhavinganemergencyasthmaproblem(“asthmaattack”)

1. Staycalm,don’tleavethechildaloneandhelpthechildtorelaxasmuchaspossibl e

2. FollowtheIPCorasthmaactionplan(AAP)REDZONE

3. Givequick‐relief(rescue)medicineimmediately

4. Call911,notifyparent

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*Whentocall911*

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• Childisunresponsive

• Breathingissodifficultthechildcan’twalkortalk

• Lipsorfingertipslookgrayorblue

• Therescuemedicineisnotworkingafter10or15minutes

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KeyPoint:

Anytimeyouarenotsureandthinkitisan

emergency,itisbettertocall911thanitistowait

toolong.

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Whenyoucall,don’thangupuntilthe911operator

tellsyouto.

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Onceasthmaisdiagnosed,childrenneedtohaveaPCPwhoisaccessibletothefamily,assessesthechild’sasthmaon

aregularbasis,andworkswiththefamilytodevelopandreviseappropriatewrittenasthmaplans.Ongoing

assessmentofasthmacontrolisoneofthekeystomaintainingeffectiveasthmamanagement–itishowhealthcare

providersdetermineifthechildisonthecorrectmedicineandhowwelltheyareabletoavoidthethingsthatmake

theirasthmaworse.

Goodasthmacontrolis:

• Whenthechildcanplayandexercisejustlikeanyoneelsetheiragewhodoesnothaveasthma

• Mostdaysthechilddoesnotcough,wheezeorfeelshortofbreath

• Thechildcansleepthroughthenight(ornaps)withoutcoughingorwakingupwithuncomfortable

breathing

• Thechilddoesnotneedtousequick‐relief(rescue)medicinemorethantwiceaweek



Youandthef amilycancontributevaluableasthmacontrolinformationtothePCP,including:

• Frequencyofdayornightcoughing

• Abilitytoplayatthesamephysicallevelasotherchildren

• Frequencyofusingquick‐relief(rescue)medicine

• Missedschool,daycare,orparentalworkdaysduetoasthma

Thefollowingisachartofthetypeofquestionsusedtohelpdetermineasthmacontrol:

Inthepast4weeks:



WellControlled



NotWellControlled

VeryPoorly

Controlled



1. Howmanytimesdidyourasthmagetinthewayor

stopyoufromdoinganactivityathome,schoolor

play?

None



Sometimes Frequently



2. Howmanytimesdidyouwheeze,cough,feeltightin

thechest,orhavetroublebreathing?

8orless,butnotmore

thanonceperday



Morethan8,or

morethanonceper

day

Everyday



3. Howmanytimesdidyourasthmawakeyouupatnight

ormakeithardtosleep?

1orless



2‐4 Morethan4



4. Howmanytimesdidyouhavetouseyourrescue

inhalerornebulizer(albuterolorxopenex)?

8orless



Morethan8 Atleasteveryday

 Answersinthese

boxesshouldindicate

goodasthmacontrol

Anyanswersinthese

sectionscould

indicatetheneedfor

anasthmavisit

Anyanswersin

theseboxes

indicatesthe

needtocallfor

anasthmavisit

 4. AsthmaControl



The

Plan

”

resp

•

*Se

Aco

tot

pare

inclu



Alth

•

ndividualPl

”

canbeuse

nsibleforc

•

Theprov

•

Theindiv

•

Develop

•

Financial

•

Theasth

CTDayCar

yofthepla

epatient/fa

nt,relative,

dingwhatm

ughtherea

•

Demogra

•

Asthmas

•

Patient‐s

•

3zonest

•

Eachzon



• GreenZ

• Yellow

• RedZon

nofCare(I

asanIPC.T

reofthechi

der’sexpert

dualpatien

entalconsi

healthinsur

aeducatio

Regulation

iskeptint

ilythatcan

aycareprov

edicationst

edifferent

phicandcon

everityclass

ecificasth

atareusual

hastheast

ne–Go!

oasthmas

akedailyco

one–Cauti

arlyasthma

ontinuedai

ddquick‐re

pdatethe

e‐Emergenc

orserioussi

akequick‐r

hildrenexp

mergencyR

all911,noti



C)isrequire

heplanism

ld.Consider

seindeter

/family’she

erations

ancecovera

requiredfo

Section–p

emedicalr

makecopie

iderand/or

take,and

ersionso

IP

tactinforma

fication

atriggersa

lycolorcod

masympto

mptoms

ntrolmedica

n!

signsandsy

ycontrolme

ief(rescue)

arentonchil

!

gnsofan“as

lief(rescue)

riencingem

oom

fyparent/gu

. Ind

foranychil

deinpartn

tionsthatn

iningmedic

lthcarebeli

econsidera

thepatient

ge23ofthi

cordsooth

foranyone

choolnurse.

hentocallf

C/AAPs,the

ion(patient

dallergens

dlikeatraff

sthatare

ionaccordin

ptoms

dicationsAN

edication

’scondition

thmaattack

”

medicationa

rgencysign

rdian

ividu



dwithasth

rshipwitht

edtobema

tionoptions

fsandvalu

ions

familytou

document

rproviders

elsewhoals

TheIPC/AA

rhelp.

basiccompo

andprovide

clight

sedtodeter

gtoplan

D

thatday

”



swrittenby

ofasthmar

lPlan

aintheDa

eprovider/

dewithinth

andmedica

s,including

derstandan

anrefertoi

providesc

identifies

nentstheys

r’s)

inewhat

uthorizedp

quireurgen

ofCa

Caresettin

atient/fami

spartnershi

ionadminis

ulturalcon

beableto

ifneeded.

reforthatc

hattodofo

ouldallcon

edications

escribers

medicalhel

.An“Asthm

yanddayca

include:

rationauth

iderations

arryoutthe

heoriginalc

ild,suchas

rasthmasy

aininclude:

ouldbeuse

fromtheir

Action

estaff

rization

plan

pyisgiven

adivorced

ptoms,



CPoran



 



10



SeeAppendixfor



Asthmatriggersisageneraltermusedtodescribeanythingthatcan

makesomeone’sasthmaworse.Sometriggerscancauseasthma

symptomsquickly,whilesometriggerscausesomeone’sasthmatoo

slowlyandsteadilyworsen.Differe nttypesofasthmatriggersand

stepsthatcanbedonetodecreaseexposurearelistedbelow:



 KeyPoint!

Mostasthmatriggerscanbereducedor

avoided.Thisisanessentialstepin

improvingasthmacontrolandavoiding

theneedforemergencyasthma

treatment!



AirwayIrritants

Airwayirritantsareanythingintheairthatcancauseareactioninthelungs,makingitmoredifficulttobreathe.

Irritantscancauseproblemsforanyone,butyoungchildrenwithasthmahavelungsthatareespeciallysensitive.

*SeeCTDayCareRegulations–page25



Environmentaltobaccosmokeisthesinglemostimportant

airwayirritanttoavoid.Secondhandsmokefromacigarette,

cigar,orpipecontainshundredsofchemicalsthatarepoisons

anddozensofcancercausingsubstances.



KeyPoints!

• Thereisnosafeamountofsecondhandsmoke

• Youcanbreatheinthesmokechemicalslongafteryoucan

nolongerseethesmoke

• Eachyearsecondhandsmoke:

o Causesmorethan25,000childrentodevelop

asthma

o Causesasthmatobeworsenedinthousandsof

children,manyrequiringemergencytreatmentand

hospitalization

o Causesthousandsofchildrenwithoutasthma toget

moreseriousrespiratory(cold)virusesandear

infections

 Whattodo:



9 Neversmokeinany

partofahomeoracar

whereachildwith

asthmaisgoingtobe–

eveniftheyarenot

thereatthetime



9 Encouragepeopletoquitsmoking.The

CTTobaccoQuitLineis:

1‐800‐

QUIT‐NOW



9 Ifsomeonedoessmoke,alwaysgo

outsideandwearacoatorshirtyou

cantakeoffbeforegoingbackin,sothe

smokeparticlesdon’tcomeinside



 6. AsthmaTriggers



 



11



Otherimportantairwayirritantsinclude:

• AirPollutionandcarexhaust

• Perfumes

• Cleaningproducts

• Paint/woodstainingproducts

• Artsupplies

• Aerosolsprays

• Woodburningstovesorfireplaces

• Brandnewcarpetorfurniturewith

odors

 Whattodo:

• Closewindowsifnearhightrafficarea

• Don’tletcarsidlemorethan3minutes(CTlaw)

• UseGreenCleaningsupplies

• Clean,paintanddocertainhomeprojectswhen

childrennotaround

• Don’tuseperfumes,hairsprays,airfresheners,art

supplies,

oranythingwithastrongscentaround

children

• Don’tburnwood,leaves,orgarbage



PestControl



Thebodypartsanddroppingofrodentsand

cockroachescancauseanallergicreaction

thatmakesasthmaworse.Anadditional

concernisthatthepesticidesandspraysthat

manypeopleusetocontrolpestscanbe

seriousairwayirritants,especiallytoyoung

childrenandthosewithasthma.



 Whatto

Do:

9 Cleanupdishes,food,grease,crumbs,andspillsquickly

9 Keepfoodstoredintight,sealedcontainers,includingpet

foods

9 Keepallgarbageinsealedcontainersandtakeout

frequently

9 Repairleakypipesanddrippingfaucets;pestsneedwater

9 Cleanupclutterlikeexcesscardboardand

newspapers

9 Sealcracksinwalls,baseboards,windows,anddoors

9 Usebaittrapsonlyiftheyareoutofreachofchildren

9 Neverusepesticidesprays whenchildrenarearound

9 Ifusingspr ays,avoidwidespreadapplicationbyspraying

smallamountsonlywhereneededandnotonsame

day

childrenwillbepresent

9 Storespraysinasafeplacewherechildrencannottouch

them

*SeeCTDayCareRegulationsSection–page24



KeyPoint:

Themost

importantpartof

pestcontrolis

preventionby

eliminatingpest

access,foodand

watersource



Clea

attr

wor

ben

and

heal

pres

how

eye,





Ana

har

brea

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swel

lung

envi

peo

effe

dete

ofe



Cleani

*SeeCT

ingproduct

ctiveandhe

place.Inad

fitsofcleani

nfectiousag

hfulindoor 

ntseveralh

ver.They

skin,orresp



Allergi



llergyisana

lessformo

hedin,and

ionscanocc

lingandmu

.Mostpeo

onment(in

lehavemild

tonasthma

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arenecess

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ng,therem

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dispo

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normallys

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usproducti

lewithasth

oororoutd

allergies,b

Allergytest

whataller

cts

lationsSect

ryformaint

ionsinthe

bviousaest

valofdust,

ltomaintai

.Cleaningpr

ironmental

emicalsass

ion,orothe

issues.Add

ncentrated

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ctsareclass

dous,creati

ing,storage,

alissuesfor

nsitiveresp

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sesreaction

overaperio

nanywhere

aareallerg

or)thatcan

tforothers,

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ion–page2

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omeand

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oductscan

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oftime,an

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calsthatstil

ngproducts

generalp

bathroom

glassclea

floor finis

handclea

oralabelwi

pendicesof

int!

hingdoesn’

at“cleans

veryirritati

n.



nbe

.These

se

setothe

ly.Some

serious

twayto

severity

napproach

lessirritati

dothejob

renowava

rposeclean

cleaners

ers

esandstrip

sersandso

htheEcoL

SampleofG

haveto“s

ell”(think

gtotheair

KeyPoint!

Themore

identifyw

thechildr

youwillb

andhelp

control.

tousingclea

gfumesand

fcleaning.G

lablefor:

rs

ers

.



goorGreen

reenCleanin

ellclean”to

fbleachan

ays,especi



ouknowab

atcausesa

nyoucaref

abletored

eeptheiras

ning

safer

reen

Seallabel

gRecipes

beclean.In

ammonia)

llyforyoun

outhowto

lergiesfor

r,themore

cethem

hmaunder



 



13



Dustmitesaretinybugsthatyoucan’tsee.

Theyliveandmultiplyincarpets,cloth

furniture,curtains,stuffedanimals,pillows,

bedding,andmattr esses.Theylivebestin

moderatetemperaturesandhumid

conditions.Dustmitesarethemostcommon

allergictriggerforpeoplewithasthma.

KeyPoint!

Roomswheremosttimeisspentaremost

important,especiallythebedroom,sleeping,

andplayareas



 WhattoDo:



9 Ifpillowsareold–getnewones(hypoallergenicarebest)

9 Coverpillows,mattressandboxspringwithallergycovers

o Don’tusepillowsthatcan’tbecovered

o Minimizestuffedanimals,especiallyifnon‐washable

9 Washbeddinginhotwater(atleast130

)weeklyanddry

completely

o Ifbeddingtoobigtowash,putinhotdryerfor20min.

9 Trytokeeproomhumiditylessthan50%usingairconditioning

oradehumidifier,especiallyduringwarmweather

9 Removeasmuchcarpetaspossible

o Dustmitessticktocarpet

fibers

9 Useavacuumwithanallergy(orHEPA)bagandfilter

o Vacuumwhenthechildisnotpresent

9 Checkiffurnaceorairconditioningfiltersneedtobecleanedor

changed



9 Wetcleanwashablesurfacestodecreasedustintheair

Moldgrowswherethereiswetness(visible)

ormoisture(humidity).Moldcanbevisible

inshowers,onwallsandceilings.Itcanalso

beundercarpets,wallpaper,orpanelin g

whereitmaynotbevisible.Anyroomthat

hashighhumidity(bathroom,kitchenor

basement)orhashadanywaterdamage

is

morelikelytohavemold.



KeyPoints!

Moldseldomrequiresprofessionaltesting.A

verypracticalguidelinetogobyis:ifyou

smellmoldorseemold,thereismold.

Moldwillalwaysrecurifthesourceof

wetnessormoistureisnotfixed.

 WhattoDo:

9 Cleanvisiblemoldonhardsurfaceswithagreencleaning

solution

o Donotusecleanerswithstrongscentsorfumes

whenchildrenarearound

9 Fixallsourcesofwaterleaks

9 Useadehumidifier,especiallyinthebasement

o Besuretoemptywhentankisfilled

9 Inspectwallsandceilingsfordiscoloredmoldstains

o Repairorreplace

9 Carpetsthatgetwetforlongerthan48hourswillusually

growmold

o Considerremovingorreplacing

9 Adequateventilation,especiallyinthebathroomand

kitchenhelps

keepmoisturecontrolled

9 Avoidoutdoormoldsinpilesofleaves,grass,orcompost

 



14



Cats,dogs,birdsandotherfurryanimals

causeallergieswiththeir flakingskin

(dander),urine,andtheirsaliva–nottheir

fur.Danderissmallandstickyandcanbe

carriedaroundfrom onebuildingtoanother 

onblankets,clothes,andcoats.Dandercan

stayinahouseformonthsafterananimalis

nolongerthere.



KeyPoint!

Thereisnosuchthingasacompletely

“hypoallergenic”catordog–somearejust

lessallergenictoindividualpeoplethan

others

 WhattoDo:

9 Ifsomeonehasapetallergy,keeppetsoutsideorfindthe

petanewhomeifpossible

9 Ifthepetmuststayinthehome:

o Keeppetsoutofthebedroomandoffcarpetsand

upholsteredfurniture

o Avoidtouching,holding,or

pettinganddon’thold

closetothechild’sfaceofthechildwithasthma

9 Ifyouhaveachildinyourhomewithasthma,newpets

shouldnotbeintroducedwithoutfirstcheckingwiththe

healthcareprovider

9 Ahigh‐efficiencyparticulateair(HEPA)roomaircleaner

mightbe

helpful



Pollen,trees,flowers,grassandweedsare

seasonalallergensthatcanbedifficultto

avoid.



KeyPoint!

Seasonalpeaksofpollens:

Trees–March,April,andMay

Grass–JuneandJuly

Weeds–August,September,andOctober

 WhattoDo:

9 Trytokeepwindowsclosedsopollendoesn’tblowintothe

home,especiallythebedroomorwherethechildsleeps

9 Washhairnightlysopollendoesn’tgetonpilloworbed

9 Checkpollencountsandavoidoutdooractivities

inthe

earlymorningorafternoonwhenpollencountsarethe

highest

9 Donotdryclothesoutdoors



 



15



Afterachild’sasthmaisassessedbyahealthcareprovider,thechild’sindividualtriggersandallergiesareidentified

andstepsaretakentoreduceoreliminateexposuretothesetriggers.Thenextstepistoidentifywhatmedication

willbeneededtohelpwiththeirasthmamanagement.Theprimarymedication

usedtotreatasthmaisuniqueinthat

itistheonlymedicationthatchildrenneedtolearnhowtoinhale.Properinhalationtechniqueisoneofthemost

importantstepstosuccessfulasthmamanagement.Thissectionwilldiscussdifferenttypesofasthmamedication,as

wellasstepsandtips

toensureproperinhalationtechnique.

Therearetwomaincategoriesofasthmamedicationthatarepartofachild’sIPC/AAP:

Quick‐relief(rescue)medicationisusedtotreatincreasedasthmasymptomsandimprovebreathingbyreducing

coughingandwheezingwithinminutesafterinhaling.

• Thismedicationprovidestemporaryreliefbyrelaxing

themusclesthatarewrappedaroundtheairways

• Itisimportanttousethismedicationwhenasthma

symptomsfirstoccurandnotwaituntilthechildactually

looksliketheyarehavingdifficultybreathingorsound

liketheyarewheezing

• Iftheasthmasymptomsworsenordon’timproveafter

givingthismedication,checktheIPC/AAPforguidance

torepeatdoses

o Ifnoimprovementcall911andnotify

parent/guardian



SideEffects:

Usedasprescribed,thesideeffectsarenot

consideredseriousandincludemild

tremors,poundingheart,nervousnessand

restlessness



 7. AsthmaMedication

KeyPoint!

Ifthismedicationneedstobeusedonafrequentorrecurringbasis,anassessmentbythehealthcareprovidermaybe

indicatedtodetermineasthmacontrolandifchangesareneededtotheasthmaplan

Asimpleguidelineisifquick‐reliefmedicationisneededmorethan2x/week

for4weeks,asthmacontrolneedstobe

re‐assessedbythehealthcareprovider

*SeeFluShotRequirementsforDayCare–page25

 



16



Dailycontrol(maintenance)medicationisusedeverydayevenwhenfeelingwell

ControlMedication:

• Reducestheswelling(inflammation)insidetheairways

• Helpspreventacute,uncontrolledasthmaepisodes

(“asthmaattacks”)

• Needstobeusedeveryday,evenwhennothavingany

asthmasymptomsorproblems

• Familiesunsureifdailycontrolmedicationisstill

necessaryshouldbeencouragedtodiscussoptionswith

theirhealthcareprovider

• Themostcommonandeffectivedailycontrol

medicationsareinhaledsteroids

KeyPoint!

Inhaledsteroidsoranydailycontrolmedicationshouldneverbe

usedtotreatacuteasthmasymptoms–theyworkslowlyovera

longperiodoftime



SideEffects:

• Usedasprescribedandwithproper

inhalationtechnique,thesemedications

donothavetheserioussideeffectsof

othertypesofsteroids.

• Thecommonsideeffectsinclude:

o Hoarsevoice

o Thrush(throatinfection‐white

patchesinthemouth)



KeyPoint!

Properinhalationandrinsingmouthoutafter

usingcanusuallypreventsideeffects–

brushingteethisideal



NamesofCommonAsthmaMedicationforChildren



Quick‐relief(rescue) DailyControl(maintenance)



BrandName GenericName DeliveryDevice BrandName GenericName DeliveryDevice

VentolinHFA Albuterol MDI Flovent HFA Fluticasone MDI

ProAirHFA Albuterol MDI

‐Var HFA Beclomethasone MDI

ProventilHFA Albuterol MDI PulmicortRespules Budesonide Nebulizer

Albuterolsolution Albuterol Nebulizer PulmicortFlexhaler Budesonide DPI

Xopenex Levalbuterol Nebulizer AsmanexTwisthaler Mometasone DPI

XopenexHFA Levalbuterol MDI Symbicort

(Pulmicort+Foradil)

Budesonide+

Formoterol

MDI

MDI=MeteredDoseInhaler

DPI=DryPowderInhaler

Nebulizer=anaircompressormachinethatturns

liquidmedicationintoamist



AdvairDiskus

(Flovent+Serevent)

Fluticasone+

Salmeterol

DPI

AdvairHFA

(Flovent+Serevent)

Fluticasone+

Salmeterol

MDI



 



17



MedicationDeliveryDevices

Thereareanumberofdifferentwayschildrencaninhaletheirasthmamedication.Thechoiceofwhichonetouseis

basedonwhatworksbestforanindividualchild.Thetwomostimportantconsiderationsare:

• Whatisthebestasthmamedicineforthechild

• Whatdevicecanbe

usedwiththechildthatgetsthemostasthmamedicineintotheirlungs

Metereddoseinhaler(MDI)isthemostcommonandpractical

medicationdeviceforyoungchildren.TheMDIisasmall

pressurizedmetalcanisterfilledwithasthmamedicationthatis

suspendedinapropellant.Whenthecanisteris

pusheddownin

itsplasticholder,adoseofmedicationis“puffed”out.



KeyPoint!

EvenveryyoungchildrencanuseaMDI;

however,allchildren(andadults)shouldusea

spacer/holdingchamberwiththeirMDI

becauseit:

• Leaveslessmedicineinthemouthand

throat

• Getsmoremedicineintothelungs

whereitneedstogotowork

• Decreasesthechanceofsideeffects,

especiallyfrominhaledsteroids



Thespacerisatubethatallowsthepuffof

medicationtobebreathedinmoreeffectively.

Somespacershavefacemaskstousewith

differentagedchildren.Whenachildisableto

holdaspacerintheirmouth,thefacemaskis

nolonger

needed.



ToUseaSpacer:

1. Shaketheinhalerwellbeforeuse(3‐4shakes)

2. Removethecapfromyourinhalerandfromyour

spacer,ifithasone

3. Puttheinhalerintothespacer

4. Breatheout,awayfromthespacer

5. Bringthespacertoyourmouth,putthemouthpiece

betweenyourteeth

andcloseyourlipsaroundit

6. Pressthetopofyourinhaleronce

7. Breatheinveryslowlyuntilyouhavetakenafull

breath.Ifyouhearawhistlesound,youarebreathing

intoofast.Slowlybreathein.

8. Holdyourbreathforabouttensecondsandthen

breatheout.

 

 



18



SpacerwithMask

1. Followsteps1‐3

2. Holdthespacerwithmasktothefacesothat

boththenoseandmoutharecovered.Itis

importanttomakeagoodsealbetweentheface

andmasksothatallthemedicinegetsbreathed

inthroughthespacer

3. Pressthetop

ofyourinhaleronce

4. Holdthemaskfirmlyinplacewhilethechild

takes4‐6breaths

5. Removethemaskfromthefaceandrepeatif

morethanonepuffisprescribed

6. 

ImportantRemindersAboutSpacersandMDIs

• Alwaysfollowtheinstructionsthatcomewith

yourspacerandMDI(inhaler)

• OnlyuseyourspacerwithaMDI,notwithadry‐

powderinhaler

• WhentheMDIisneworhasn’tbeenusedfora

while,it’sagoodideato“prime”itbypuffinga

dose

outintotheair(awayfromanyone)tomake

sureitisworkingproperly

• Sprayonlyonepuffintoaspaceratatime.

• Useyourspacerassoonasyou'vesprayedapuff

intoit

• Itisveryimportantthatyouconsultyourdoctor,

asthmaeducator

orotherhealthcareprofessional

toreviewproperinhalertechnique

• Neverletanyoneelseuseyourspacer

• Keepyourspacerawayfromheatsources

• Ifyourspacerhasavalvethatisdamaged,orif

anyotherpartofthespacerisdamaged,donot

useit,thespacer

willhavetobereplaced

• Somespacershaveawhistle.Yourtechniqueis

fineifyoudonothearthewhistle.Ifyouhearthe

whistle,youshouldslowyourbreathdown

Tocleanyourspacer(onceaweek)Followtheinstructions

thatcomewithit.Mostwilladviseyouto:

1. Takethespacerapart.

2. Gentlymovethepartsbackandforthinwarmwater

usingamildsoap.Neverusehigh‐pressureorboiling

hotwater,rubbingalcoholordisinfectant.



3. Rinsethepartswellincleanwater.

4. Donotdryinsideofthespacerwithatowelasitwill

causestatic.Instead,letthepartsairdry(for

example,leavethemoutovernight).

5. Putthespacerbacktogether.



TocleaningyourMDI(every2‐3

daysofuse)

1. Takethemetalcanisteroutofthe

plasticholder

2. Neverputthemetalcanisterinwater

orwashit

3. Rinseonlytheplasticholderunder

warmwater

4. Letairdry

5. Replacemetalcanisterand“prime”a

dosebeforeusingagain

 



19



MedicationDeliveryDevices

isamachinethatworkslikeanaircompressor,convertingliquid

medicationintoafinemistthatcanbebreathedin.Itrequiresa

matchingfacemask,oramouthpieceheldinthemouthand

usuallyrequires10–15minutestoadminister.



KeyPoint!

Themedicationmistfromanebulizermustbeindirectcontact

withthechild’smouthusingamaskormouthpiece–mistheld

anydistanceawayfromthemouthwastesmostofthemedication

andverylittleofitisactuallyinhaled





ToUseaNebulizer

1. Setupandpluginthenebulizermachineina

locationwherethepowersourceisclosetoa

comfortablelocationforthemedicationtobe

administered

2. Followthedirectionsforthespecificbrandof

nebulizermachineandcup

3. Mostnebulizercupsunscrewfromthetop

4. Most

nebulizedmedicationcomespackagedina

unit‐doseformat,requiringtheentirecontentsto

besquirtedintothebottomhalfofthenebulizer

cup

5. Screwthetopofthecupbackonandattachthe

tubingfromthecuptothenebulizermachineand

thecupontothefacemask

ormouthpiece

6. Placeeitherthefacemaskonthechildorthe

mouthpieceintheirmouthandturnonthe

machine–amistofmedicationshouldrapidly

appear

7. Instructthechildtotakenormalslowdeep

breaths

8. Thecupmayrequiresometappingonthesides

towardthe

endofthetreatmenttogetallthe

medicinecompleted

9. Thetreatmentiscompletewhenthereisnomore

mistfromthecup

10. Alwaysunplugthemachineafter

eachuseandstoreinacleandry

place



Cleaninganebulizercup

1. Aftereachtreatment,rinsethenebulizercupwithwarmwater,shakeoffexcesswaterandletitairdry.

2. Attheendofeachday,thenebulizercup,mask,ormouthpieceshouldbewashedinwarm,soapywaterusing

amilddetergent,rinsedthoroughly,andallowedtoairdry.



9 Note:Thereisnoneedtocleanthetubingthatconnectsthenebulizertotheaircompressor

9 Donotputthesepartsinthedishwasher

3. Everythirdday,afterwashingyourequipment,disinfecttheequipmentusingavinegar/watersolutionorthe

disinfectantsolutionyoursuppliersuggests.

Tousethevinegarsolution,mix1/2cupwhitevinegarwith1‐1/2cupsofwater.Soaktheequipmentfor30

minutesandrinsewellunderasteadystreamofwater.Shakeofftheexcesswaterandallowtoairdryona

papertowel.Alwaysallowtheequipmenttocompletely

drybeforestoringinaplastic,zipperstoragebag.



Dry

med

able

inha

instr



•

owderInha

cineinthef

tosealtheir

erscomein

uctiononpr

. Holdthe

onthegr

snapsint

. Holdthe

willgo.Y

comforta

. Putthe

through

. Holdyou

theDISK

Prope

•

Shallbe

•

Alwaysr

•

Alwaysc

•

Storeinh

•

Liquidm

9 C

•

Storeme

•

Iftransp

•

Foilpouc

KeyPoint!

Thistypeof

childrenan



er(DPI)isa

rmofafine

lipsaroundi

ifferentsha

peruse.

DISKUS

ino

p.Pushawa

place.

DISKUS

lev

ushouldhe

ble.(Never

outhpiecet

heDISKUS

.

breathfor

.

Storage

toredinasa

adthepack

ecktheexp

lers(MDIs)

dicationfor

ution:liqui

everuseliq

icationsaw

rtingmedic

onotleave

esmaycon

sthmamed

adults

reathactiv

powder.Th

andbreath

pesandsize

ehand.Pla

fromyou,

l.Slidethel

araclick.Br

reatheouti

yourlips.B

bout10sec

ofAsth

emanner,i

geinsertso

rationdate

troomtem

nebulizerss

nebulizers

idnebulizer

yfromdire

tionsonan

nymedicati

ainmedicat

cineisusual

teddevicet

personusi

infastand

–eachone

ethethum

ntilthemo

verawayfr

atheoutas

totheDISK

eatheinqui

nds.Breath

aMedi

accessiblet

eachmedic

nddonotu

erature

ouldnotbe

lutionshoul

medicineth

tsunlight

typeoffiel

nsinacart

on.Onceop

ymoreappr

atdelivers

gaDPIhast

deep.Dryp

requiresspe

oftheothe

thpieceapp

myouasfa

farasis

).

cklyanddee

out.Then

ations

children,al

tionandfol

eafterthel

refrigerated

dlooklike

tiscloudy,

trip,becar

atmightge

ned,datea

priateforo

obe

wder

ific

hand

arsand

asit

ply

LOSE



lowforquic

lowspecific

stdayofth

aterandsh

iscolored,o

fultokeept

extremely

dusebefor

der

accessina

nstructions

monthprin

uldneverb

crystallized

hemfromg

otorcold

expiration

emergency

orstoragea

tedonthe

ingestedby

ttingtooho

ndstorein



duse

edicine

mouth

ortoocold

hepouch



 



21



Allergymedication

Sinceallergiescanbesuchanimportanttriggerforsome

children’sasthmaandnotallallergiescanbeavoided,allergy

medicationisoftenusedaspartoftheIPC/AAP.These

medicationscomeinmanyformsincluding:pills,liquid,

chewabletabletsandnosesprays.



KeyPoint!

Someallergymedicationneedstobetaken

everydayaspartofthecontrolmedicationin

thegreenzoneoftheIPC/AAP,whileother

allergymedicationisusedseasonallyoras

needed



EmergencyAllergyMedication

Somechildrenwithasthmaalsohavelife‐threateningallergies.Themostcommononesare:peanuts,treenuts,

shellfish,fish,milk,andinsectstings.Onlyahealthcareprovidercandetermineifanallergyispotentiallylife‐

threatening,cancausingananaphylacticreactionand/orrequireaprescriptionforanemergencymedication

commonlyknownasanEpiPenorEpiPenJr.AnEpiPenisapre‐filledinjectiondevicethatautomaticallyinjects

epinephrine.Caregiversforchildrenwi thknownlife‐threateningallergiesmustbetrainedinthesignsandsymptoms

ofanaphylaxisandhowtoadministeranEpiPen.Thesechildrenshouldallhaveemergencyallergyplansthatexplain

whattodo.

KeyPoint!

Mostanaphylacticallergyreactionscanbepreventedbyavoidingaccidentalcontactoringestionwithaknown

allergen.Carefullyreadingfoodlabelsandrestrictingthepresenceoffoodthatyouknowachildisallergictoare

essentialtopreventingemergencyallergyreactions.



SymptomsofLIFE‐THREATENINGanaphylaxis:

Usuallyoccurswithinminutes,butmayoccurupto2hoursafterexposure

• Facial,lips,tongueswelling • Itchyskin,hives

• Chesttightness,wheezing,cough,shortnessofbreath • Difficultyswallowing,tightnessinthroat

• Dizziness,fainting,“feelingofimpendingdoom” • Abdominalcramping,nausea,vomiting



*Se



touse

. Flipopen

capofth

. Remove

tube.

. Graspth

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 



23



AdministrationofMedicationsinDayCares

19a‐79‐9a.AdministrationofMedications



 

*SeeAppendicesforSampleForm



*SeeAppendicesforsampleofIndividual

PlanofCareform



 Agroupdaycarehomeorchilddaycarecentershallnotdenyservices

toachildonthebasisofachild'sdiagnosisof

asthmaorbecausea

childhasaprescriptionforaninhalantmedicationtotreatasthma.



(b)AdministrationofMedicationsOtherThanNonprescriptionTopical

Medications

inhalant medication used to treat asthma on site during all hours when

a child who has a diagnosis of asthma and who has a prescription for

an inhalant medication to treat asthma is on-site.



(D)Thefacilityshallhavestafftrainedintheuseofanautomatic

prefilledcartridgeinjectororsimilarautomaticinjectableequipment

used

totreatanallergicreactiononsiteduringallhourswhenachild

withaprescriptionforanautomaticprefilledcartridgeinjector or

similarautomaticinjectableequipmentusedtotreatanallergic

reactionison‐site.



(3)OrderFromAnAuthorizedPrescriber/Parent'sPermission

(A)Exceptfornonprescriptiontopicalmedications

describedin

section19a‐79‐9a(a)(1)oftheRegulationsoftheConnecticutState

Agencies,nomedication,prescriptionornonprescriptionshallbe

administeredtoachildwithoutthewrittenorderofanauthorized

prescriberandthewrittenpermissionofthechild'sparent(s)which

shallbeonfileatthefacility

foratleasttwo(2)yearsafterthechildis

nolongerattendingtheprogram.



(5)StorageandLabeling

(A)Medicationshallbestoredintheoriginalchild‐resistantsafety

container.Thecontainerorpackagingshallhavealabelwhich

includesthefollowinginformation:

(i)thechild'sname;

(ii)the

nameofthemedication;

(iii)directionsforthemedication'sadministration;and

(iv)thedateoftheprescription.



8. DayCareRegulationsandStatutes

KeyPoint!

StateDayCareLicensingrequires

anIndividualPlanofCarein

additiontoamedication

authorization.

 



24



CleaningandDisinfecting

19a‐79‐7a. Physical Plant Toilet and

WashingFacilities



19a‐79‐10. Physical  Plant Linens and

ClothingandBedding



19a‐79‐10.ToysandOtherObjects







SanitizersandDisinfectantsforDayCares



*UsetheEnvironmentalProtection

Agenciesdefinitionandlistofapprove d

productsat:http://www.epa.gov/



 

 (G)(5)Walls,

ceilings,floorsandrugsshallbemaintainedinastateof

goodrepairandbewashableoreasilycleanable. 



(2)Allchildren'slinensshallbewashedatleastweeklyandasneeded.

(4) When cribs and cots are shared, they must be washed and

disinfectedandlinenschangedbetweenchildren.



(1) Toys used for infants shall be kept separate, washed and

disinfected atleast daily. Toys for toddlers, includingfloor and riding

toys,shallbewashedanddisinfectedatleastweekl yandasneeded.





Environment

19a‐79a.PesticideApplicationsatDay

CareFacilities



*PublicActNo.99‐165,Sec.2Pesticide

ApplicationsatSchoolsandDayCare

Centers.Thisisinadditiontowhatisin

theStateLicensingDayCareRegulations.



(b)Noapplicationofpesticidemaybemadeinanybuildingoronthe

groundsofanychilddaycarecenter,group daycarehomeorfamily

daycarehome,eachasdescribedinsection19a‐77,duringregular

businesshoursexceptthatanemergencyapplicationmaybemadeto

eliminate

animmediatethreattohumanhealthif(1)itisnecessaryto

maketheapplicationduringregularbusinesshours,and(2)such

emergencyapplicationdoesnotinvolvearestrictedusepesticide,as

definedinsection22a‐47.Nochildenrolledatsuchcenterorhome

mayenteranareawhere

pesticideshavebeenapplieduntilitissafe

todosoaccordingtotheprovisions onthepesticidelabel.

*Sec.2.(NEW)OnandafterJuly1,2000,noperson,otherthana

pesticideapplicatorwithsupervisorycertificationmayapplypesticide



KeyPoint!

Sanitizer–Asanitizerreducesbutdoesnotnecessarilyeliminate

microorganismsonatreatedsurfacetolevelsthatareconsidered

acceptableaccordingtocurrenthealthcodesorregulations.EPA

registersfood‐contactsurface sanitizersforsurfacessuchassanitizing

rinsesfordishes,utensilsandfoodprocessingequipment,andnon

‐

food‐contactsurfacesanitizers.

Disinfectant–Adisinfectantdestroysorirreversiblyinactivates

microorganisms,butnotnecessarilytheirspores,onhard,inanimate

surfacesandobjects.EPAregistersthreetypesofdisinfectantsbased

onthetypeofefficacydatasubmitted:Limited,General(orBroad‐

spectrum),andHospital.

 



25



Smoking

19a‐79‐7aPhysicalPlant



 (9)Smokingisprohibitedinallchilddaycarecentersorgroupdaycare

homesandoutdoorareasexceptindesignatedsmokingareas,

providedtheseareasareseparate,properlyventilatedandenclosed

awayfromanychildrenpresentatthefacility.Signsshallbeposted,

visible

tothepublic,onentrancetothefacilityindicatingthatsmoking

isprohibitedexceptindesignatedareas.Matchesandlightersshallbe

inaccessibletochildrenatalltimes.



FluShotRequirementsforDayCares



*FluGuidancechangeseachseasonto

ensureyouhavethemostup‐to‐dateflu

informationvisit: 

http://www.flu.gov/prof essional/school/



 InaccordancewithConnecticutGeneralStatutes(CGS)19a‐7f

(StandardofCareforImmunizationofChildreninConnecticut),

childrenwhoareenrolledorareenrolling

inalicensedfamilydaycare

home,alicensedchilddaycarecenteroralicensedgroupdaycare

homearerequiredtoshowproofofimmunitytoinfluenza.



ByJanuary1,2011andeachJanuary1thereafter,childrenaged6–59

monthsattendingachilddaycarecenter,groupdaycare

home,or

familydaycarehomeshallreceiveatleastonedoseofinfluenza

vaccinebetweenSeptember1andDecember31ofthepreceding

year.IfchildrenarevaccinatedduringAugustwiththeupcoming

seasonalfluvaccine,thesevaccinationswillbeacceptedandcount

towardthemandaterequirement.Allchildren

aged6–59monthswho

havenotreceivedvaccinationagainstinfluenzapreviouslyshall

receive2dosesofvaccine thefirstinfluenzaseasonthattheyare

vaccinated.ChildrenenrollingbetweenJanuary1andMarch31shall

receiveinfluenzavaccinepriortodaycareentry.Childrenenrolling

afterMarch31duringanygivenyearare

notmandatedtomeetthe

influenzavaccinerequirementuntilthefollowingJanuary,asthe

influenzaseasonhasgenerallypassedbythisdateandvaccinemayno

longerbeavailable.



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 

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

SampleFormsFlyers&Brochures



1. AsthmaActionPlan



2. AsthmaFriendlyChildCareChecklistfor

ParentsandProviders



3. DailyAsthma/AllergyCommunication

(English/Spanish)



4. IndividualPlanofCareForm



5. MedicationConsentForm





1. AsthmaTriggersintheChildCareEnvironment



2. CDCFluGuidelines



3. GreenCleaningRecipes



4. HowdoIKnowifmyChildShouldgottoChild

CareToday(English/Spanish)



5. CTNursesAssociation‐MedicationTraining



6. MajorCausesofFoodAllergies



7. QuitLine‐SmokingCessation



8. TipsforFamilieswhohaveChildrenwithAsthma

(English/Spanish)



 



 10.HandoutsandForms

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29



GovernmentAgencies



ConnecticutDepartmentofPublicHealth

AsthmaProgramWebpage



ConnecticutDepartmentofPublicHealth

DaycareLicensingProgram



ConnecticutDepartmentofPublicHealth

TobaccoProgramWebpage



 Providesthelatestinformationandeducationforchildcare

providers,children,and,parentsContacttheAsthmaProgramat

(860)509‐8251

www.ct.gov/dph/asthma 

Providesthelatestinformationandeducationforchildcare

providersTheChildDayCareLicensingHelpDeskiscoveredeach

dayduringcustomarybusinesshourstoassis tyouwithgeneral

questionsconcerningthelicensingregulationsandrequirements,

thechilddaycarelicensingprogram'spoliciesandprocedures,

verifystaffapprovalorother

generalinformation.Contactthe

DaycareProgramat(860)‐509‐8045http://www.ct.gov/dph/

Provideseducationinformationforthegeneralpublicandparents

ofchildrenregardingsmokeexposureandothertopicsrelatedto

smokingaswellassmokingcessationprograms.Contactthe

TobaccoProgramat(860)509‐8251

http://www.ct.gov/dph/

tobacco 



Parents



AsthmaMoms



YouCanControlAsthma:ABookforthe

FamilyandYouCanControlAsthma:A

BookforKids



TheFamilyDoctor

 



Anetworkofconcernedparentsofchildrenwithasthma.

Providesextensivelistsoflinkstoasthma‐relatedinformationfor

families,includingresourcesaboutasthmatriggers,medications,

legislation,medicalliterature,statistics,initiatives,andcamps.

InformationinSpanishisavailable.www.asthmamoms.com



Asetofeasy‐to‐readbooksinbothSpanishandEnglish.

Onebook

isforthefamilyandtheotherisforchildrenages6‐12tohelp

learneverythingaboutasthma.Orderbytelephone800‐7‐

ASTHMA.(AsthmaandAllergyFoundationofAmerica)



Asthmarelatedhealthinformationforthewholefamilybythe

AmericanAcademyofFamilyPhysicians.

http://familydoctor.org/online/famdocen/home/common/asthm

a/basics/014.html





 



30



Trainings

DayCareStaff:AmericanLung

Association



DayCareStaff:ConnecticutNurses

Association



DayCareNurseConsultants:Train‐the‐

trainercurriculumforlicensedmedical

consultants



AisForAsthma

Apreschooleducationalprogramdesignedforchildcare

professionalsinEnglishandSpanish.ItwasdevelopedbyChildren's

TelevisionWorkshopandfundedbythePrudentialFoundationfor

theAmericanLungAssociati on.Thefullybi‐lingualpackage

includes:a15‐minutevideo,aCaregiverGuidetosharewithother



adultsinyourchildcareprogramandaposterthatreinforcesthe

video'simportantmessages.Toorder,pleasecalltheAmerican

LungAssociationofConnecticutat(860)289‐5401orthenational

numberat800‐LUNGUSA.



MedicationAdministrationTraining

http://www.ctnurses.org/

ConnecticutMedicationAdministrationinEarlyEducationand

ChildCareSettingshttp://www.ct.train.org



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RespiratorySystem

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Sanitizer

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Triggers

 

Adeviceforadministeringmedicationsbyinhalation.



Amachinethatpumpsairthroughaliquidmedicinemakingthemedicine

bubbleuntilafinemistisformedthatisbreathedin.Itis

usuallyusedinthe

hospitaloratthedoctor’soffice.



Asmalltube‐likehand‐helddeviceusedtomeasurethespeedatwhicha

personcanpushairoutoftheirlungs.Monitoringpeakflowcantellhowwell

asthmaisbeingcontrolledevenbeforesymptomsappear.



Short

termmedicationsthatprovideimmediaterelieftotheairwaysduring

anasthmaattack.



Thegroupoforgansresponsibleforbreathing.Thisincludesthenose,throat,

airways,andthelungs.



Anagentreducestheamountofbacteriaonasurface.



Adevicethatattachestoaninhalerthathelpsdirect

themedicationintothe

lungs.Theseareusefulforveryyoungchildrenwhohavedifficultygetting

adequatemedicineintotheirlungswithaninhaleralone.



Physicalchangesorfeelingsexpressedhatshowadiseaseorconditionexists.

Forasthma,thesemaybecoughing,wheezing,breathingdifficulty,ora

tightnessin

thechest.



Activities,conditions,orsubstancesthatcausetheairwaystoreactand

asthmasymptomstooccur.Someexamplesofpossibleasthmatriggersare

dustmites,mold,changesintemperature,tobaccosmoke,andfurrypets.

Triggersaredifferentforeachperson.



 

Name: Birth Date: Date:

Parent/Guardian Phone #’s: Provider Phone #:

Fax #:

(or stamp)

Important! Things that make your asthma worse (Triggers): ☒ smoke ☐ pets ☐ mold ☐ dust

☐ tree/grass/weed pollen ☐ colds/viruses ☐ exercise ☐ seasons: other:

Severity Classification: ☐ Severe Persistent ☐ Moderate Persistent ☐ Mild Persistent ☐ Intermittent



Make an appointment with your primary care provider within two days of an emergency visit, hospitalization, or anytime for ANY problem or question with asthma

SchoolNurse:Call provider for control concerns or if rescue medication is used more than 2 times/week for asthma symptoms

Parents: Call your doctor for control concerns or if rescue medication is used more than 2 times/week for asthma symptoms

EALTHCARE PROVIDER SCHOOL MEDICATION AUTHORIZATION REQUIRED FOR ___________________as stated in accordance with CT State Law and Regulations 10-212a

Self–Administration:  This student is capable to safely and properly self-administer this medication OR  This student is not approved to self-administer this medication

Signature:_________________________________Provider Printed Name:___________________________Date:_____________ For use from ______ to ______

Parent/Guardian Consent: REQUIRED

 I authorize this medication to be administered by school personnel OR  I authorize the student to possess and self-administer medication.

I also authorize communication between the prescribing health care provider, the school nurse, the school medical advisor and school-based clinic providers necessary for

asthma management and administration of this medication.

Parent/Guardian Signature: ____________________________________ Date: _____________ * Bring asthma meds and spacer to all visits

You have any of these:

 First signs of a cold

 Exposure to known trigger

 Cough

 Wheeze

 Tight chest

 Coughing at night

Your asthma is

getting worse fast:

 Medicine is not helping

 Breathing is hard and fast

 Nose opens wide

 Can’t talk well

 Getting nervous

GO – You’re Doing Well! USE THESE MEDICINES EVERY DAY TO PREVENT SYMPTOMS

CAUTION – Slow Down! Continue with Green Zone Medicine and Add:

DANGER

–

Get Hel

! TAKE THESE MEDICINES

ND SEE

MEDICAL HELP NOW!

You have all of these:

 Breathing is good

 No cough or wheeze

 Sleep through

the night

 Can work

and play

CONTROLLER MEDICINE DIRECTIONS

___________________________________ ______________________________________

☐Ifyourchildusuallyhassymptomswithexercisethengive:

___________________________________ ______________________________________

 Inhalers work better with spacers. Always use with a mask when prescribed.

RESCUE MEDICINE DIRECTIONS



___________________________________________________________________________

Then:Wait20minutesandseeifthetreatment(s)helped

 IfyouareGETTINGWORSEorNOTIMPROVINGafterthetreatment(s)GOTOREDZONE

 IfyouareBETTER,continuetreatmentsevery4to6hoursasneededfor24to48hours

Then: Ifyoustillhavesymptomsafter24hours,CALLYOURDOCTORandifhe/sheagrees:

 Start:

________________________________________________________________



Ifrescuemedicationisneededmorethan2timesaweek,callyourdoctorat:_______________________

RESCUE MEDICINE DIRECTIONS



_____________________________________________________________________________

Then: Wait15minutesandseeiftreatmenthelped

 IfGETTINGWORSEorNOTIMPROVING,gotothehospitalorcall911

 IfyouaregettingBETTER,continuetreatmentsevery4to6hoursandcallyourdoctor–sayyouare

havinganasthmaattackandneedtobeseenTODAY

!

Then: Ifyourdoctoragrees,start:_________________________________________________

Peak Flow may be useful

for some kids.

Asthma Action Plan

Ages 0 – 11 Years

STATE OF CONNECTICUT

DEPARTMENT OF PUBLIC HEALTH

www.ct.gov/dph/asthma

STATE OF CONNECTICUT

DEPARTMENT OF PUBLIC HEALTH

www.ct.gov/dph/asthma

Nombre de paciente: Fecha de nacimiento: Fecha:

# teléfono del Padre/Guardián: # teléfono del Médico:

# fax:

¡Importante! Cosas que hace peor el asma: □ humo □ mascotas □ moho □ polvo

□ polen de árbol/hierba □ resfriado/virus □ ejercício □ cambio de clima: □ otras cosas:

Clasificación de Severidad: □ Severo persistente □ Moderado persistente □ Leve persistente □ Leve Intermitente

 Haga una cita con su proveedor de cuidado primario dentro de dos días a partir de una visita al ED o una hospitalización, o en cualquier momento para cualquier

problema o pregunta sobre asma.

SchoolNurse:Call provider for control concerns or if rescue medication is used more than 2 times/week for asthma symptoms

Padre/Guardián: Llame al médico para discutir preguntas sobre control del asma o si uso de medicina de rescate es más que 2 veces/semana

EALTHCARE PROVIDER SCHOOL MEDICATION AUTHORIZATION REQUIRED FOR ___________________as stated in accordance with CT State Law and Regulations 10-212a

Self–Administration:  This student is capable to safely and properly self-administer this medication OR  This student is not approved to self-administer this medication

Signature:_________________________________Provider Printed Name:___________________________Date:_____________ For use from ______ to ______

Padre/Guardián: OBLIGATARIO

 Autorizo al empleados medicos de la escuela para dar estas medicinas a mi niño/a O  Autorizo al estudiante para tener estas medicinas y tomárselas a si mismo

Autorizo también la comunicación, entre el médico que prescribe las medicinas, la enfermera escolar, el consejero médico escolar, y professionales de clínica basados en la

escuela que es necesario para el manejo de asma y administración de estas medicinas.

Firma del Padre/Guardián: ___________________________ Fecha: _____________ Traiga medicinas para asma y espaciador a todas citas.

Rápidamente, su asma

está empeorando:

 La medicina no le ayuda

 Respiración es difícil y rápido

 Las fosas nasales se abre ancha

 No puede hablar bien

 Se

one nervioso

Si tiene estos sintomas:

 Síntomas iniciales del resfriado

 Contacto con alguna cosa que

provoca asma

 Tos

 Sibilancia

 Pecho apretado

 Tos por la noche

Usted tiene todos estos

sintomas:

 Respira bien

 No hay tos o sibilancias

 Duerme toda la noche

 Puede trabajar y jugar

Proceda – ¡Está haciendo bien! USE ESTAS MEDICINAS CADA DÍA PARA PREVENIR SÍNTOMAS

PRECAUCIÓN – ¡Detengase! Continúe con medcina de la Zona Verde y Añade:

MEDICINA DE CONTROL COMO DEBERÍA TOMARLA

___________________________________ ______________________________________

☐SiporlogeneralsuniñotienesÍntomasdeasmaduranteelejercicio,déle:

___________________________________ ______________________________________

 Inhaladores funciona mejor con un espaciador.

Siempre use con el espaciador con mascarilla o boquilla.

MEDICINA DE RESCATE COMO DEBERÍA TOMARLA



___________________________________________________________________________

Entonces:Espere20minutosyevalúesieltratamientoayudó

 SiESTÁEMPEORANDOoNOHAYMEJORÍAdespuésdeltratamiento,PROCEDAALAZONAROJA

 SiHAYMEJORÍA,continúeconlamedicinaendosisindicadacada4a6horascomonecesario

durante24a48horas

Entonces:Sitodavíatienesíntomasdespúesde24horas,LLAMEASUMÉDICO.Sié

l/ellaestádeacuerdo:

 Empiece:________________________________________________________________



Sinecesitamedicinaderescatemásquedosvecesenunasemana,llameasumédico:_________________

MEDICINA DE RESCATE COMO DEBERÍA TOMARLA



_____________________________________________________________________________

Entonces:Espere15minutosyevalúesieltratamientoayudó

 SiESTÁEMPEORANDOoNOHAYMEJORÍA,vayaalhospitalollame911

 SiHAYMEJORÍA,continúeconlamedicinaendosisindicadacada4a6horasyllameasumédico–

DígalequeestáteniendounataquedeasmaynecesitaunacitaHO

Y!

Entonces:Siél/ellaestádeacuerdo,empiece:_________________________________________________

Información sobre flujo máximo

podría ser útil para niños que no

perciben bien sus síntomas.

Plan de Acción Contra el Asma

Niños 0 – 11 años

PELIGRO

–

Obten

a a

uda! TOME ÉSTAS MEDICIN

SYCOJA

YUDA MEDICA AHORA MISMO!

■

TIPS for PARENTS with CHILDREN with ASTHMA

 Letthechildcareproviderknowthatyourchildhasasthma.



 Determinewhetherornotyourchildcareprovideradministers

medication.



 Letthechildcareproviderknow:

 Whattriggersyourchild’sasthma

 Ifyourchildistakinganymedications

 Thesymptomsyourchildusuallyexhibitsbeforean

attack



 Provideacopyofyourchild’sAsthmaActionPlan.Makesureboth

youandtheproviderunderstandtheAsthmaActionPlanandagree

onthestepstofollow.TheAAPdescribesstepstotakeifachildwith

asthmaisexperiencinganyasthmasymptoms.



 IfyourchilddoesnothaveanAsthmaActionPlan(AAP),talktoyour

healthcareprovideraboutgettingone.Besuretodiscussstepsto

takeintheeventoftheasthmaattack,ifyourchilddoesn’thavean

AsthmaActionPlan.



 Ifyourchildrequiresasthmamedication,besuretogivethechild

careprovidermedicationintheoriginalpharmacycontainer.

MedicationmustalwaysbeaccompaniedbyaMedication

AuthorizationFormcompletedbythechild’shealthcareprovider.



 Talktoyourchildcareproviderregularlyaboutyourchild’sasthma.

Itisagoodideaforparentsandproviderstocommunicateaboutthe

child’sasthmasignsorsymptomseveryday.



 Makesurethecontactinformationyougiveyourchild

careprovideriscurrentandup‐to‐date.Thisisvery

important,sothatyoucanbereachedinthecaseofan

emergency.

How Do I Know if My Child

Should Go to Child Care Today?

May attend child care if:

 Child has a stuffy nose, but no wheezing

 Child has wheezing which goes away after taking medication

 Child is able to perform usual activities (getting dressed,

eating) without using extra effort to breathe

The child should not attend child care if:

 Wheezing or coughing continues after treatment

 Child has trouble breathing or is breathing fast

 Child has a fever over 100 degrees

 Child is too weak or tired to take part in normal

activities (dressing self, eating)

Adapted from: Illinois Department of Human Services

StateofConnecticutDepartmentofPublicHealth

CommunityHealthandPrevention

AsthmaProgram

410CapitolAvenue,MS#11HLS,POBox340308

Hartford,CT06134‐0308

Phone:(860)509‐8251,Fax:(860)509‐7854



http://www.ct.gov/dph/asthma

Fish

Milk

Eggs

Peanuts*

Shellfish

Soy

Tree Nuts

(Walnuts, Pecans)

Wheat

*Peanuts are the leading cause of severe allergic reactions.

From The Food Allergy Network

Breathe Easy While Cleaning

Hazardous chemicals can often be found in common cleaning products. For example, products containing

ammonia or chlorine bleach are highly irritating to the lungs and are harmful to the environment if disposed

improperly. Companies are not required to list ingredients so you may not be able to tell if hazardous

chemicals are in the product. Protect yourself by looking for the signal word on product labels. Below

is a chart to help you understand what the signal words mean. Look for environmentally-friendly,

healthier cleaning products that are now available in most stores or you can make your own.

For more information and recipes (such as furniture polish and drain cleaner), visit www.ct.gov/deep/greencleaning.

CT Department of Environmental Protection, 79 Elm St., Hartford, CT 06106-5127, (860) 424-3297. Revised 03/2012

Recipes for Healthy Cleaners

All Purpose Cleaner – Pour 3 Tablespoons vinegar, 1 teaspoon borax and 2 cups hot water into a spray bottle.

Shake until dissolved. Then add 1 teaspoon liquid soap (or dishwashing liquid) to the bottle and shake it again. Spray

on surface and then wipe clean. For tough dirt, leave cleaner on for a few minutes and then wipe off.

Glass Cleaner – Pour 2 Tablespoons of vinegar and 2 cups of water into a spray bottle. Add 2 drops of

liquid soap (or dishwashing liquid) and shake to mix. Spray on glass and wipe with lint-free cloth. Dry off

with a second lint-free cloth.

Sink, Tub and Tile Cleaner – Sprinkle on baking soda, rub with wet sponge or scrub cloth and rinse.

For mineral deposits, soak a cloth in vinegar and leave it on the deposit for about an hour and then

clean off area. For soap scum deposits, spread liquid soap or clarifying shampoo on the surface and

leave it for about an hour. The deposits will be softened and then can be cleaned away with a scrub

cloth or a brush. For mold or mildew, make a paste of borax and water and put it on the surface to

be cleaned. Leave paste on the area for about an hour and then scrub it off.

Toilet Bowl Cleaner – Squirt vinegar from squeeze bottle under the rim. Pour about ½ cup borax into

the toilet and use a toilet brush to clean the bowl. For mineral deposits, leave mixture in toilet for at

least an hour. Then use the brush again to clean. Use the all-purpose cleaner and a sponge or scrub cloth

to clean the seat and outside of the bowl.

Oven Cleaner – Make sure oven is turned off. Make a paste of baking soda and

water and put on the sides and bottom of the oven. Let it set overnight. Scoop out baking soda and

then wipe clean with damp cloth. Use scouring pad for tough spots.

Hazard Level

Signal

Word

What the Label Means

MOST DANGEROUS

POISON

Highly toxic

DANGER

Extremely flammable,

corrosive or highly toxic

WARNING

Moderate hazard

LEAST DANGEROUS

CAUTION

Mild or moderate hazard

Tobacco Use Cessation Programs in Connecticut

Connecticut Quitline

Telephone Tobacco Use Cessation Assistance available 7 days a week

1-800-QUIT-NOW, or 1-800-784-8669

Birmingham Group Health Services, Inc. ***

435 East Main Street

Ansonia, CT 06401

Attn: Pamela Mautte

203-736-8566

Harbor Health Services***

14 Sycamore Way

Branford, CT 06405

Attn: Maggie Goodwin

203-483-2630 Ext. 241

Bridgeport Hospital QuitSmart

267 Grant Street

Bridgeport, CT 06610

Attn: Gretchen May Fendo

203-336-7375

St. Vincent’s Medical Center Foundation

Teen Smoke Stoppers Program

2800 Main Street

Bridgeport, CT 06606

Attn: Mary Ellen Bolcer

203-576-5451

Mountainside Treatment Center

Nicotine Anonymous

P.O. Box 717

Canaan, CT 06018

Attn: Matt Eikan

800-762-5433

Danbury Hospital

Quit Now Smoking Cessation Program

24 Hospital Avenue

Danbury, CT 06810

Attn: Marianne Mitchell

203-739-8161

United Services, Inc. ***

1007 North Main Street

PO Box 839

Dayville, CT 06241

Attn: Earl Henrichon

860-774-2020

American Lung Assoc. Helpline

45 Ash Street

East Hartford, CT 06108

Attn: Michelle Marichal

860-838-4370

Intercommunity, Inc. ***

281 Main Street

East Hartford, CT 06118

Attn: Jessica LeRoy

860-690-1707

Town of Fairfield

725 Old Post Road

Fairfield, CT 06824

Attn: Sarah Levy

203-256-3150

Uconn Health Center

Smoking Cessation

263 Farmington Ave

Farmington, CT 06032

Attn: Peter Krzykowski

860-679-3136

Attn: Karen

860-372-8418

Greenwich Hospital

Community Health Smoke Stoppers

5 Perryridge Road

Greenwich, CT 06830

Attn: Diane DeMain

203-863-3786

Ledge Light Health District

943 North Road

Groton, CT 06340

Attn: Kerensa Mansfield

860-448-4882

Town of Guilford Health Dept.

VNA Community Healthcare

50 Boston Street

Guilford, CT 06437

Attn: Kathy Hand

203-458-4239

Hartford Behavioral Health ***

One Main Street

Hartford, CT 06106

Attn: Judith Vazquez

860-727-8703

Hartford Hospital

80 Seymour Street

Hartford, CT 06102

Attn: Jeremy Barbagallo

860-545-3127

St. Francis Hospital & Medical

Center

Break Free From Smoking

114 Woodland Street

Hartford, CT 06105

Attn: Sally Lerman

877-783-7262

Rushford Center ***

883 Paddock Avenue

Meriden, CT 06450

Attn: Melissa Hall

203-630-5280

City of Meriden **

Dept. of Health and Human

Services

165 Miller Street

Meriden, CT 06450

Attn: Geralyn Laut

203-630-4003

Life Changes LLC

193 Main Street

Middletown, CT. 06457

Attn: Andrew Degling

860-944-1171

Middlesex Hospital Center for

Chronic Care Management **

80 South Main Streets

Middletown, CT 06457

Attn: Beth Roberts

860-358-3003

Bridges: A Community Support

System ***

949 Bridgeport Avenue

Milford, CT 06460

Attn: Jane Skolnick

203-878-6365

BecomeAnEX.org

Re-learn Life Without Cigarettes

National Alliance for Tobacco Cessation

Milford Hospital Education

Dept, Freedom From Smoking

300 Seaside Avenue

Milford, CT 06460

Attn: Diane Frankel Gramelis

203-876-4003

AIDS Project New Haven, Inc.

1302 Chapel Street

New Haven, CT 06511

Attn: Seph Mayo

203-624-0947 Ext. 227

Fair Haven Community Health

Clinic, Inc.

374 Grand Ave

New Haven, CT 06513

Attn: Anne Somsel

203-777-7411

Fellowship Place***

441 Elm Street

New Haven, CT 06511

Attn: Carol Legmen

203-401-4227 Ext. 127

Hospital of Saint Raphael **

Haelen Center

1450 Chapel Street

New Haven, CT 06511

Attn: Doreen DeCerbo

203-789-4146

Yale School of Medicine

50 York Street

New Haven, CT 06511

Attn: Susan Neveu

203-974-7588

VA CT Healthcare System

Smoking Cessation Treatment

555 Willard Avenue

Newington, CT 06111

Attn: Regina Gilbert

860-594-6302

New Milford Hospital Freshstart

21 Elm Street

New Milford, CT 06776

Attn: Dorothy Christman

203-794-5429

Newtown Health District *

3 Primrose Street

Newtown, CT 06470

Attn: Donna Culbert

203-270-4291

Girl Scouts of Connecticut

20 Washington Avenue

North Haven, CT 06473

Attn: Cathy Monckton

203-239-2922 Ext 3342

Norwalk Hospital Stop Smoking

34 Maple Street

Norwalk, CT 06856

Attn: Margaret Haggerty

203-852-2484

Day Kimball Hospital

Wellness Program

320 Pomfret Street

Putnam, CT 06260

Judith Hansen

860-928-6541 Ext. 2015

The Stamford Hospital

Tully Health Care Center

32 Strawberry Hill Court

Stamford, CT 06904

Attn: Mary Judge

203-276-7875

Charlotte Hungerford Hospital

Pulmonary Education (FFS)

Fill Online, Printable, Fillable, Blank Revised 2011 (Connecticut Office of Early Childhood) Form

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