Revised 2011
1
ManagingAsthmainConnecticutChild
CareFacilities
TableofContents
Page
1. Purpose/Acknowledgments 2
CaringforaChildwithAsthma:Checklist 3
3. AsthmaFacts 4
a. WhatisAsthma? 4
b. WhatCausesAsthma? 4
c. HowisAsthmaDiagnosedinYoungChildren? 5
d. SignsandSymptomsofAsthma 5
i. EarlywarningSigns 5
ii. Emergency
Signs 6
iii. WhatToDoforanAsthmaEmergency(“Asthma
Attack”)
6
4. AsthmaControl 8
5. IndividualPlanofCare(IPC)canbeanAsthmaActionPlan 9
6. IdentifyingandAvoidingAsthmaTriggersandAllergens 10
a. AirwayIrritantsandTobaccoSmoke 10
b. PestControl 11
c.
CleaningProducts/Allergens 12
7. AsthmaMedication 15
a. Quickrelief(Rescue)Medication 15
b. ControlMedication 16
c. HowtoAdministerAsthmaMedication 17
d. AsthmaMedicationsStorage 20
e. EmergencyAllergyReactions(Anaphylaxis) 21
8. DaycareRegulationsandStatutes 23
9. NurseConsultant/AsthmaEducator 26
10. HandoutsandForms
27
11. Resources 28
12. GlossaryofTerms 31

2
1. Acknowledgements & Purpose
Theintentofthismanualistoprovideresourcesandguidanceforprogramsthatcareforchildrenintheirpreschool
years.TheregulationscitedthroughoutthemanualareapplicabletofacilitieslicensedbytheConnecticut
DepartmentofPublicHealth(DPH).
ProgramsinschoolsettingsnotlicensedbyDPHare
coveredbyfederalregulationsthatmayormaynotbethesame
astheregulationscontainedinthisdocument.Programsinthesesettingsmustbeawareofandcomplywiththe
applicableregulationsfortheagencythatprovidestheiroversightandcompliance.
TheStateofConnecticutDPH,AsthmaProgramwouldlike
toacknowledgeandgivecredittothemanyindividuals
andagencieswhogavetheirtimeandsharedresourcestoupdateandrevisethisguideinordertoprovidea
comprehensivemanualtochildcareproviders.
Disclaimer:
ThisguideisNOTAPOLICYMANDATE.
Instead,itisdesignedtoserveasa
resourcefordaycaresinmanagingasthmaanddoesnotsupersedeanyofthe
provisionsoftheRegulationsofConnecticutStateAgenciesSections19a791athrough19a7913thatgovernchild
daycarecentersandgroupdaycarehomes.Furthermore,thisguideisnotintendedtoendorseany
particularbrand
ofproductdiscussedorshowninitspages.Picturesanddescriptionsofsuchproductsareforillustrativepurposes
only.Finally,thisguideisforeducationalpurposesonly.Itisnotintendedtoreplacethemedicaladviceorservicesof
alicensedhealthcareprovider.
ReneeD.ColemanMitchell,M.P.H.EileenBoulay,B.S.N.,R.N.
SectionChief,HealthEducation,ProgramSupervisor,AsthmaProgram
Management&SurveillanceConnecticutDepartmentofPublicHealth
ConnecticutDepartmentofPublicHealth
ElizabethD.Reynolds,B.S.N.,R.N.,NCSN SalinaHargrove,B.S.
NurseConsultant,AsthmaProgramHealthProgramAssistant,AsthmaProgram
ConnecticutDepartmentof
PublicHealth ConnecticutDepartmentofPublicHealth
ValerieBryan,R.N.JoanSimpson,M.P.H.S.
DayCareLicensingEnvironmental&OccupationalHealthIndoorAirQuality
SupervisingNurseConsultantConnecticutDepartmentofPublicHealth
ConnecticutDepartmentofPublicHealth
DevonConover,M.S.
DivisionofCommunityBasedRegulation
ConnecticutDepartmentofPublicHealth
Permissionwasgrantedtoreprintand/oradaptcomponentsfromthefollowing:
AmericanAcademyofAllergy,AsthmaandImmunology AmericanCollegeofChestPhysicians
CaliforniaChildcareHealthProgramCentersforDiseaseControlandPrevention
3
2. CaringforaChildwithAsthma


CHECKLIST
Learnthebasicsaboutasthma
9 Whatisasthma?
9 Whatcausesasthma?
9 Signsandsymptoms
9 Howisitdiagnosed?
9 Asthmacontrol
Knowyourresponsibilitiesasachildcareprovider
9 Whichchildrenhaveasthma
9 Howyouhelpthemavoidthethingsthatmaketheirasthmaworse
9 Howyougivethemasthmamedicine
9 Howyouusetheirasthmaplans
9 Whatdoyoudoinanasthmaemergency
KnowtheConnecticutstatelawsandregulations
9 Medicationauthorizationsandadministration
9 Cleaninganddisinfectants
9 Environmentalrequirements
9 Illnessprocedures
9 Healthconsultants

Knowwhereelsetofindmoreinformationaboutasthmaandenvironmentalhealth

4
3. AsthmaFacts
WhatisAsthma?
Asthmaisaverycommonchroniclungdiseasethat
affectspeopleofallages.Asthmacausestheairway
passagesinthelungstobecomenarrow,makingit
hardertogetairinandoutofthelungs.Whenasthmais
notwellcontrolleditcausesepisodesofdayornighttime
coughing,breathlessness,chesttightness,andwheezing.
Theproblemthatmakesasthmaachronicdiseaseis:
Inflammation(swelling)oftheliningofthe
airways(bronchusorbronchioles).
Whentheairwaysareinflameditmakesthemmore
sensitiveandlikelytohaveserioussymptomswhen
exposedtoasthmatriggerscausing:
Tightening(constricting)ofthemusclesthatare
wrappedaroundtheairways
Increasingmucusthatclogstheairways
WhatCausesAsthma?
Asthmaisnotcontagious.Thereisnotonespecificthingthatcausessomeonetodevelopasthma.Whatwedoknow
isthattherearecertainriskfactorsthatmakeitmorelikelyforchildrentodevelopasthma,including:
Ifanimmediatefamilymemberhasasthma(heredity)
Ifthechildhashadeczema(dry,itchyskincondition)
Ifthechildhasfoodorenvironmentalallergies
Somechildrenfirstdevelopasthmasymptomsafterarespiratorycoldvirus.Althoughcoldvirusesdon’tcause
asthma,theyareanimportanttriggerformostyoungchildrenthatcanresultinsomeone’sfirstorrecurringasthma
episodes.Anychildwhomightbeatriskfordevelopingasthmacanhavetheirasthmamadeworsebyexposureto
tobaccosmoke,anyotherformofairpollution,orenvironmentalallergens.
5
HowisAsthmaDiagnosedinChildren?
Asthmacanbedifficulttodiagnoseinyoungchildren.Healthcareprovidersusenationalguidelinestoidentifyhealth
historyinformation,questionnaires,andphysicalexamfindingstoassistinthediagnosisofasthma.Recurringasthma
symptomssuchaswheezing,difficultybreathing,andexcessivecoughingareusedalongwiththechild’sfamilyand
medicalhistorytohelpmakethediagnosis.
Somechildrenundertheageof5yearsoldhaveahistoryofasthmathattheydoseemtooutgrow.Otherchildren
developasthmaatayoungageandhaveittherestoftheirlives.Childrenover5yearsoldmaybeabletoperforma
spirometrytestthatmeasureshowtheairflowsinandoutoftheirlungs.Thesetestsandassessmentsaredoneat
thechild’sPrimaryCareProvider(PCP)orapulmonaryorallergyspecialist.
AsthmaSignsandSymptoms
EarlyWarningSignsandSymptoms
VisibleSigns
Breathingharderandfasterthanusual
Excessiveoruncontrollablecoughing
o Whensleeping
o Whenawake
o Whenactive
Exercising
Laughing
Crying
Anyhardblowing
Unusuallytired/notwantingtoplay
Appearsworried,fearful,orirritable
VerbalStatements
Childrenhavedifferentwaysofdescribingwhattheir
asthmafeelslike.Somecommonphrasesare:
“it’shardtobreathe”
“ithurtstobreathe”
“mychestfeelstight”
“mythroathurtswhenIbreathe
6
Emergencysignsandsymptoms:“AsthmaAttack”
Whenasthmagetssobadthaturgentoremergencymedicalcareisneededitisoftenrefe rredtoasan“asthma
attack”.However,theterm“asthmaattack”canactuallybemisleadi ng. Most“asthmaattacks”canbeprevented
byfollowingachild’swrittenasthmaplan,stayingondailycontrolmedications,avoidingasthmatriggersand
allergens,recognizingtheearlysignsandsymptoms,andproperlyadministeringmedication.
Signsthatachildmaybehavinganemergencyasthma(orbreathing)probleminclude:
Thechildisstrugglingtobreath(hardandfast),evenwhenresting
Youcanhearthechildwheezingwithoutastethoscope
Thechildishavingdifficultytalking,concentrating,orwalking
Thechildcan’tseemtocatchhisorherbreath
Thechild’slipsorfingernailsappearblueorgray
Paleorsweatyskin
Thechildappearsextremelyexhaustedorlethargic
Thechild’schestorneckmusclesseemtobe“suckedin”witheachbreath
Whattodoforachildhavinganemergencyasthmaproblem(“asthmaattack”)
1. Staycalm,don’tleavethechildaloneandhelpthechildtorelaxasmuchaspossibl e
2. FollowtheIPCorasthmaactionplan(AAP)REDZONE
3. Givequickrelief(rescue)medicineimmediately
4. Call911,notifyparent
*Whentocall911*
Childisunresponsive
Breathingissodifficultthechildcan’twalkortalk
Lipsorfingertipslookgrayorblue
Therescuemedicineisnotworkingafter10or15minutes

KeyPoint:
Anytimeyouarenotsureandthinkitisan
emergency,itisbettertocall911thanitistowait
toolong.
Whenyoucall,don’thangupuntilthe911operator
tellsyouto.

7
7
8
Onceasthmaisdiagnosed,childrenneedtohaveaPCPwhoisaccessibletothefamily,assessesthechild’sasthmaon
aregularbasis,andworkswiththefamilytodevelopandreviseappropriatewrittenasthmaplans.Ongoing
assessmentofasthmacontrolisoneofthekeystomaintainingeffectiveasthmamanagementitishowhealthcare
providersdetermineifthechildisonthecorrectmedicineandhowwelltheyareabletoavoidthethingsthatmake
theirasthmaworse.
Goodasthmacontrolis:
Whenthechildcanplayandexercisejustlikeanyoneelsetheiragewhodoesnothaveasthma
Mostdaysthechilddoesnotcough,wheezeorfeelshortofbreath
Thechildcansleepthroughthenight(ornaps)withoutcoughingorwakingupwithuncomfortable
breathing
Thechilddoesnotneedtousequickrelief(rescue)medicinemorethantwiceaweek
Youandthef amilycancontributevaluableasthmacontrolinformationtothePCP,including:
Frequencyofdayornightcoughing
Abilitytoplayatthesamephysicallevelasotherchildren
Frequencyofusingquickrelief(rescue)medicine
Missedschool,daycare,orparentalworkdaysduetoasthma
Thefollowingisachartofthetypeofquestionsusedtohelpdetermineasthmacontrol:
Inthepast4weeks:
WellControlled
NotWellControlled
VeryPoorly
Controlled
1. Howmanytimesdidyourasthmagetinthewayor
stopyoufromdoinganactivityathome,schoolor
play?
None
Sometimes Frequently
2. Howmanytimesdidyouwheeze,cough,feeltightin
thechest,orhavetroublebreathing?
8orless,butnotmore
thanonceperday
Morethan8,or
morethanonceper
day
Everyday
3. Howmanytimesdidyourasthmawakeyouupatnight
ormakeithardtosleep?
1orless
24 Morethan4
4. Howmanytimesdidyouhavetouseyourrescue
inhalerornebulizer(albuterolorxopenex)?
8orless
Morethan8 Atleasteveryday
Answersinthese
boxesshouldindicate
goodasthmacontrol
Anyanswersinthese
sectionscould
indicatetheneedfor
anasthmavisit
Anyanswersin
theseboxes
indicatesthe
needtocallfor
anasthmavisit
4. AsthmaControl
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SeeAppendixfor
Asthmatriggersisageneraltermusedtodescribeanythingthatcan
makesomeone’sasthmaworse.Sometriggerscancauseasthma
symptomsquickly,whilesometriggerscausesomeone’sasthmatoo
slowlyandsteadilyworsen.Differe nttypesofasthmatriggersand
stepsthatcanbedonetodecreaseexposurearelistedbelow:
KeyPoint!
Mostasthmatriggerscanbereducedor
avoided.Thisisanessentialstepin
improvingasthmacontrolandavoiding
theneedforemergencyasthma
treatment!
AirwayIrritants
Airwayirritantsareanythingintheairthatcancauseareactioninthelungs,makingitmoredifficulttobreathe.
Irritantscancauseproblemsforanyone,butyoungchildrenwithasthmahavelungsthatareespeciallysensitive.
*SeeCTDayCareRegulationspage25
Environmentaltobaccosmokeisthesinglemostimportant
airwayirritanttoavoid.Secondhandsmokefromacigarette,
cigar,orpipecontainshundredsofchemicalsthatarepoisons
anddozensofcancercausingsubstances.
KeyPoints!
Thereisnosafeamountofsecondhandsmoke
Youcanbreatheinthesmokechemicalslongafteryoucan
nolongerseethesmoke
Eachyearsecondhandsmoke:
o Causesmorethan25,000childrentodevelop
asthma
o Causesasthmatobeworsenedinthousandsof
children,manyrequiringemergencytreatmentand
hospitalization
o Causesthousandsofchildrenwithoutasthma toget
moreseriousrespiratory(cold)virusesandear
infections
Whattodo:
9 Neversmokeinany
partofahomeoracar
whereachildwith
asthmaisgoingtobe
eveniftheyarenot
thereatthetime
9 Encouragepeopletoquitsmoking.The
CTTobaccoQuitLineis:
1800‐
QUITNOW
9 Ifsomeonedoessmoke,alwaysgo
outsideandwearacoatorshirtyou
cantakeoffbeforegoingbackin,sothe
smokeparticlesdon’tcomeinside
6. AsthmaTriggers
11
Otherimportantairwayirritantsinclude:
AirPollutionandcarexhaust
Perfumes
Cleaningproducts
Paint/woodstainingproducts
Artsupplies
Aerosolsprays
Woodburningstovesorfireplaces
Brandnewcarpetorfurniturewith
odors
Whattodo:
Closewindowsifnearhightrafficarea
Don’tletcarsidlemorethan3minutes(CTlaw)
UseGreenCleaningsupplies
Clean,paintanddocertainhomeprojectswhen
childrennotaround
Don’tuseperfumes,hairsprays,airfresheners,art
supplies,
oranythingwithastrongscentaround
children
Don’tburnwood,leaves,orgarbage
PestControl
Thebodypartsanddroppingofrodentsand
cockroachescancauseanallergicreaction
thatmakesasthmaworse.Anadditional
concernisthatthepesticidesandspraysthat
manypeopleusetocontrolpestscanbe
seriousairwayirritants,especiallytoyoung
childrenandthosewithasthma.
Whatto
Do:
9 Cleanupdishes,food,grease,crumbs,andspillsquickly
9 Keepfoodstoredintight,sealedcontainers,includingpet
foods
9 Keepallgarbageinsealedcontainersandtakeout
frequently
9 Repairleakypipesanddrippingfaucets;pestsneedwater
9 Cleanupclutterlikeexcesscardboardand
newspapers
9 Sealcracksinwalls,baseboards,windows,anddoors
9 Usebaittrapsonlyiftheyareoutofreachofchildren
9 Neverusepesticidesprays whenchildrenarearound
9 Ifusingspr ays,avoidwidespreadapplicationbyspraying
smallamountsonlywhereneededandnotonsame
day
childrenwillbepresent
9 Storespraysinasafeplacewherechildrencannottouch
them
*SeeCTDayCareRegulationsSectionpage24
KeyPoint:
Themost
importantpartof
pestcontrolis
preventionby
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access,foodand
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Clea
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ctsthathav
e
i
calsthatstil
l
ngproducts
a
9
generalp
u
9
bathroom
9
glassclea
n
9
floor finis
h
9
handclea
n
f
oralabelwi
t
p
pendicesof
o
int!
t
hingdoesn’
t
h
at“cleans
m
e
veryirritati
n
e
n.
s
a
nbe
s
.These
u
se
o
setothe
l
ly.Some
serious
s
twayto
e
severity
a
napproach
t
e
lessirritati
n
l
dothejob
o
a
renowava
i
u
rposeclean
e
cleaners
n
ers
h
esandstrip
p
n
sersandso
a
t
htheEcoL
o
SampleofG
t
haveto“s
m
m
ell”(think
o
n
gtotheair
w
KeyPoint!
Themore
y
identifyw
h
thechildr
e
youwillb
e
andhelp
k
control.
tousingclea
n
gfumesand
o
fcleaning.G
i
lablefor:
e
rs
p
ers
a
ps
.
o
goorGreen
reenCleanin
m
ellclean”to
o
fbleachan
d
w
ays,especi
a
y
ouknowab
h
atcausesa
l
e
nyoucaref
o
e
abletored
u
k
eeptheiras
t
1
2
ning
safer
G
reen
Seallabel
gRecipes
beclean.In
d
ammonia)
a
llyforyoun
g
outhowto
l
lergiesfor
o
r,themore
u
cethem
t
hmaunder
2
g
13
Dustmitesaretinybugsthatyoucan’tsee.
Theyliveandmultiplyincarpets,cloth
furniture,curtains,stuffedanimals,pillows,
bedding,andmattr esses.Theylivebestin
moderatetemperaturesandhumid
conditions.Dustmitesarethemostcommon
allergictriggerforpeoplewithasthma.
KeyPoint!
Roomswheremosttimeisspentaremost
important,especiallythebedroom,sleeping,
andplayareas
WhattoDo:
9 Ifpillowsareoldgetnewones(hypoallergenicarebest)
9 Coverpillows,mattressandboxspringwithallergycovers
o Don’tusepillowsthatcan’tbecovered
o Minimizestuffedanimals,especiallyifnon‐washable
9 Washbeddinginhotwater(atleast130
0
)weeklyanddry
completely
o Ifbeddingtoobigtowash,putinhotdryerfor20min.
9 Trytokeeproomhumiditylessthan50%usingairconditioning
oradehumidifier,especiallyduringwarmweather
9 Removeasmuchcarpetaspossible
o Dustmitessticktocarpet
fibers
9 Useavacuumwithanallergy(orHEPA)bagandfilter
o Vacuumwhenthechildisnotpresent
9 Checkiffurnaceorairconditioningfiltersneedtobecleanedor
changed
9 Wetcleanwashablesurfacestodecreasedustintheair
Moldgrowswherethereiswetness(visible)
ormoisture(humidity).Moldcanbevisible
inshowers,onwallsandceilings.Itcanalso
beundercarpets,wallpaper,orpanelin g
whereitmaynotbevisible.Anyroomthat
hashighhumidity(bathroom,kitchenor
basement)orhashadanywaterdamage
is
morelikelytohavemold.
KeyPoints!
Moldseldomrequiresprofessionaltesting.A
verypracticalguidelinetogobyis:ifyou
smellmoldorseemold,thereismold.
Moldwillalwaysrecurifthesourceof
wetnessormoistureisnotfixed.
WhattoDo:
9 Cleanvisiblemoldonhardsurfaceswithagreencleaning
solution
o Donotusecleanerswithstrongscentsorfumes
whenchildrenarearound
9 Fixallsourcesofwaterleaks
9 Useadehumidifier,especiallyinthebasement
o Besuretoemptywhentankisfilled
9 Inspectwallsandceilingsfordiscoloredmoldstains
o Repairorreplace
9 Carpetsthatgetwetforlongerthan48hourswillusually
growmold
o Considerremovingorreplacing
9 Adequateventilation,especiallyinthebathroomand
kitchenhelps
keepmoisturecontrolled
9 Avoidoutdoormoldsinpilesofleaves,grass,orcompost
14
Cats,dogs,birdsandotherfurryanimals
causeallergieswiththeir flakingskin
(dander),urine,andtheirsalivanottheir
fur.Danderissmallandstickyandcanbe
carriedaroundfrom onebuildingtoanother
onblankets,clothes,andcoats.Dandercan
stayinahouseformonthsafterananimalis
nolongerthere.
KeyPoint!
Thereisnosuchthingasacompletely
“hypoallergenic”catordogsomearejust
lessallergenictoindividualpeoplethan
others
WhattoDo:
9 Ifsomeonehasapetallergy,keeppetsoutsideorfindthe
petanewhomeifpossible
9 Ifthepetmuststayinthehome:
o Keeppetsoutofthebedroomandoffcarpetsand
upholsteredfurniture
o Avoidtouching,holding,or
pettinganddon’thold
closetothechild’sfaceofthechildwithasthma
9 Ifyouhaveachildinyourhomewithasthma,newpets
shouldnotbeintroducedwithoutfirstcheckingwiththe
healthcareprovider
9 Ahighefficiencyparticulateair(HEPA)roomaircleaner
mightbe
helpful
Pollen,trees,flowers,grassandweedsare
seasonalallergensthatcanbedifficultto
avoid.
KeyPoint!
Seasonalpeaksofpollens:
TreesMarch,April,andMay
GrassJuneandJuly
WeedsAugust,September,andOctober
WhattoDo:
9 Trytokeepwindowsclosedsopollendoesn’tblowintothe
home,especiallythebedroomorwherethechildsleeps
9 Washhairnightlysopollendoesn’tgetonpilloworbed
9 Checkpollencountsandavoidoutdooractivities
inthe
earlymorningorafternoonwhenpollencountsarethe
highest
9 Donotdryclothesoutdoors
15
Afterachild’sasthmaisassessedbyahealthcareprovider,thechild’sindividualtriggersandallergiesareidentified
andstepsaretakentoreduceoreliminateexposuretothesetriggers.Thenextstepistoidentifywhatmedication
willbeneededtohelpwiththeirasthmamanagement.Theprimarymedication
usedtotreatasthmaisuniqueinthat
itistheonlymedicationthatchildrenneedtolearnhowtoinhale.Properinhalationtechniqueisoneofthemost
importantstepstosuccessfulasthmamanagement.Thissectionwilldiscussdifferenttypesofasthmamedication,as
wellasstepsandtips
toensureproperinhalationtechnique.
Therearetwomaincategoriesofasthmamedicationthatarepartofachild’sIPC/AAP:
Quickrelief(rescue)medicationisusedtotreatincreasedasthmasymptomsandimprovebreathingbyreducing
coughingandwheezingwithinminutesafterinhaling.
Thismedicationprovidestemporaryreliefbyrelaxing
themusclesthatarewrappedaroundtheairways
Itisimportanttousethismedicationwhenasthma
symptomsfirstoccurandnotwaituntilthechildactually
looksliketheyarehavingdifficultybreathingorsound
liketheyarewheezing
Iftheasthmasymptomsworsenordon’timproveafter
givingthismedication,checktheIPC/AAPforguidance
torepeatdoses
o Ifnoimprovementcall911andnotify
parent/guardian
SideEffects:
Usedasprescribed,thesideeffectsarenot
consideredseriousandincludemild
tremors,poundingheart,nervousnessand
restlessness
7. AsthmaMedication
KeyPoint!
Ifthismedicationneedstobeusedonafrequentorrecurringbasis,anassessmentbythehealthcareprovidermaybe
indicatedtodetermineasthmacontrolandifchangesareneededtotheasthmaplan
Asimpleguidelineisifquickreliefmedicationisneededmorethan2x/week
for4weeks,asthmacontrolneedstobe
reassessedbythehealthcareprovider
*SeeFluShotRequirementsforDayCarepage25
16
Dailycontrol(maintenance)medicationisusedeverydayevenwhenfeelingwell
ControlMedication:
Reducestheswelling(inflammation)insidetheairways
Helpspreventacute,uncontrolledasthmaepisodes
(“asthmaattacks”)
Needstobeusedeveryday,evenwhennothavingany
asthmasymptomsorproblems
Familiesunsureifdailycontrolmedicationisstill
necessaryshouldbeencouragedtodiscussoptionswith
theirhealthcareprovider
Themostcommonandeffectivedailycontrol
medicationsareinhaledsteroids
KeyPoint!
Inhaledsteroidsoranydailycontrolmedicationshouldneverbe
usedtotreatacuteasthmasymptomstheyworkslowlyovera
longperiodoftime
SideEffects:
Usedasprescribedandwithproper
inhalationtechnique,thesemedications
donothavetheserioussideeffectsof
othertypesofsteroids.
Thecommonsideeffectsinclude:
o Hoarsevoice
o Thrush(throatinfectionwhite
patchesinthemouth)

KeyPoint!
Properinhalationandrinsingmouthoutafter
usingcanusuallypreventsideeffects
brushingteethisideal
NamesofCommonAsthmaMedicationforChildren
Quickrelief(rescue) DailyControl(maintenance)
BrandName GenericName DeliveryDevice BrandName GenericName DeliveryDevice
VentolinHFA Albuterol MDI Flovent HFA Fluticasone MDI
ProAirHFA Albuterol MDI
Q
Var HFA Beclomethasone MDI
ProventilHFA Albuterol MDI PulmicortRespules Budesonide Nebulizer
Albuterolsolution Albuterol Nebulizer PulmicortFlexhaler Budesonide DPI
Xopenex Levalbuterol Nebulizer AsmanexTwisthaler Mometasone DPI
XopenexHFA Levalbuterol MDI Symbicort
(Pulmicort+Foradil)
Budesonide+
Formoterol
MDI
MDI=MeteredDoseInhaler
DPI=DryPowderInhaler
Nebulizer=anaircompressormachinethatturns
liquidmedicationintoamist
AdvairDiskus
(Flovent+Serevent)
Fluticasone+
Salmeterol
DPI
AdvairHFA
(Flovent+Serevent)
Fluticasone+
Salmeterol
MDI
17
MedicationDeliveryDevices
Thereareanumberofdifferentwayschildrencaninhaletheirasthmamedication.Thechoiceofwhichonetouseis
basedonwhatworksbestforanindividualchild.Thetwomostimportantconsiderationsare:
Whatisthebestasthmamedicineforthechild
Whatdevicecanbe
usedwiththechildthatgetsthemostasthmamedicineintotheirlungs
Metereddoseinhaler(MDI)isthemostcommonandpractical
medicationdeviceforyoungchildren.TheMDIisasmall
pressurizedmetalcanisterfilledwithasthmamedicationthatis
suspendedinapropellant.Whenthecanisteris
pusheddownin
itsplasticholder,adoseofmedicationis“puffed”out.
KeyPoint!
EvenveryyoungchildrencanuseaMDI;
however,allchildren(andadults)shouldusea
spacer/holdingchamberwiththeirMDI
becauseit:
Leaveslessmedicineinthemouthand
throat
Getsmoremedicineintothelungs
whereitneedstogotowork
Decreasesthechanceofsideeffects,
especiallyfrominhaledsteroids
Thespacerisatubethatallowsthepuffof
medicationtobebreathedinmoreeffectively.
Somespacershavefacemaskstousewith
differentagedchildren.Whenachildisableto
holdaspacerintheirmouth,thefacemaskis
nolonger
needed.

ToUseaSpacer:
1. Shaketheinhalerwellbeforeuse(34shakes)
2. Removethecapfromyourinhalerandfromyour
spacer,ifithasone
3. Puttheinhalerintothespacer
4. Breatheout,awayfromthespacer
5. Bringthespacertoyourmouth,putthemouthpiece
betweenyourteeth
andcloseyourlipsaroundit
6. Pressthetopofyourinhaleronce
7. Breatheinveryslowlyuntilyouhavetakenafull
breath.Ifyouhearawhistlesound,youarebreathing
intoofast.Slowlybreathein.
8. Holdyourbreathforabouttensecondsandthen
breatheout.

18
SpacerwithMask
1. Followsteps13
2. Holdthespacerwithmasktothefacesothat
boththenoseandmoutharecovered.Itis
importanttomakeagoodsealbetweentheface
andmasksothatallthemedicinegetsbreathed
inthroughthespacer
3. Pressthetop
ofyourinhaleronce
4. Holdthemaskfirmlyinplacewhilethechild
takes46breaths
5. Removethemaskfromthefaceandrepeatif
morethanonepuffisprescribed
6.
ImportantRemindersAboutSpacersandMDIs
Alwaysfollowtheinstructionsthatcomewith
yourspacerandMDI(inhaler)
OnlyuseyourspacerwithaMDI,notwithadry
powderinhaler
WhentheMDIisneworhasn’tbeenusedfora
while,it’sagoodideato“prime”itbypuffinga
dose
outintotheair(awayfromanyone)tomake
sureitisworkingproperly
Sprayonlyonepuffintoaspaceratatime.
Useyourspacerassoonasyou'vesprayedapuff
intoit
Itisveryimportantthatyouconsultyourdoctor,
asthmaeducator
orotherhealthcareprofessional
toreviewproperinhalertechnique
Neverletanyoneelseuseyourspacer
Keepyourspacerawayfromheatsources
Ifyourspacerhasavalvethatisdamaged,orif
anyotherpartofthespacerisdamaged,donot
useit,thespacer
willhavetobereplaced
Somespacershaveawhistle.Yourtechniqueis
fineifyoudonothearthewhistle.Ifyouhearthe
whistle,youshouldslowyourbreathdown
Tocleanyourspacer(onceaweek)Followtheinstructions
thatcomewithit.Mostwilladviseyouto:
1. Takethespacerapart.
2. Gentlymovethepartsbackandforthinwarmwater
usingamildsoap.Neverusehighpressureorboiling
hotwater,rubbingalcoholordisinfectant.

3. Rinsethepartswellincleanwater.
4. Donotdryinsideofthespacerwithatowelasitwill
causestatic.Instead,letthepartsairdry(for
example,leavethemoutovernight).
5. Putthespacerbacktogether.
TocleaningyourMDI(every23
daysofuse)
1. Takethemetalcanisteroutofthe
plasticholder
2. Neverputthemetalcanisterinwater
orwashit
3. Rinseonlytheplasticholderunder
warmwater
4. Letairdry
5. Replacemetalcanisterand“prime”a
dosebeforeusingagain
19
MedicationDeliveryDevices
isamachinethatworkslikeanaircompressor,convertingliquid
medicationintoafinemistthatcanbebreathedin.Itrequiresa
matchingfacemask,oramouthpieceheldinthemouthand
usuallyrequires1015minutestoadminister.
KeyPoint!
Themedicationmistfromanebulizermustbeindirectcontact
withthechild’smouthusingamaskormouthpiecemistheld
anydistanceawayfromthemouthwastesmostofthemedication
andverylittleofitisactuallyinhaled

ToUseaNebulizer
1. Setupandpluginthenebulizermachineina
locationwherethepowersourceisclosetoa
comfortablelocationforthemedicationtobe
administered
2. Followthedirectionsforthespecificbrandof
nebulizermachineandcup
3. Mostnebulizercupsunscrewfromthetop
4. Most
nebulizedmedicationcomespackagedina
unitdoseformat,requiringtheentirecontentsto
besquirtedintothebottomhalfofthenebulizer
cup
5. Screwthetopofthecupbackonandattachthe
tubingfromthecuptothenebulizermachineand
thecupontothefacemask
ormouthpiece
6. Placeeitherthefacemaskonthechildorthe
mouthpieceintheirmouthandturnonthe
machineamistofmedicationshouldrapidly
appear
7. Instructthechildtotakenormalslowdeep
breaths
8. Thecupmayrequiresometappingonthesides
towardthe
endofthetreatmenttogetallthe
medicinecompleted
9. Thetreatmentiscompletewhenthereisnomore
mistfromthecup
10. Alwaysunplugthemachineafter
eachuseandstoreinacleandry
place
Cleaninganebulizercup
1. Aftereachtreatment,rinsethenebulizercupwithwarmwater,shakeoffexcesswaterandletitairdry.
2. Attheendofeachday,thenebulizercup,mask,ormouthpieceshouldbewashedinwarm,soapywaterusing
amilddetergent,rinsedthoroughly,andallowedtoairdry.

9 Note:Thereisnoneedtocleanthetubingthatconnectsthenebulizertotheaircompressor
9 Donotputthesepartsinthedishwasher
3. Everythirdday,afterwashingyourequipment,disinfecttheequipmentusingavinegar/watersolutionorthe
disinfectantsolutionyoursuppliersuggests.
4.
Tousethevinegarsolution,mix1/2cupwhitevinegarwith11/2cupsofwater.Soaktheequipmentfor30
minutesandrinsewellunderasteadystreamofwater.Shakeofftheexcesswaterandallowtoairdryona
papertowel.Alwaysallowtheequipmenttocompletely
drybeforestoringinaplastic,zipperstoragebag.
Dry
P
med
i
able
inha
l
instr
1
2
3
4
P
owderInha
l
i
cineinthef
o
tosealtheir
l
erscomein
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uctiononpr
o
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onthegr
i
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o
2
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willgo.Y
o
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t
4
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theDISK
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Prope
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Shallbe
s
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e
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Storeinh
a
Liquidm
e
9 C
a
9
N
Storeme
d
Iftransp
o
9
D
Foilpouc
h
KeyPoint!
Thistypeof
a
childrenan
d
l
er(DPI)isa
b
o
rmofafine
lipsaroundi
d
ifferentsha
o
peruse.
DISKUS
®
ino
n
i
p.Pushawa
y
o
place.
DISKUS
®
lev
e
o
ushouldhe
ble.(Never
b
m
outhpiecet
o
t
heDISKUS
®
.
r
breathfor
a
U
S
®
.
r
Storage
toredinasa
f
e
adthepack
a
h
ecktheexp
i
a
lers(MDIs)
a
e
dicationfor
a
ution:liqui
d
N
everuseliq
u
d
icationsaw
a
o
rtingmedic
a
D
onotleave
a
h
esmaycon
t
a
sthmamed
i
d
adults
b
reathactiv
a
powder.Th
e
t
andbreath
e
pesandsize
s
n
ehand.Pla
c
y
fromyou,
u
e
l.Slidethel
e
araclick.Br
e
b
reatheouti
n
o
yourlips.B
r
a
bout10sec
o
ofAsth
m
f
emanner,i
n
a
geinsertso
f
i
rationdate
a
a
troomtem
nebulizerss
h
d
nebulizers
o
u
idnebulizer
a
yfromdire
c
a
tionsonan
y
a
nymedicati
o
t
ainmedicat
i
i
cineisusual
l
a
teddevicet
h
e
personusi
n
e
infastand
s
eachone
c
ethethum
b
u
ntilthemo
u
e
verawayfr
o
e
atheoutas
n
totheDISK
U
r
eatheinqui
o
nds.Breath
e
m
aMedi
c
n
accessiblet
o
f
eachmedic
a
a
nddonotu
s
p
erature
h
ouldnotbe
o
lutionshoul
medicineth
a
c
tsunlight
y
typeoffiel
d
o
nsinacart
h
i
on.Onceop
e
l
ymoreappr
o
h
atdelivers
n
gaDPIhast
o
deep.Dryp
o
requiresspe
c
b
oftheothe
r
u
thpieceapp
e
o
myouasfa
r
farasis
U
S
®
).
cklyanddee
e
out.Then
C
c
ations
o
children,al
a
tionandfol
l
s
eafterthel
a
refrigerated
dlooklike
w
a
tiscloudy,
d
d
trip,becar
e
h
atmightge
t
e
ned,datea
n
o
priateforo
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o
wder
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r
hand
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asit
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C
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i
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w
aterandsh
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r
e
fultokeept
t
extremely
h
n
dusebefor
e
l
der
k
accessina
n
i
nstructions
f
e
monthprin
o
uldneverb
e
r
crystallized
hemfromg
e
h
otorcold
e
expiration
a
n
emergency
f
orstoragea
n
tedonthe
m
e
ingestedby
e
ttingtooho
t
a
ndstorein
t
2
0
n
duse
m
edicine
mouth
t
ortoocold
t
hepouch
0
21
Allergymedication
Sinceallergiescanbesuchanimportanttriggerforsome
children’sasthmaandnotallallergiescanbeavoided,allergy
medicationisoftenusedaspartoftheIPC/AAP.These
medicationscomeinmanyformsincluding:pills,liquid,
chewabletabletsandnosesprays.
KeyPoint!
Someallergymedicationneedstobetaken
everydayaspartofthecontrolmedicationin
thegreenzoneoftheIPC/AAP,whileother
allergymedicationisusedseasonallyoras
needed
EmergencyAllergyMedication
Somechildrenwithasthmaalsohavelifethreateningallergies.Themostcommononesare:peanuts,treenuts,
shellfish,fish,milk,andinsectstings.Onlyahealthcareprovidercandetermineifanallergyispotentiallylife
threatening,cancausingananaphylacticreactionand/orrequireaprescriptionforanemergencymedication
commonlyknownasanEpiPenorEpiPenJr.AnEpiPenisaprefilledinjectiondevicethatautomaticallyinjects
epinephrine.Caregiversforchildrenwi thknownlifethreateningallergiesmustbetrainedinthesignsandsymptoms
ofanaphylaxisandhowtoadministeranEpiPen.Thesechildrenshouldallhaveemergencyallergyplansthatexplain
whattodo.
KeyPoint!
Mostanaphylacticallergyreactionscanbepreventedbyavoidingaccidentalcontactoringestionwithaknown
allergen.Carefullyreadingfoodlabelsandrestrictingthepresenceoffoodthatyouknowachildisallergictoare
essentialtopreventingemergencyallergyreactions.
SymptomsofLIFETHREATENINGanaphylaxis:
Usuallyoccurswithinminutes,butmayoccurupto2hoursafterexposure
Facial,lips,tongueswelling Itchyskin,hives
Chesttightness,wheezing,cough,shortnessofbreath Difficultyswallowing,tightnessinthroat
Dizziness,fainting,“feelingofimpendingdoom” Abdominalcramping,nausea,vomiting
Ho
w
1
2
3
4
5
6
7
8
*Se
e
K
D
O
K
T
c
w
touse
1
. Flipopen
capofth
e
2
. Remove
b
tube.
3
. Graspth
e
downwa
r
4
. Withoth
e
5
. Holdthe
o
6
. Swingan
d
clicks.Th
e
thethigh
.
7
. Holdfirm
seconds
t
8
. Remove
n
seconds.
e
ResourcesS
K
eyPoint!
D
ONOTINJ
E
O
NLYINJEC
T
K
eyPoint!
T
heautoinj
e
c
lothing.
anEpiPe
theyellowc
e
EpiPenJrc
a
b
ytippingan
e
carriertub
e
r
dbyformin
g
e
rhandpull
o
o
rangetipn
e
d
firmlypus
h
e
injectorsh
o
.
lyagainstth
e
t
odeliverth
e
n
eedleand
m
ectionforIn
f
E
CTINTOBU
T
INTOOUTE
R
e
ctorisdesig
n
norEpi
P
apoftheEpi
a
rriertube.
dslidingito
u
e
withtheor
a
g
afistaroun
d
o
uttheblue
s
e
artheoute
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23
AdministrationofMedicationsinDayCares
19a799a.AdministrationofMedications

*SeeAppendicesforSampleForm
*SeeAppendicesforsampleofIndividual
PlanofCareform
Agroupdaycarehomeorchilddaycarecentershallnotdenyservices
toachildonthebasisofachild'sdiagnosisof
asthmaorbecausea
childhasaprescriptionforaninhalantmedicationtotreatasthma.
(b)AdministrationofMedicationsOtherThanNonprescriptionTopical
Medications
(C) The facility shall have staff trained in the administration of
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)Thefacilityshallhavestafftrainedintheuseofanautomatic
prefilledcartridgeinjectororsimilarautomaticinjectableequipment
used
totreatanallergicreactiononsiteduringallhourswhenachild
withaprescriptionforanautomaticprefilledcartridgeinjector or
similarautomaticinjectableequipmentusedtotreatanallergic
reactionisonsite.
(3)OrderFromAnAuthorizedPrescriber/Parent'sPermission
(A)Exceptfornonprescriptiontopicalmedications
describedin
section19a799a(a)(1)oftheRegulationsoftheConnecticutState
Agencies,nomedication,prescriptionornonprescriptionshallbe
administeredtoachildwithoutthewrittenorderofanauthorized
prescriberandthewrittenpermissionofthechild'sparent(s)which
shallbeonfileatthefacility
foratleasttwo(2)yearsafterthechildis
nolongerattendingtheprogram.
(5)StorageandLabeling
(A)Medicationshallbestoredintheoriginalchildresistantsafety
container.Thecontainerorpackagingshallhavealabelwhich
includesthefollowinginformation:
(i)thechild'sname;
(ii)the
nameofthemedication;
(iii)directionsforthemedication'sadministration;and
(iv)thedateoftheprescription.
8. DayCareRegulationsandStatutes
KeyPoint!
StateDayCareLicensingrequires
anIndividualPlanofCarein
additiontoamedication
authorization.
24
CleaningandDisinfecting
19a797a. Physical Plant Toilet and
WashingFacilities
19a7910. Physical Plant Linens and
ClothingandBedding
19a7910.ToysandOtherObjects

SanitizersandDisinfectantsforDayCares
*UsetheEnvironmentalProtection
Agenciesdefinitionandlistofapprove d
productsat:http://www.epa.gov/

(G)(5)Walls,
ceilings,floorsandrugsshallbemaintainedinastateof
goodrepairandbewashableoreasilycleanable.
(2)Allchildren'slinensshallbewashedatleastweeklyandasneeded.
(4) When cribs and cots are shared, they must be washed and
disinfectedandlinenschangedbetweenchildren.
(1) Toys used for infants shall be kept separate, washed and
disinfected atleast daily. Toys for toddlers, includingfloor and riding
toys,shallbewashedanddisinfectedatleastweekl yandasneeded.

Environment
19a79a.PesticideApplicationsatDay
CareFacilities
*PublicActNo.99165,Sec.2Pesticide
ApplicationsatSchoolsandDayCare
Centers.Thisisinadditiontowhatisin
theStateLicensingDayCareRegulations.
(b)Noapplicationofpesticidemaybemadeinanybuildingoronthe
groundsofanychilddaycarecenter,group daycarehomeorfamily
daycarehome,eachasdescribedinsection19a77,duringregular
businesshoursexceptthatanemergencyapplicationmaybemadeto
eliminate
animmediatethreattohumanhealthif(1)itisnecessaryto
maketheapplicationduringregularbusinesshours,and(2)such
emergencyapplicationdoesnotinvolvearestrictedusepesticide,as
definedinsection22a47.Nochildenrolledatsuchcenterorhome
mayenteranareawhere
pesticideshavebeenapplieduntilitissafe
todosoaccordingtotheprovisions onthepesticidelabel.
*Sec.2.(NEW)OnandafterJuly1,2000,noperson,otherthana
pesticideapplicatorwithsupervisorycertificationmayapplypesticide
KeyPoint!
SanitizerAsanitizerreducesbutdoesnotnecessarilyeliminate
microorganismsonatreatedsurfacetolevelsthatareconsidered
acceptableaccordingtocurrenthealthcodesorregulations.EPA
registersfoodcontactsurface sanitizersforsurfacessuchassanitizing
rinsesfordishes,utensilsandfoodprocessingequipment,andnon
foodcontactsurfacesanitizers.
DisinfectantAdisinfectantdestroysorirreversiblyinactivates
microorganisms,butnotnecessarilytheirspores,onhard,inanimate
surfacesandobjects.EPAregistersthreetypesofdisinfectantsbased
onthetypeofefficacydatasubmitted:Limited,General(orBroad
spectrum),andHospital.
25
Smoking
19a797aPhysicalPlant
(9)Smokingisprohibitedinallchilddaycarecentersorgroupdaycare
homesandoutdoorareasexceptindesignatedsmokingareas,
providedtheseareasareseparate,properlyventilatedandenclosed
awayfromanychildrenpresentatthefacility.Signsshallbeposted,
visible
tothepublic,onentrancetothefacilityindicatingthatsmoking
isprohibitedexceptindesignatedareas.Matchesandlightersshallbe
inaccessibletochildrenatalltimes.
FluShotRequirementsforDayCares
*FluGuidancechangeseachseasonto
ensureyouhavethemostuptodateflu
informationvisit: 
http://www.flu.gov/prof essional/school/
InaccordancewithConnecticutGeneralStatutes(CGS)19a7f
(StandardofCareforImmunizationofChildreninConnecticut),
childrenwhoareenrolledorareenrolling
inalicensedfamilydaycare
home,alicensedchilddaycarecenteroralicensedgroupdaycare
homearerequiredtoshowproofofimmunitytoinfluenza.

ByJanuary1,2011andeachJanuary1thereafter,childrenaged6–59
monthsattendingachilddaycarecenter,groupdaycare
home,or
familydaycarehomeshallreceiveatleastonedoseofinfluenza
vaccinebetweenSeptember1andDecember31ofthepreceding
year.IfchildrenarevaccinatedduringAugustwiththeupcoming
seasonalfluvaccine,thesevaccinationswillbeacceptedandcount
towardthemandaterequirement.Allchildren
aged6–59monthswho
havenotreceivedvaccinationagainstinfluenzapreviouslyshall
receive2dosesofvaccine thefirstinfluenzaseasonthattheyare
vaccinated.ChildrenenrollingbetweenJanuary1andMarch31shall
receiveinfluenzavaccinepriortodaycareentry.Childrenenrolling
afterMarch31duringanygivenyearare
notmandatedtomeetthe
influenzavaccinerequirementuntilthefollowingJanuary,asthe
influenzaseasonhasgenerallypassedbythisdateandvaccinemayno
longerbeavailable.
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
SampleFormsFlyers&Brochures
1. AsthmaActionPlan
2. AsthmaFriendlyChildCareChecklistfor
ParentsandProviders
3. DailyAsthma/AllergyCommunication
(English/Spanish)
4. IndividualPlanofCareForm
5. MedicationConsentForm

1. AsthmaTriggersintheChildCareEnvironment
2. CDCFluGuidelines
3. GreenCleaningRecipes
4. HowdoIKnowifmyChildShouldgottoChild
CareToday(English/Spanish)
5. CTNursesAssociationMedicationTraining
6. MajorCausesofFoodAllergies
7. QuitLineSmokingCessation
8. TipsforFamilieswhohaveChildrenwithAsthma
(English/Spanish)
10.HandoutsandForms
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29
GovernmentAgencies
ConnecticutDepartmentofPublicHealth
AsthmaProgramWebpage
ConnecticutDepartmentofPublicHealth
DaycareLicensingProgram
ConnecticutDepartmentofPublicHealth
TobaccoProgramWebpage
Providesthelatestinformationandeducationforchildcare
providers,children,and,parentsContacttheAsthmaProgramat
(860)5098251
www.ct.gov/dph/asthma
Providesthelatestinformationandeducationforchildcare
providersTheChildDayCareLicensingHelpDeskiscoveredeach
dayduringcustomarybusinesshourstoassis tyouwithgeneral
questionsconcerningthelicensingregulationsandrequirements,
thechilddaycarelicensingprogram'spoliciesandprocedures,
verifystaffapprovalorother
generalinformation.Contactthe
DaycareProgramat(860)5098045http://www.ct.gov/dph/
Provideseducationinformationforthegeneralpublicandparents
ofchildrenregardingsmokeexposureandothertopicsrelatedto
smokingaswellassmokingcessationprograms.Contactthe
TobaccoProgramat(860)5098251
http://www.ct.gov/dph/
tobacco
Parents
AsthmaMoms
YouCanControlAsthma:ABookforthe
FamilyandYouCanControlAsthma:A
BookforKids
TheFamilyDoctor

Anetworkofconcernedparentsofchildrenwithasthma.
Providesextensivelistsoflinkstoasthmarelatedinformationfor
families,includingresourcesaboutasthmatriggers,medications,
legislation,medicalliterature,statistics,initiatives,andcamps.
InformationinSpanishisavailable.www.asthmamoms.com
AsetofeasytoreadbooksinbothSpanishandEnglish.
Onebook
isforthefamilyandtheotherisforchildrenages612tohelp
learneverythingaboutasthma.Orderbytelephone8007
ASTHMA.(AsthmaandAllergyFoundationofAmerica)
Asthmarelatedhealthinformationforthewholefamilybythe
AmericanAcademyofFamilyPhysicians.
http://familydoctor.org/online/famdocen/home/common/asthm
a/basics/014.html

30
Trainings
DayCareStaff:AmericanLung
Association
DayCareStaff:ConnecticutNurses
Association
DayCareNurseConsultants:Trainthe
trainercurriculumforlicensedmedical
consultants
AisForAsthma
Apreschooleducationalprogramdesignedforchildcare
professionalsinEnglishandSpanish.ItwasdevelopedbyChildren's
TelevisionWorkshopandfundedbythePrudentialFoundationfor
theAmericanLungAssociati on.Thefullybilingualpackage
includes:a15minutevideo,aCaregiverGuidetosharewithother
adultsinyourchildcareprogramandaposterthatreinforcesthe
video'simportantmessages.Toorder,pleasecalltheAmerican
LungAssociationofConnecticutat(860)2895401orthenational
numberat800LUNGUSA.
MedicationAdministrationTraining
http://www.ctnurses.org/
ConnecticutMedicationAdministrationinEarlyEducationand
ChildCareSettingshttp://www.ct.train.org
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32
Inhaler
Nebulizer
PeakFlowMeter
Relief(Rescue)
Medications
RespiratorySystem
Sanitizer
Spacer
Symptoms
Triggers
Adeviceforadministeringmedicationsbyinhalation.
Amachinethatpumpsairthroughaliquidmedicinemakingthemedicine
bubbleuntilafinemistisformedthatisbreathedin.Itis
usuallyusedinthe
hospitaloratthedoctor’soffice.
Asmalltubelikehandhelddeviceusedtomeasurethespeedatwhicha
personcanpushairoutoftheirlungs.Monitoringpeakflowcantellhowwell
asthmaisbeingcontrolledevenbeforesymptomsappear.
Short
termmedicationsthatprovideimmediaterelieftotheairwaysduring
anasthmaattack.
Thegroupoforgansresponsibleforbreathing.Thisincludesthenose,throat,
airways,andthelungs.
Anagentreducestheamountofbacteriaonasurface.
Adevicethatattachestoaninhalerthathelpsdirect
themedicationintothe
lungs.Theseareusefulforveryyoungchildrenwhohavedifficultygetting
adequatemedicineintotheirlungswithaninhaleralone.
Physicalchangesorfeelingsexpressedhatshowadiseaseorconditionexists.
Forasthma,thesemaybecoughing,wheezing,breathingdifficulty,ora
tightnessin
thechest.
Activities,conditions,orsubstancesthatcausetheairwaystoreactand
asthmasymptomstooccur.Someexamplesofpossibleasthmatriggersare
dustmites,mold,changesintemperature,tobaccosmoke,andfurrypets.
Triggersaredifferentforeachperson.

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
SchoolNurse: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
H
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
p
! TAKE THESE MEDICINES
A
ND SEE
K
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
___________________________________ ______________________________________
___________________________________ ______________________________________
Ifyourchildusuallyhassymptomswithexercisethengive:
___________________________________ ______________________________________
Inhalers work better with spacers. Always use with a mask when prescribed.
RESCUE MEDICINE DIRECTIONS
___________________________________________________________________________
Then:Wait20minutesandseeifthetreatment(s)helped
IfyouareGETTINGWORSEorNOTIMPROVINGafterthetreatment(s)GOTOREDZONE
IfyouareBETTER,continuetreatmentsevery4to6hoursasneededfor24to48hours
Then: Ifyoustillhavesymptomsafter24hours,CALLYOURDOCTORandifhe/sheagrees:
Start:
________________________________________________________________
Ifrescuemedicationisneededmorethan2timesaweek,callyourdoctorat:_______________________
RESCUE MEDICINE DIRECTIONS
_____________________________________________________________________________
Then: Wait15minutesandseeiftreatmenthelped
IfGETTINGWORSEorNOTIMPROVING,gotothehospitalorcall911
IfyouaregettingBETTER,continuetreatmentsevery4to6hoursandcallyourdoctorsayyouare
havinganasthmaattackandneedtobeseenTODAY
!
Then: Ifyourdoctoragrees,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
PRINT
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.
SchoolNurse: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
H
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
p
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
___________________________________ ______________________________________
___________________________________ ______________________________________
SiporlogeneralsuniñotienesÍntomasdeasmaduranteelejercicio,déle:
___________________________________ ______________________________________
Inhaladores funciona mejor con un espaciador.
Siempre use con el espaciador con mascarilla o boquilla.
MEDICINA DE RESCATE COMO DEBERÍA TOMARLA
___________________________________________________________________________
Entonces:Espere20minutosyevalúesieltratamientoayudó
SiESTÁEMPEORANDOoNOHAYMEJORÍAdespuésdeltratamiento,PROCEDAALAZONAROJA
SiHAYMEJORÍA,continúeconlamedicinaendosisindicadacada4a6horascomonecesario
durante24a48horas
Entonces:Sitodavíatienesíntomasdespúesde24horas,LLAMEASUMÉDICO.Sié
l/ellaestádeacuerdo:
Empiece:________________________________________________________________
Sinecesitamedicinaderescatemásquedosvecesenunasemana,llameasumédico:_________________
MEDICINA DE RESCATE COMO DEBERÍA TOMARLA
_____________________________________________________________________________
Entonces:Espere15minutosyevalúesieltratamientoayudó
SiESTÁEMPEORANDOoNOHAYMEJORÍA,vayaalhospitalollame911
SiHAYMEJORÍA,continúeconlamedicinaendosisindicadacada4a6horasyllameasumédico
DígalequeestáteniendounataquedeasmaynecesitaunacitaHO
Y!
Entonces:Siél/ellaestádeacuerdo,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
g
a a
y
uda! TOME ÉSTAS MEDICIN
A
SYCOJA
A
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alwaysbe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currentanduptodate.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
StateofConnecticutDepartmentofPublicHealth
CommunityHealthandPrevention
AsthmaProgram
410CapitolAvenue,MS#11HLS,POBox340308
Hartford,CT061340308
Phone:(860)5098251,Fax:(860)5097854
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)
780 Litchfield Street
Torrington, CT 06790
Attn: Sandy Markus
860-738-6661
Heart Center of Greater
Waterbury
Freedom from Smoking
1075 Chase Parkwa