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Heading off to college?
Heading Off to College? First, Get an Education in Asthma Management by Gretchen W. Cook
Late night phone calls are part of a resident director’s job on a college campus. They can be about anything from a bad breakup with a boyfriend to a medical emergency. For Andy Davis, resident director at Taylor University, Ft. Wayne, Ind., asthma attacks have been a recurring theme during this academic year. “I have had five events this year so far, says Davis. “My last call was about 1:30 in the morning in February. I had a female student undergoing a horrible asthma attack. An ambulance was called, which arrived about 2 minutes after I arrived on the scene. The RA [resident assistant] was pretty unnerved by it.” While this episode was brought under control, the student’s asthma returned 2 days later, and the student had to go home for a consultation with the family’s regular physician. 16
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ASTHMA MAGAZINE
May/June 2005
“In my job, keeping calm is part of my responsibility,” says Davis. “But students who aren’t familiar with an asthma attack can get panicky when a friend or roommate has a severe attack.” For many students headed off to college, the big decisions center around the choice of which notebook computer to purchase and pack. For a student with asthma, the packing list will also include some more healthfocused items, such as rescue inhalers, peak-flow meters, and pharmacy cards. Judy Groop, coordinator of health services at Messiah College in Grantham, Penn., knows about college students with asthma, and she sees many with uncontrolled asthma. “Especially when they’re sick, students come in with chest tightness and breathlessness,” says Groop, a certified college health nurse. “In many cases, these students know they have asthma, but they have let things get out of control, and I see them when they are getting into trouble.” Trouble for a student with asthma means more than a low midterm grade; it can be an emergency room visit, hospitalization, or, in rare cases, even death from a severe asthma episode. Unfortunately, trouble seems to find college students easily. In many cases it starts when students stop following their asthma management plan. “Money can be an issue,” says Groop. “These prescriptions are expensive and students have limited funds.” Another factor that leads to noncompliance is the lack of a strict schedule for most college students. College life is considerably more flexible and less routine than home life. Another reason students may stop taking their maintenance meds is simply because they feel fine without them. Combine this with no parental reminders (i.e., nagging) for students to measure their peak flows and take their daily meds, and students can quickly stray from a well-organized asthma management plan that has been effective for years. To avoid getting into trouble, Groop offers some simple advice for students with asthma.
Start With the Residence Hall The type of living arrangements can make a big difference in the life of a student with asthma. “Students with asthma are frequently allergic to mold,” says Groop. “I would suggest that in choosing a residence hall the student request a room on a higher floor—away from the basement level. Lower level rooms, especially in basements, are more likely to harbor conditions for mold.” The student should request a nonsmoking residence hall if there are residence halls or floors that allow smoking. If possible, ask for an uncarpeted room, as carpets
In many cases, asthma trouble begins when students stop following their asthma management plan.
and even floor rugs can host a variety of asthma triggers, including mold, dust mites, and animal dander. “In cooler climates where all residence halls may not be equipped with air conditioning, be sure to request one that does have it,” says Groop. Air conditioning removes moisture from the air (which inhibits mold and mite infestation) and tends to lessen ones exposure to seasonal allergens. Another way to help prevent asthma problems is to use care in furnishing the student’s room. Try to avoid cramming the entire room full, as this makes cleaning harder and allows dust to build up. Beware of hand-medown upholstered furniture and carpeting if the student is to furnish the room, as this may harbor years of builtup allergens. Mite-proof mattress covers, if the student is allergic to dust mites, are a good idea. Just be sure to check with
ASTHMA MAGAZINE
to subscribe call 1.800.654.2452
|
17
Friends at college need to have an understanding of what to do in case an asthma episode becomes severe.
the school and get the exact size of the bed before ordering a cover. Colleges are renowned for having unique bed sizes. Davis suggests considering a suite situation in which the occupants of two or three rooms share a bathroom. He explains, “We have had cases where the cleaners used by housekeeping staff are asthma triggers. When students take care of their own bathrooms, they can select chemicals that cause fewer problems.”
Provide the School With All Pertinent Information “Many colleges send out forms for students to complete about housing preferences and such,” says Groop. “They also solicit health information. The college wants to know about a student’s medical condition—for example, whether he or she has asthma or diabetes. Being as open and honest as possible on these forms is essential.” Privacy laws protect the information students put on the forms, so students should not fear that being honest will in some way tarnish their records. “College personnel need to know as much as possible about each student’s health,” says Groop. While it is not necessary to share everything in your records with the college, it may be useful to request a copy of your medical records to have on hand if they are needed by a doctor at the college health center or by a local doctor.
Connect Locally One issue for students attending colleges that are distant from home is health insurance. For someone taking maintenance medications, prescription coverage is
18
|
ASTHMA MAGAZINE
May/June 2005
important. Students should make sure their prescription coverage will work for them at college. “In some cases, it is wise for a student to transfer prescriptions to a network of pharmacies that serves both the home area and the college town,” says Groop. “National chains often have computers that are linked, so a prescription on file at [a local pharmacy] can be filled away at college. It would be a good idea to check with the college and find out what drug stores operate locally so the prescriptions can be transferred to these chains before the student arrives at college.” Another issue with health insurance involves coverage by health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Calling your health insurance provider and determining in advance how to get coverage for medical care at college can save medical dollars and headaches. If possible, find a local doctor in the vicinity of the college who treats asthma and allergies. Ask your regular physician if he can make a recommendation. A “well visit” to this doctor before school starts is a great way to ensure continued treatment.
Educate Peers “If possible, room with a roommate or suitemate who has asthma,” says Davis. Or, at least find a roommate who is willing to become educated about it. “This person will [need to] be familiar with what causes attacks and when to call for help.” A roommate and other friends need to have an understanding of what to do if an asthma episode becomes severe.
Transportation “It is important for the student with asthma to become familiar with how to get transportation to a medical facility [when at college],” says Groop. This includes knowing where the health center is located on campus, knowing its hours, and knowing what to do for after-hours emergencies. “In some situations, especially if the student does not have a car, knowing how to get a taxi or bus is critical. For an uncontrolled asthma episode that does not respond to fast-acting [rescue] inhalers, it may be best to call an ambulance.” The best way to prepare your college student for handling an asthma emergency is to find out in advance if the college has policies regarding such an event. It may be that students should contact a residence hall director or advisor who will then handle the contact with emergency medical services. Perhaps a phone call to the health center is the most expedient way to get help.
Things to take to college— ✔ Month’s supply of maintenance meds ✔ Fast-acting [rescue] inhaler ✔ Asthma management plans ✔ Peak flow meter ✔ List of triggers ✔ Insurance cards and information on how to use them while at college ✔ Prescription card (if different) ✔ Name of local allergy doctor recommended by your regular allergy doctor ✔ Name of local pharmacy that can fill prescriptions
Things to do— • Wash sheets regularly in hot water • Request to sleep in top bunk • Keep a diary of peak flow readings
For more information, see the tips from the American Academy of Allergy, Asthma and Immunology’s (AAAAI’s) “College Survival tips for allergies and asthma. You can locate it by visiting www.aaaai.org and entering “college” in the search bar.
And, of course, if there is an asthma crisis, the student should not delay getting medical attention going through complicated channels. When in doubt, dial 911. “Students need to know how to access transportation in case of an asthma episode,” says Groop.
Prevention Prevention is, of course, the best possible way to manage asthma. Groop suggests that students going off to college be equipped with a peak-flow meter, a diary, and an asthma management plan, as well as a generous supply of all necessary medications. “Students need to know what their normal peak flow
is so that they can describe what is happening when symptoms present themselves,” says Groop. “Knowing that they have dropped into the “yellow zone” or “red zone” will help the health care practitioner know how to treat an asthma episode.” The “zones” are part of most asthma management plans. These are measurements of lung function taken by a simple, inexpensive hand-held device—the peak-flow meter. When a patient’s peak-flow readings drop below 80% of personal best, medical intervention is recommended. “The [Peak Flow] diary is helpful in identifying trends and triggers,” says Groop. Other things students should have on hand on move-in day are at least a month’s supply of their medicines. “Students should also have, in addition to their daily medicines, a fast-acting [rescue] inhaler,” says Groop. “I’d recommend that a student carry the inhaler in his backpack.” The inhaler should be full, notes Groop, and not yet expired. “Sometimes students come with an inhaler they’ve had for months after the expiration date because they didn’t want to throw it out when it still felt full.” Knowledge is a powerful part of the off-to-college packing list. It is helpful to know, or perhaps even have a list, of asthma triggers. Knowing asthma triggers will help the student avoid them. “There are triggers that are not allergens,” say Groop, “and students should know about and consider these.” Stress is believed by some to be an asthma trigger, respiratory illness is known to trigger asthma episodes, cold air triggers asthma for some, and cigarette smoke is a trigger for most people. These are all things to which a student may be exposed to a greater degree upon going away to college. Going off to college with asthma should not mean that the college or university experience is in any way curtailed. Students with asthma should have the same full and enjoyable college experience as those without the condition. “What we do need to do is have an asthma management plan, maintain daily meds, and monitor peak flows,” says Groop. With these steps in place, a student is ready for 4 great years. Gretchen W. Cook is a freelance writer in Jackson, Miss., who specializes in family and health topics. She was diagnosed with asthma at age 6. Reprint orders: Elsevier, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318; phone 314-453-4350. doi:10.1016/j.astmamag.2005.04.001
ASTHMA MAGAZINE
to subscribe call 1.800.654.2452
|
19
Late night phone calls are part of a resident director’s job on a college campus. They can be about anything from a bad breakup with a boyfriend to a medical emergency. For Andy Davis, resident director at Taylor University, Ft. Wayne, Ind., asthma attacks have been a recurring theme during this academic year. “I have had five events this year so far, says Davis. “My last call was about 1:30 in the morning in February. I had a female student undergoing a horrible asthma attack. An ambulance was called, which arrived about 2 minutes after I arrived on the scene. The RA [resident assistant] was pretty unnerved by it.” While this episode was brought under control, the student’s asthma returned 2 days later, and the student had to go home for a consultation with the family’s regular physician. 16
|
ASTHMA MAGAZINE
May/June 2005
“In my job, keeping calm is part of my responsibility,” says Davis. “But students who aren’t familiar with an asthma attack can get panicky when a friend or roommate has a severe attack.” For many students headed off to college, the big decisions center around the choice of which notebook computer to purchase and pack. For a student with asthma, the packing list will also include some more healthfocused items, such as rescue inhalers, peak-flow meters, and pharmacy cards. Judy Groop, coordinator of health services at Messiah College in Grantham, Penn., knows about college students with asthma, and she sees many with uncontrolled asthma. “Especially when they’re sick, students come in with chest tightness and breathlessness,” says Groop, a certified college health nurse. “In many cases, these students know they have asthma, but they have let things get out of control, and I see them when they are getting into trouble.” Trouble for a student with asthma means more than a low midterm grade; it can be an emergency room visit, hospitalization, or, in rare cases, even death from a severe asthma episode. Unfortunately, trouble seems to find college students easily. In many cases it starts when students stop following their asthma management plan. “Money can be an issue,” says Groop. “These prescriptions are expensive and students have limited funds.” Another factor that leads to noncompliance is the lack of a strict schedule for most college students. College life is considerably more flexible and less routine than home life. Another reason students may stop taking their maintenance meds is simply because they feel fine without them. Combine this with no parental reminders (i.e., nagging) for students to measure their peak flows and take their daily meds, and students can quickly stray from a well-organized asthma management plan that has been effective for years. To avoid getting into trouble, Groop offers some simple advice for students with asthma.
Start With the Residence Hall The type of living arrangements can make a big difference in the life of a student with asthma. “Students with asthma are frequently allergic to mold,” says Groop. “I would suggest that in choosing a residence hall the student request a room on a higher floor—away from the basement level. Lower level rooms, especially in basements, are more likely to harbor conditions for mold.” The student should request a nonsmoking residence hall if there are residence halls or floors that allow smoking. If possible, ask for an uncarpeted room, as carpets
In many cases, asthma trouble begins when students stop following their asthma management plan.
and even floor rugs can host a variety of asthma triggers, including mold, dust mites, and animal dander. “In cooler climates where all residence halls may not be equipped with air conditioning, be sure to request one that does have it,” says Groop. Air conditioning removes moisture from the air (which inhibits mold and mite infestation) and tends to lessen ones exposure to seasonal allergens. Another way to help prevent asthma problems is to use care in furnishing the student’s room. Try to avoid cramming the entire room full, as this makes cleaning harder and allows dust to build up. Beware of hand-medown upholstered furniture and carpeting if the student is to furnish the room, as this may harbor years of builtup allergens. Mite-proof mattress covers, if the student is allergic to dust mites, are a good idea. Just be sure to check with
ASTHMA MAGAZINE
to subscribe call 1.800.654.2452
|
17
Friends at college need to have an understanding of what to do in case an asthma episode becomes severe.
the school and get the exact size of the bed before ordering a cover. Colleges are renowned for having unique bed sizes. Davis suggests considering a suite situation in which the occupants of two or three rooms share a bathroom. He explains, “We have had cases where the cleaners used by housekeeping staff are asthma triggers. When students take care of their own bathrooms, they can select chemicals that cause fewer problems.”
Provide the School With All Pertinent Information “Many colleges send out forms for students to complete about housing preferences and such,” says Groop. “They also solicit health information. The college wants to know about a student’s medical condition—for example, whether he or she has asthma or diabetes. Being as open and honest as possible on these forms is essential.” Privacy laws protect the information students put on the forms, so students should not fear that being honest will in some way tarnish their records. “College personnel need to know as much as possible about each student’s health,” says Groop. While it is not necessary to share everything in your records with the college, it may be useful to request a copy of your medical records to have on hand if they are needed by a doctor at the college health center or by a local doctor.
Connect Locally One issue for students attending colleges that are distant from home is health insurance. For someone taking maintenance medications, prescription coverage is
18
|
ASTHMA MAGAZINE
May/June 2005
important. Students should make sure their prescription coverage will work for them at college. “In some cases, it is wise for a student to transfer prescriptions to a network of pharmacies that serves both the home area and the college town,” says Groop. “National chains often have computers that are linked, so a prescription on file at [a local pharmacy] can be filled away at college. It would be a good idea to check with the college and find out what drug stores operate locally so the prescriptions can be transferred to these chains before the student arrives at college.” Another issue with health insurance involves coverage by health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Calling your health insurance provider and determining in advance how to get coverage for medical care at college can save medical dollars and headaches. If possible, find a local doctor in the vicinity of the college who treats asthma and allergies. Ask your regular physician if he can make a recommendation. A “well visit” to this doctor before school starts is a great way to ensure continued treatment.
Educate Peers “If possible, room with a roommate or suitemate who has asthma,” says Davis. Or, at least find a roommate who is willing to become educated about it. “This person will [need to] be familiar with what causes attacks and when to call for help.” A roommate and other friends need to have an understanding of what to do if an asthma episode becomes severe.
Transportation “It is important for the student with asthma to become familiar with how to get transportation to a medical facility [when at college],” says Groop. This includes knowing where the health center is located on campus, knowing its hours, and knowing what to do for after-hours emergencies. “In some situations, especially if the student does not have a car, knowing how to get a taxi or bus is critical. For an uncontrolled asthma episode that does not respond to fast-acting [rescue] inhalers, it may be best to call an ambulance.” The best way to prepare your college student for handling an asthma emergency is to find out in advance if the college has policies regarding such an event. It may be that students should contact a residence hall director or advisor who will then handle the contact with emergency medical services. Perhaps a phone call to the health center is the most expedient way to get help.
Things to take to college— ✔ Month’s supply of maintenance meds ✔ Fast-acting [rescue] inhaler ✔ Asthma management plans ✔ Peak flow meter ✔ List of triggers ✔ Insurance cards and information on how to use them while at college ✔ Prescription card (if different) ✔ Name of local allergy doctor recommended by your regular allergy doctor ✔ Name of local pharmacy that can fill prescriptions
Things to do— • Wash sheets regularly in hot water • Request to sleep in top bunk • Keep a diary of peak flow readings
For more information, see the tips from the American Academy of Allergy, Asthma and Immunology’s (AAAAI’s) “College Survival tips for allergies and asthma. You can locate it by visiting www.aaaai.org and entering “college” in the search bar.
And, of course, if there is an asthma crisis, the student should not delay getting medical attention going through complicated channels. When in doubt, dial 911. “Students need to know how to access transportation in case of an asthma episode,” says Groop.
Prevention Prevention is, of course, the best possible way to manage asthma. Groop suggests that students going off to college be equipped with a peak-flow meter, a diary, and an asthma management plan, as well as a generous supply of all necessary medications. “Students need to know what their normal peak flow
is so that they can describe what is happening when symptoms present themselves,” says Groop. “Knowing that they have dropped into the “yellow zone” or “red zone” will help the health care practitioner know how to treat an asthma episode.” The “zones” are part of most asthma management plans. These are measurements of lung function taken by a simple, inexpensive hand-held device—the peak-flow meter. When a patient’s peak-flow readings drop below 80% of personal best, medical intervention is recommended. “The [Peak Flow] diary is helpful in identifying trends and triggers,” says Groop. Other things students should have on hand on move-in day are at least a month’s supply of their medicines. “Students should also have, in addition to their daily medicines, a fast-acting [rescue] inhaler,” says Groop. “I’d recommend that a student carry the inhaler in his backpack.” The inhaler should be full, notes Groop, and not yet expired. “Sometimes students come with an inhaler they’ve had for months after the expiration date because they didn’t want to throw it out when it still felt full.” Knowledge is a powerful part of the off-to-college packing list. It is helpful to know, or perhaps even have a list, of asthma triggers. Knowing asthma triggers will help the student avoid them. “There are triggers that are not allergens,” say Groop, “and students should know about and consider these.” Stress is believed by some to be an asthma trigger, respiratory illness is known to trigger asthma episodes, cold air triggers asthma for some, and cigarette smoke is a trigger for most people. These are all things to which a student may be exposed to a greater degree upon going away to college. Going off to college with asthma should not mean that the college or university experience is in any way curtailed. Students with asthma should have the same full and enjoyable college experience as those without the condition. “What we do need to do is have an asthma management plan, maintain daily meds, and monitor peak flows,” says Groop. With these steps in place, a student is ready for 4 great years. Gretchen W. Cook is a freelance writer in Jackson, Miss., who specializes in family and health topics. She was diagnosed with asthma at age 6. Reprint orders: Elsevier, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318; phone 314-453-4350. doi:10.1016/j.astmamag.2005.04.001
ASTHMA MAGAZINE
to subscribe call 1.800.654.2452
|
19