School Asthma Action Plan Form
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3DUBLIN SCHOOLS
DUBLIN UNIFIED SCHOOL DISTRICT
Asthma Action Plan
Dear Parent/Guardian,
Enclosed is an “Asthma Action Plan” that will serve as your child’s individualized treatment plan to
help us effectively meet his or her asthmatic needs while at school. The form will need to be
completed by parent and physician annually, or whenever there is a change in prescription, and
returned to the school office with prescribed medication(s)/supplies.
Asthma is the leading cause of school absenteeism. It causes more missed days of school than any
other chronic condition, and combined with allergic rhinitis, it accounts for more than 8 million lost
days of school every year.
The DUSD nurse has worked with local physicians to establish an asthma action plan that keeps the
incidence of asthma symptoms at a minimum during school, and provides a plan of action for school
personnel in case of an asthma flare. Each student’s action plan is developed by the parent/guardian,
student and health care provider to meet your child’s unique health care needs.
The Asthma Action Plan now includes an area for managing your child’s asthma using a peak
flow meter at school. This is a small device that measures how well air moves out of the airways. It
can be used to determine the severity of an asthma episode, guide prescribed treatment and monitor
response following treatment. This is one important indicator of asthma problems. Symptoms such
as coughing, wheezing, and chest tightness are also indicators of a worsening asthma episode.
If you and your doctor choose to use the peak flow meter as part of your child’s Asthma Action Plan,
please supply the school with a peak flow meter for your child. Your child’s peak flow reading and
signs/symptoms will guide the prescribed asthma treatment. The health clerk has been trained in the
proper use of the peak flow meter and can supervise your child in its use as needed.
As you know, the proper technique for administering prescribed asthma medications is also vital to
managing your child’s health condition. A spacer is highly recommended for use with an inhaler at
school and at all times for proper delivery of medication. Since many of our students are not currently
using the proper technique for administering asthma medication, please review them with your child.
If you have any questions or concerns please call the district nurse at 828-2551 ext. 8036.
Dublin Unified School District Nurse
Asthma Action Plan 7/10
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