SDE: Clinical Guidelines Ch7A

Clinical Procedure Guidelines for Connecticut School NursesPrintable version | Back to Contents
Specialized Health Care Procedures

A. Asthma Management


A chronic inflammatory disease that results in bronchial hyper-reactivity (bronchospasm), mucous production, and reversible airway obstruction. Successful asthma management is based on the four components of the National Asthma Education and Prevention Program (NAEPP):

  • measures of assessment and monitoring;
  • education for a partnership in asthma care;
  • control of environmental factors and comorbid conditions that affect asthma; and
  • medications.


Asthma management and control significantly contributes to school attendance and the general health and wellbeing of students.


Metered Dose Inhaler with Spacer

Equipment: metered dose inhaler and holding chamber/spacer. Instructions for the use of a common brand of holding chamber/spacer may be found on the Forest Laboratories Inc. (2011) Web site. Instructions for the use of other brands of holding chamber/spacer may be found on the manufacturer’s Web site.

Nebulizer Administration

Equipment: medication, nebulizer machine (air compressor), facemask, or a mouthpiece held in the mouth.

  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 student or the mouthpiece in his or her mouth and turn on the machine. A mist of medication should rapidly appear.
  7. Instruct the student to take relatively normal slow deep breaths.
  8. The cup may require some tapping on the sides toward the end of the treatment to optimize the completion of the dose.
  9. The treatment is complete when there is no more mist from the cup (usually 10–15 minutes).

Peak Flow Meter (PFM) Administration

The proper use of a PFM can assist in providing an objective measure of one aspect of lung function. The PFM can measure the forced expiratory volume (FEV1) at the first second of a forced exhalation. Accurate use of the PFM is primarily dependent on having a three-zone system that is based on the student’s individual personal best measurement:

  • Green Zone is 80–100 percent of the personal best.
  • Yellow Zone is 50–80 percent of the personal best.
  • Red Zone is less than 50 percent of the personal best.
  1. Stand up (if possible).
  2. Shake down (like a thermometer) to reset.
  3. Take a deep breath.
  4. Seal your lips around the mouthpiece.
  5. Do not stick your tongue in the mouthpiece or cover the end with your fingers.
  6. Blow out as hard and fast as possible.
  7. If you cough or make a mistake, try again.
  8. Do three measurements with good technique. Record the best one.

Delegation Considerations

These procedures may be performed by the school nurse, RN (registered nurse), or LPN (licensed practical nurse). Asthma monitoring may also be delegated to appropriately trained, unlicensed assistive personnel with supervision, evaluation, and feedback and an individualized care plan (IHCP) in place.

Select Nursing Considerations

The school nurse can effectively partner with families and community health providers in assessing asthma control and having a positive impact on a student’s asthma management. Key components of asthma management that are ideal for school nursing include:

  • assessing history of cough (day and night), and exercise or activity intolerance;
  • physical exam findings for complaints of acute symptoms, including response to medications;
  • teaching and reevaluating proper inhaled medication technique;
  • monitoring the frequency of quick-relief medication use and reporting to prescriber as indicated;
  • reviewing the asthma action plan with student and family and making recommendations for follow-up asthma care as indicated; and
  • active participation in the school’s indoor air quality program.

School nurses must ensure that adequate inhaled medication is being administered, all medication administered for as needed (PRN) or acute symptoms is accompanied by the appropriate respiratory assessment before and after medication, and encourage the use of a holding chamber/spacer with all medication administration using a metered-dose inhaler (MDI).


American Lung Association.

Center for Disease Control and Prevention. Asthma.

Connecticut Department of Public Health Asthma Program

Connecticut State Department of Education Coordinated School Health Services Cadre of Trainers can provide a professional development session on asthma in schools.

Corjulo, M. (2011). Mastering the metered-dose inhaler: an essential step toward improving asthma control in school. NASN School Nurse 2011 26: 285.

Forest Laboratories, Inc. (2011). Instructions for use: AeroChamber Plus Flow-Vu (aVHC), Retrieved January 20, 2012.

National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program Expert Panel Report 3.


Guidelines for the Diagnosis and Management of Asthma 

National Asthma Education and Prevention Program

Asthma public education materials.


Content Last Modified on 7/23/2014 1:24:56 PM