Although the National Heart Lung and Blood Institute (NHLBI) 1997 guidelines provide practical, up-to-date information regarding many specialty populations, there is little information regarding the college-age asthmatic. There are enormous psychosocial changes occurring during this stage from teen to independent young adult. Any chronic medical condition such as diabetes or asthma only further complicates the process by requiring mastery of additional skills to become successful in asthma control.
For the late teen leaving home for the first time, “task mastery” can be a natural progression with little difficulty, or an intense struggle with grave consequences if failed. You may have a supportive family or existing support system, while others are “on their own.” You may have insurance coverage and adequate funding available for medications, but a surprising number of college students do not. You may be forced to decide whether to eat or to buy medication because of your financial situation. Students in general will adhere to maintenance health care routines only if the “perceived gain” is greater than the “perceived cost.” Cost verses gain balance may be disrupted by the “I am invincible” attitude common to this age group. These factors influence your decisions, as does the simple matter of transportation to and from the clinic or pharmacy. If you do not have a car, it is difficult to use off-campus facilities. Even if the clinic or pharmacy is on campus, the student with asthma may have difficulty walking across campus to class or the health center especially in cold weather and therefore may need assistance.
Most freshman students are required to live in dormitories on campus for the first year. Some older dorms may have old heating and cooling systems, mold or pest infestation problems or roommates who smoke. For students living in apartments, previous tenants or roommates may have had or acquired pets or they may have smoked. Those students who are rushing for a sorority or fraternity may be required to live in extremely close proximity with “sisters” or “brothers” for a certain length of time to encourage “bonding”. Unfortunately, this practice also promotes rapid spread of respiratory infections.
College students are more likely to attend class while ill and often have difficulty in determining the severity of their illness and how to respond appropriately to illness. In some instances, the psychological pressure to conform to peer standards or “fit in” while still trying to be an individual, all the while maintaining academic standards, could contribute to depression, anxiety, mood and eating disorders. Uncontrolled mood disorders affect grades, social accomplishments, overall health maintenance and long-term self image (i.e. “I couldn’t make it in college” and “I’m just not cut out for this”). Asthma management complicated by mood disorders becomes even more of a challenge.
Preparation and education provide the cornerstones of student-based self-management. A well visit without your parent prior to “The Move” is essential. During this visit your Asthma & Allergy Center doctor will review all medications and inhaler techniques with you. Written prescriptions will be provided to have filled at a pharmacy close to the college that you will be attending. Written instructions for medication use, as well as a written asthma crisis management plan will be provided. Inhaler and peak flow meter instructions and techniques will be given. You will be asked to show the nurse the way you take your medication and how you use the peak flow meter.
Prior to departure for school, it is important for you to talk to your parents about insurance coverage and available funding for medication. There usually is a student insurance policy available at a fairly reasonable rate through the university, but you need to obtain coverage BEFORE you become ill and in crisis. Ask about pre-existing condition coverage and medication coverage packages.
Students may not be aware that they can ask for medication samples. One southern university established a universal “pool” of samples (kindly provided by pharmaceutical companies), which were kept in the health center pharmacy. Sample availability was recorded in a central logbook. When a particular medication was needed, the student was sent to the pharmacy with a script marked “Sample.” If you do not have funds for medication, this should be made known to your Asthma & Allergy Center doctor.
For students living in the dormitory, prevention is paramount. If the dorm room heating and cooling system is an older model that heats the entire building, inexpensive individual vent filters can be obtained from local stores. If a particular room has suffered mold damage or a roommate smokes, a room change for health reasons can usually be accomplished with your Asthma & Allergy Center doctor’s note (often bypassing room change fees). The meningitis vaccine and hepatitis B vaccine series are recommended. Please check with your student health center or the local health department for low-priced vaccine availability. It is also recommended that students receive an influenza vaccine yearly. Most student health centers or medical facilities will promote a “flu shot special” with discount injections during specific times. Influenza spreads rapidly through a classroom or dormitory of unvaccinated students.
Are you emotionally ready? Are you confident or fearful? Depression or anxiety may be exacerbated by asthma or allergy symptoms or may be independent. You may not have progressed through all the stages of acceptance and may be experiencing anger or denial. If needed, there often are student counseling services located on campus with a reduced fee, or sometimes no fee at all. Students usually agree to seek counseling for symptoms of depression or anxiety when reassured that they are not “crazy” or “weird”.
This is an exciting time for you and asthma should not complicate or cause missed days of school. Asthma control, therefore, is a must so that this period in your life will be filled with academic successes and not failures.
Adapted from “Asthma Management in the Collegiate Setting” b y Jeanette L. Arnold, C-FNP