At home, her parents gave her controller medicine each morning and evening. Except when triggered by occasional colds which seem to make perpetual rounds of day care centers-Kia's asthma was well controlled for the four years she attended day care. When she began elementary school, her parents again made her teachers and other school personnel aware of her asthma, gave them copies of her management plan, and made sure they understood how to implement it. By the time Kia started middle school, her asthma was so well controlled that her parents let down their guard. Kia was now old enough to recognize symptoms herself, and she always carried a quick-relief inhaler and spacer in her backpack. Her parents didn't bother to contact the middle school personnel about her asthma. But after a few months in middle school, which was an older building, Kia's symptoms appeared more frequently. She still used a controller medicine at home, but her parents noticed that she was coughing more at night and often seemed short of breath, With a little gentle prodding, her parents discovered that Kia had been using her quick-relief medicine much more often. They took her to the doctor who did a spirometry breathing test, reviewed the technique for administering her metered dose inhaler and spacer, and wrote new prescriptions with refills. In the end, they agreed that Kia's recent problems were probably related to triggers at school. Her parents called the school nurse and told her of Kia's condition. They said they would send in a copy of Kia's asthma management plan and asked the nurse to review it with Kia's teachers. The nurse said she was happy to cooperate and mentioned, almost as an aside, that since she had started working at this middle school a few years ago, she was seeing a lot more students with asthmas.Kia's story had a happy ending. The school nurse and her teachers kept an eye on her, watched for symptoms, and quietly reminded Kia when to use her inhaler and spacer without making a big deal of it or drawing attention to her. More importantly, the school nurse took the lead in alerting the principal and faculty to the growing incidence of asthma at their school. By the end of the year, the old building had been thoroughly cleaned air ducts, vents, radiators, shelves, ceiling tiles. As a school community, the PTA and staff made it a priority to be better informed about asthma and to keep triggers to a minimum. One of the primary goals of successful asthma control is for children to be able to attend and participate in all day care and school activities. Since parents cannot guarantee this goal entirely on their own, the best way to achieve it is to work cooperatively with school and day care personnel. Some suggestions for doing that include:At the beginning of each school year, contact your child's teacher, school nurse, and any other personnel who are in contact with your child and inform them that she has asthma. Provide written instructions for your child's medicines and devices (nebulizer, MDI/spacer, DPI, or peak flow meter) to make sure your child doesn't miss any doses of medicine. Ask your child's doctor or nurse practitioner to fill out the necessary paperwork well ahead of time so your child won't miss any doses of medicine. Fill out school forms at the start of every school year. If your child's school has it own form with instructions for administering medicine, fill it out completely and be sure that your physician completes and signs the appropriate part. Attach a copy of your child's asthma management plan to the forms. When a permission slip comes home for a class trip to a zoo, farm, or other destination where your child might encounter asthma triggers, attach a note to remind the teacher to look over your child's asthma management plan and take along contact information (for you and your child's doctor or nurse practitioner) in the event a flare occurs.