By. Cyndy Merse, GSNN Content Writer

The North East Independent School District (NEISD) is the second largest school district in the San Antonio, Texas area and serves approximately 67,500 students.  Like many districts of its size, NEISD is not a stranger to dealing with cases of asthma among its student population.  In 2006, district data revealed that students were making over 70,000 school nurse visits each year due to complications from asthma, resulting in a loss of valuable instruction time for these students.  With approximately 12% of its student body affected by asthma, NEISD realized it needed to take action to ensure all of its students had a safe and healthy environment in which to learn.


A Coordinated Effort

Up until 2006, NEISD had been taking a reactionary approach to indoor air quality (IAQ) concerns.  That year, NEISD hired a registered respiratory therapist/certified asthma educator to create, launch, and oversee its Asthma Awareness Education Program.  The asthma program was developed to empower the district’s IAQ efforts, reduce the number of asthma triggers in schools, and improve the health outcomes of students with asthma.  The Asthma Awareness Education Program and the IAQ Program work closely together to coordinate on IAQ issues across the district, as well as educate staff and the general public on IAQ and asthma.  The custodial, maintenance, and health services staff play vital roles in identifying potential IAQ problems, alerting the IAQ team, and resolving issues in as timely a manner as possible.  They are essentially the “eyes and ears” for IAQ across all schools in the district.  The Environmental Protection Agency’s (EPA) IAQ Tools for Schools framework, which was used to shape NEISD’s Asthma and IAQ programs, continues to be a valuable resource in the program’s evolution.




Innovative Software Aids in IAQ Efforts

NEISD’s IAQ program is overseen by an IAQ coordinator and an IAQ technician who are responsible for conducting routine environmental health assessments of the district’s school buildings, identifying potential IAQ issues, performing corrective action to remove or reduce contaminants, and responding to IAQ concerns raised by building occupants.  To make their jobs easier, and to improve data collection and tracking, the IAQ team and the Asthma Educator worked together to influence the development of two unique in-house software programs.

  • The first tool is an environmental assessment tool that assesses current conditions against the district’s standards for what a healthy school environment should look like. The tool is designed from the perspective of a teacher or a custodian, and allows the IAQ team to proactively address IAQ issues before they become the subject of a complaint.
  • The second tool is a system called HealthCheck, which gathers information on a student’s health, medications taken, nurse visits, and the location of onset of symptoms, among other variables. This system enables users to drill down to a specific school campus and track why students are coming to the nurse’s office, as well as determine if there are high instances of inhaler use coming from a particular location in a school building.


A Four Component Approach to Asthma Control

NEISD’s Asthma Education Awareness Program works in conjunction with the district’s IAQ program since IAQ issues tend to impact individuals with asthma the most.  The program uses a four component approach to promote asthma management and create healthy school environments:

  • The program aims to raise awareness among staff, parents, and students about the impacts of asthma on student health and achievement, and how poor IAQ can exacerbate asthma symptoms.
  • Medication/Tools. The program offers tools and resources to campus nurses that enable them to help students better manage their asthma.  This includes showing students how to properly use their asthma inhalers and conducting Asthma Control Tests on asthmatic students who frequent the nurse’s office to determine if their medication is adequate and/or if environmental factors are the culprit.
  • This component overlaps with the work conducted by the IAQ Coordinator, who is continually assessing, monitoring, and correcting IAQ issues (which includes asthma triggers) throughout the district’s schools.
  • The program offers multiple opportunities for educating staff, parents, and students about asthma symptoms, triggers, and management.  Teachers and school staff participate in innovative training activities that cover asthma pathophysiology, triggers, and symptoms. To make the training more engaging, participants get to “experience” asthma for themselves through simulating asthma symptoms and crawling through a constricted tunnel meant to represent an asthmatic’s airways after being “exposed” to asthma triggers.  The “asthma obstacle course” has received such a positive response from teachers that it is used by middle school students and at community health fairs to educate parents.


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A Culture Shift

NEISD’s IAQ and asthma program efforts have been real eye-openers for the district’s teachers and staff.  Before undergoing training, district teachers did not know that environmental triggers were causing asthma symptoms in their students.  Once these triggers were removed from the classroom and teachers saw a difference in their student’s health and academic success, they became champions of the program and active stewards of their classroom environment.  Says Diane Rhodes RRT, AE-C, Asthma Awareness Education Program, Assistant Director, Health Services:  “Teachers love their students; they don’t want to do anything to hurt them. Many of our teachers simply didn’t know about asthma triggers. Armed with this education, they were more than willing to change their classrooms to eliminate asthma triggers.”

Since implementing its IAQ and Asthma Awareness Education Programs, NEISD has been the recipient of numerous awards, including recognition from the EPA’s IAQ Tools for Schools Program and the American Lung Association (ALA).  The district has won the IAQ Tools for Schools Leadership Award (2007); National Excellence Award (2008); Special Achievement Award: Asthma Program (2008); National Mentorship Award (2009); Model of Sustained Excellence Award (2010); and the EPA National Environmental Leadership Award in Asthma Management (2013).  In addition, eighteen of NEISD’s school campuses earned Gold Level Recognition from the ALA’s Asthma Friendly Schools Initiative, the only schools in the country to receive this distinction since its inception in 2013.



Interview with Diane Rhodes RRT, AE-C, Assistant Director, Health Services Department and Nick Kellar, IAQ Coordinator, North East Independent School District, Texas

Diane Rhodes is a Certified Asthma Educator (AE-C) and Registered Respiratory Therapist (RRT) with a thirty-five year career in the healthcare profession.  She holds a Bachelor’s Degree in Business Administration from Texas Tech University.  After joining North East Independent School District in 2006, Rhodes developed and implemented an innovative, comprehensive Asthma Awareness Education Program. The Asthma Awareness Education Program was the catalyst for the district’s award winning IAQ Program.  The district’s IAQ Program received the Environmental Protection Agency’s Excellence Award (2008) and the Model for Sustained Excellence Award (2010) for dedication to providing a healthy school environment.  In 2013, the Asthma Awareness Education Program received the EPA National Environmental Leadership Award in Asthma Management.  Rhodes was individually recognized by the EPA with the Special Achievement Award (2008).


Nick Kellar is the IAQ Coordinator for the North East Independent School District (NEISD) in San Antonio, Texas.  He has an extensive background in building maintenance, holding certifications as an HVAC technician and an IAQ technician, and is also a Master Plumber.  Mr. Kellar has worked in the IAQ department for over 5 years and has helped to educate not only the staff but the community on the importance of the IAQ program.  His efforts have helped NEISD obtain several American Lung Association AFSI Gold Champion Awards in 2013 (3), 2014 (7) and 2015 (8).  Mr. Kellar was happy to have a part in the NEISD IAQ Program earning the EPA’s 2013 National Environmental Leadership Award in Asthma Management.  Nick is happily married to the love of his life and has 2 children who attend NEISD schools.


NEISD Receives National Honor for Improving Indoor Air Quality. North East Independent School District. December 10, 2010. (

North East Independent: Envisioning Excellence: Lessons from Effective School Indoor Air Quality Programs – A Snapshot of Profiles in Excellence. Environmental Protection Agency. (

North East Independent School District (Asthma Awareness Education Program), 2013 Asthma Award Winner. Environmental protection Agency. (

North East Independent School District Asthma Awareness Education Program Webpage (

North East Independent School District Department of Environmental Health Webpage (

North East Independent School District Department of Indoor Air Quality Webpage (

North East Independent School District Profile on the Asthma Community Network. (