ASTHMA AT SCHOOL

A guide for teachers

Although one in ten children in the UK have asthma, most children can expect to lead anormal life if medicines are taken properly and used regularly. Periodically, however, some children may experience attacks of asthma.

Despite the large number of children who have asthma (one in ten), the condition is rarely fatal. However, it should not be underestimated: more children are admitted to hospital with asthma than with any other single condition.

What is asthma?

Asthma, which is sometimes described as wheezing or wheezy bronchitis, particularly affects children. It causes the airways in the lungs to narrow, making it difficult to breathe. Sudden narrowing produces what is usually called an attack of asthma. Lesser or more persistent narrowing leads to less dramatic symptoms.

The causes of asthma attacks

People with asthma have airways which are almost continuously inflamed (red and sore) and are therefore very sensitive to a variety of common stimuli. It is not an infectious, nervous or psychological condition, although stress may sometimes lead to symptoms.

A child's inflamed airways are quick to react to certain triggers (irritants) that do not affect other children without asthma. The things that trigger asthma vary from child to child; the known triggers include:

• Viral infections (especially common colds)
• Allergies
• Exercise
• Cold weather or strong winds
• Excitement or prolonged laughing
• Sudden changes in temperature
• Numerous fumes such as glue, paint and tobacco smoke

Allergy

Certain substances which do not affect other people can cause symptoms to develop in those with asthma. As the substance does not affect most others it is described as an allergen.

Common allergens

• House-dust mites which live in soft furnishings and beds
• Furry or feathery animals
• Grass pollen
• In rare cases, foods such as milk and eggs

Other allergic symptoms include itching and redness of the skin (eczema), watery eyes (allergic conjunctivitis) and a runny nose or sneezing (hayfever, rhinitis). These symptoms can occur with or without the symptoms of asthma.

How asthma affects children

Children with asthma may have episodes (attacks) of breathlessness and coughing during which wheezing or whistling noises can be heard coming from the chest. They feel a 'tightness' inside their chest which is sometimes frightening and may cause great difficulty in breathing.

Individual children are affected by their asthma in different ways. One child may occasionally experience minor coughing bouts and breathlessness; while another is unable to participate in games and is sometimes forced to stay off school. Sometimes a cough can be the only symptom of asthma.

Avoiding attacks of asthma

In the majority of cases only the use of modern treatments will help to avoid the symptoms of asthma. However, allergic triggers can sometimes be avoided.

• Grass pollen can cause severe attacks from about late May to the end ofjuly and children who are allergic to pollen may need to keep clear of flowering grass.
• Guinea pigs, hamsters, birds and rabbits may need to be removed from the classroom if they are causing trouble.
• Fumes from science experiments can provoke symptoms.
• Food allergy is rare, but if the doctor asks a child to avoid certain foods it is important to follow this advice and not to regard it as a 'food fad'.

When a child with asthma joins your class

• Ask the parents about their child's asthma and current treatment. If the child has severe asthma it may be helpful for teachers to consult either the school nurse and doctor or the child's own GP.
• Allow the child easy access to their medication: do not lock it away in the school office. Even the slightest delay in taking medication can cause unnecessary distress and can be dangerous.
• Let the school doctor or nurse know if a child is absent a lot with chest problems.
• Some children need a discreet reminder to take medication (especially before exercise); it is worth remembering that some children are shy of taking medication in front of others.
• Remind the child to carry his or her medication on school trips.

How sports affect asthma

'Total normal activity' should be the goal for all but those with the most severe asthma.

Nearly all children with asthma become wheezy, during exercise. After a 5-minute run a child can get a severe attack of wheezing and coughing which can last half an hour or more if it is not treated.

This type of asthma is called exercise-induced asthma. Teachers can help to identify undiagnosed asthma by spotting children who cough a lot after exercising in the winter.

The type of sport and the weather conditions are often critical:

• Wheezing due to asthma is usually worse on cold, dry days than when the air is moist and warm.
• Prolonged spells of exercise are more likely to induce asthma than short bursts.
• Exercising with the arms or legs alone is less likely to trigger an attack than exercise using both.
• Swimming is an excellent form of exercise for children with asthma and seldom provokes an attack unless the water is very cold or heavily chlorinated.

The symptoms of exercise-induced asthma may be prevented if the child takes a dose of reliever medicine before beginning exercise. A dose of Intal or Cromogen before taking exercise may also reduce the symptoms. Children should warm-up before playing games; several 30-second sprints over five to ten minutes may protect the lungs for up to an hour or so.

It is important that PE teachers encourage children with asthma to take part in sport, to take their medication beforehand and to keep it with them during the class. Children who are forced into inactivity may become psychologically and socially isolated and a child who is physically fit is probably better able to cope with an asthma attack.

Children who have lost confidence in their ability to participate should be encouraged to take part in active sports. It may help them to know that people with asthma (such as Ian Botham and Adrian Moorhouse) do succeed in competitive sports.

No child should be forced to continue games if they say that they are too wheezy to continue.

Asthma treatments

There are two types of treatments:
Preventers: These medicines are taken daily to make the airways less sensitive to the triggers. Generally speaking preventers come in brown, and sometimes white, containers.

Relievers: These medicines, sometimes called bronchodilators, quickly open up the narrowed airways and help the child's breathing difficulties. Generally speaking relievers come in blue containers.

Methods of taking asthma medicines

The best way of taking asthma medicines is to inhale them. Children need to use their inhalers properly to ensure that the correct dose of medicine reaches their lungs. Many children, including some with co-ordination problems, need to use a large plastic chamber, called a spacer, into which the aerosol spray is released. Some children use a dry-powder device and many find this easier to take than an aerosol.

If you think that a child is having problems with taking his or her medication correctly please let their parents or the school nurse know.

If another child gets hold of an inhaler and uses it, it will not cause any damage to that child.

Asthma treatments

Preventers Intal¹ (sodium cromoglycate²) *
Becotide¹ (beclomethasone)² *
Pulmicort¹ (budesonide)² *

Relievers (Bronchodilators)
Atrovent¹ (ipratropium bromide)² *
Bricanyl¹ (terbutaline)² * †
Ventolin¹ (salbutamol)² * †

Longer acting relievers
Nuelin¹ (theophylline) †
Phyllocontin¹ (aminophylline) †
Serevent¹ (salmeterol) *

Key

¹ Trade Name
² General Name
Aerosol, puffer or dry-powder inhaler
* † Tablet and/or syrup

This is not a comprehensive list of asthma treatments and is not meant to replace instructions from the parent or doctor. Doses are not shown because they vary from one child to another.

Children with asthma may need to take their medicine during school hours and school staff can help by making sure that it is taken correctly. If treatment is not taken properly and regularly, severe asthma may develop and the child may have to be sent home or even to hospital.

How you can help during an attack

Children with asthma learn from their past experience of attacks; they usually know just what to do and will probably carry the correct emergency treatment. Because asthma varies from child to child, it is impossible to give rules that suit everyone; however the following guidelines may be helpful:
1. Ensure that the reliever medicine is taken promptly and properly
A reliever inhaler (usually blue) should quickly open up narrowed air passages: try to make sure it is inhaled correctly. Preventer medicine is of no use during an attack; it should be used only if the child is due to take it.

2. Stay calm and reassure the child
Attacks can be frightening, so stay calm and do things quietly and efficiently. Listen carefully to what the child is saying and what he or she wants: the child has probably been through it before. Try tactfully to take the child's mind off the attack. It is very comforting to have a hand to hold but don't put your arm around the child's shoulder as this is very restrictive.

3. Help the child to breathe
In an attack people tend to take quick and shallow breaths, so encourage the child to breathe slowly and deeply. Most people with asthma find it easier to sit fairly upright or leaning forwards slightly. They may want to rest their hands on their knees to support the chest. Leaning forwards on a cushion can be restful, but make sure that the child's stomach is not squashed up into the chest. Lying flat on the back is not recommended.

In addition to these three steps loosen tight clothing around the neck and offer the child a drink of warm water because the mouth becomes very dry with rapid breathing.

Call a doctor urgently if

• The reliever has no effect after five to ten minutes.
• The child is either distressed or unable to talk.
• The child is getting exhausted.
• You have any doubts at all about the child's condition.

If a doctor is unobtainable call an ambulance.

After the attack

Minor attacks should not interrupt a child's concentration and involvement in school activities. As soon as the attack is over, encourage the child to continue with normal school activities.

Further information

Please contact the National Asthma Campaign or call the Asthma Helpline on 0345 010203.