Reviewed by: Sarah Cokayne, Resources Committee, 8th November 2021

Next Review: Autumn 2023

Background

A child’s educational years are the greatest opportunities for investment in the next generation.  For years schools and teachers have worked to ensure all children have an equal opportunity in their educational environment.  Many issues remain within the sole remit of education.  However, key areas which impact on a child’s ability to get the most from school, such as health lie outside the remit of education.

The impact of many medical conditions on a child in the classroom can be significant.  Some conditions can be severe and are rare such as epilepsy and diabetes.  Others particularly asthma are common. Asthma UK (2009) states asthma is the most common long-term childhood medical condition, affecting 1.1 million children in the UK. One in 10 children has asthma. The decision to administer medicines by teachers remains voluntary. This document is designed to support, educate and train school staff to enable them to take on this role if they wish with appropriate input from the local National Health Services (NHS) and Community Health Service. This policy is designed to run alongside the risk assessments and care plans schools develop in accordance with the Department for Education (DFS) documentation.

Asthma in the Classroom

Asthma is a common condition, but its severity varies considerably.  People can be affected to greater and lesser degrees.  For any one individual the occurrence of the condition can be episodic.  This means that children can be well for long periods of time and then have sudden acute, and at times severe relapses (Asthma U.K. 2009). 

The major principle underlying the policy is immediate access for all children to reliever medication.

Therefore every asthmatic child should carry their own inhaler, wherever possible, both in school at Physical Education (PE) and on school trips.  For younger children (usually those in infant school) this is not practical. There should therefore be a system in school that teachers, parents and children know about and to allow for safe and ready access. (e.g. a “spice rack” or “cloth pouch” system). Inhalers and spacer devices should have the children’s names clearly marked. In the event of an inhaler being lost parents/carers are asked to bring in a spare which will have the child’s name clearly marked.  

Asthma Symptoms

Asthma is caused by a reversible narrowing of the airways to the lungs.  It restricts the passage of air both in and out as you breath. The symptoms of asthma occur when the muscles around the airways tighten and the lining of the airway becomes inflamed and start to swell; this leads to a narrowing of the airways. The usual symptoms of asthma are:

• Coughing
• Shortness of breath
• Wheezing
• Tightness in the chest
• Being unusually quiet
• Difficulty speaking in full sentences
• Sometimes younger children will express the feeling of tightness in the chest as a tummy ache.

The symptoms however are rapidly reversible with appropriate medication. Only when symptoms fail to be reversed medical attention must be sought (See Section 7 management of an acute asthma attack).

Types of Treatment

There are two types of treatment for asthma:

a) ‘Relievers’

Every child with asthma should have access to a reliever in school.  The reliever inhaler is commonly blue, but may come in different colours, and they come in different shapes and sizes. It is the parents’ responsibility to provide the correct reliever inhaler. These treatments give immediate relief and are called bronchodilators because they cause the narrowed air passages to open up by relaxing the airway muscle. They do not however reduce the inflammation. 

b) ‘Preventers’

Preventers are a group of treatment that are designed to prevent the narrowing and inflammation of the airway passages. The ultimate objective is to reduce asthma attacks of any kind.  These medicines should be taken regularly usually morning and evening.  There is therefore no indication for them to come to school with the child.

Even if they are taken during an attack, they will not have an immediate effect.

THIS POLICY REFERS ONLY TO RELIEVERS.

• The best way for people to take their asthma medication is to inhale them directly into the lungs.  There are a variety of devices available and the asthma medication needs to be breathed in steadily and deeply.
• For young children and those with co-ordination problems, other devices are sometimes used.  These devices are breath activated so that the device fires automatically when the child is breathing in.
• Some younger children use a spacer device to deliver their aerosol inhaler, this maybe a volumatic or aerochamber. The aerosol is pressed into the spacer and the child breaths slowly and steadily for approximately 10 seconds. If the child is using an aerochamber and it whistles they are inhaling too quickly. Spacers are very useful for those who have difficulty co-ordinating their breathing and inhaler.  The spacer device is also very useful in the case of an acute asthmatic attack. (‘see section 7 on managing an acute asthmatic attack’
• Irrespective of the type of device, the medicine being delivered is a reliever.
• All children who need their relievers should have them in school and readily available at all times.  For all children in secondary and junior schools, the child must carry their reliever inhaler with them at all times.  The administration of the reliever to children should be on their own perception of whether or not they need it.
• Primary school children may need more help and encouragement with taking their reliever. Inhalers should be kept in an easily accessible place where either child or teacher can reach it with the minimum of difficulty.
• For primary school children, it is recommended that an agreement between parents and schools be drawn up and signed so that the parents are fully informed of the school policy on the management of asthma in the classroom for their child. (See appendix 1 for parental letter)   This should also include a reliever inhaler supplied by the General Practioner (GP) and a spare device and inhaler, which will be held in school. (See section 7 on managing an acute asthmatic attack).
• When a primary school child needs a dose of their reliever, it is recommended that this is noted in the provided record sheet and the parent is informed.  If a child is using their inhaler three or more times a week, the teacher should inform the parent/carer as the child’s asthma care may need reviewing. It remains the responsibility of the parent to seek medical attention and to liaise with the school on the frequency with which inhalers are taken.

The Physical Environment 

Many environmental aspects can have a profound effect on a child’s symptoms at anytime.  The four key points for schools are:

a) Materials

The school should as far as possible avoid the use of art and science materials that are potential triggers for asthma.

b) Animal Fur and Hair

Some children can have marked acute and chronic symptoms if they are exposed to animals including, mice, rabbits, rats, guinea pigs, hamsters, gerbils, chinchillas and birds.  Consideration should be given to the placement of school pets in the classroom, and special vigilance may be needed on trips to farms and zoos where children handle animals.

c) Grass Pollen

Grass pollens are common triggers in provoking an exacerbation of asthma.   Consideration should be given to grass being cut in school time.  Children may require extra vigilance. 

d) Sport

Children with asthma should be encouraged to participate in sports however teachers need to be mindful that exercise may trigger asthma. Children should effectively warm up before exercise and cool down following exercise.  Reliever inhalers should be taken in to P.E. lessons and when the children are playing outside sports the P.E teacher may hold them.

Access to Reliever Medication

1. Asthmatic children must have immediate access to reliever inhalers at all times.  If the child does not carry their device it must be immediately accessible if required and school staff and teachers should know where the device is.
2. Children in juniors and secondary school should all carry their own devices and self-administer their reliever medication. (see special concerns under section 8).
3. At the start of each school year a child should bring in a new reliever device and spacer clearly labelled with his/her name.’ It is the responsibility of the parent/carer to ensure that medication provided in school is in date.’ This device remains the property of the school for the school year.. It can be returned to the child on the last day of the summer term.
4. In addition to the reliever device held by the school every child should have their own reliever that they keep with them.  In the case of younger children this may be in a spice rack or wall pocket system.
5. All staff must know where the reliever devices are kept.
6. The school keeps two emergency inhalers in the school office. 

What to do if a Child has an Asthma Attack

If an asthmatic pupil in your class becomes breathless or wheezy or starts to cough:

1. Keep calm, it’s treatable.  If the treatment is given at an early stage the symptoms can be completely and immediately reversible.
2. Let the child sit in a position they find most comfortable. Many children find it most comfortable to sit forwards with their arms crossed on the table.
3. Ensure the child has 2 puffs of their usual reliever.

If the pupil has forgotten their reliever inhaler or their device is out of date or empty then:

1. Give 2 puffs of the school reliever inhaler provided by the parents, preferably via their spacer or aero chamber.
2. STAY WITH THE CHILD. The reliever should work in 5 – 10 minutes
3. If the symptoms disappear, the pupil can return to the lesson as normal.  
4. If symptoms have improved but not disappeared then:
   • Give 1 puff of the reliever inhaler every minute for 5 minutes
   • Stay with the child

IF THE CHILD HAS WORSENED SEE SECTION 7.

8. Management of a Severe Asthma Attack

HOW TO RECOGNISE A SEVERE ATTACK

• The reliever has no effect after 5-10 minutes
• The child is either distressed or unable to talk
• The child is getting exhausted
• You have any doubts about the child’s condition

STAY WITH THE CHILD

Call 999 or send someone else to call 999 immediately – Inform them the child is having a SEVERE ASTHMA ATTACK AND REQUIRES IMMEDIATE ATTENTION.

• Using the child’s reliever and spacer device give one puff into the spacer. Allow the child to breathe the medicine from the spacer. If the spacer device is an aerochamber and it whistles ask the child to breath more slowly and gently. After one minute give another puff and allow the child to breathe the medicine. Repeat at not more than one minute intervals until the ambulance arrives.
• Contact the parents and inform them what has happened.
• If you are concerned and need emergency advice ring the Accident and Emergency department at The Royal Oldham Hospital on 0161 627 8228.

Special Areas for Concern

1. Many teachers are concerned that an unsupervised child with an inhaler may result in the medication being taken by the peer group.  This does not pose a danger to the health of other children.
2. Many teachers are concerned that using the device of another child will leave them vulnerable to legal action or criticism.  Teachers are reminded they have a duty of care to the children in school.  Taking no action, or not using another device could be interpreted in a failure of that care (see joint Statement Appendix 4). 
3. Reliever inhalers and spacer devices should always be taken to swimming lessons, sports, cross country, team games and educational visits out of schools, and used according to need.  Children with known exercise induced asthma will need to take their reliever immediately prior to exercise.
4. Self administration of the reliever is the usual and best practice.  Any concerns about inappropriate use or abuse of the devices should be reported to the Head Teacher or the parents/guardian.
5. In an event of an uncertainty about a child’s symptoms being due to asthma, TREAT AS FOR ASTHMA.  This will not cause harm even if the final diagnosis turns out to be different.

Information to parents and guardians and carers

As part of the school policy it is proposed that all parents are made aware of how the school will manage a child who has symptoms due to their asthma whilst they are in school.  The school will need a Metered Dose Inhaler reliever and spacer prescribed by the child’s GP to be kept in school.

All opportunities should be taken to promote the policy to parents so they can participate.  The school prospectus, open days and sessions for reception classes are good opportunities.

Administration of Medicines

The school will follow the procedures set out in the ‘Administration of Medicine’ policy which requires the school to acquire written permission from the parent or carer and to record details of doses administered.  A copy of the permission form will be in the zippy wallet with the inhaler and in the school office.  The dose record sheet will be kept with the inhaler.

Storage of Asthma Pumps

All pumps and spacers are stored in the child’s class room in a space that is accessible to both the child,  the class teacher and the teaching assistant.  Where the children are younger, the teacher may decide to keep the pump in a locked cupboard.  Older children (YRs 5 and 6) can keep the pumps themselves with the permission of their parents.  If they decide to keep their own pump, another pump must be kept with the class teacher in case the pump is lost.  If the child needs their pump at lunchtime – a meals supervisor or first aider should escort the child to their classroom to administer the pump.  It is important that the child knows where their pump is stored.

Pupils with special educational needs

Children who are statemented under Part III of the Education Act 1996 receive a statement of special educational needs.  It is possible that for any of these children who may have asthma they will have special requirements to ensure that they take their asthma medication appropriately and that they are appropriately treated in the event of an acute attack.  This will be made explicit by the medical team responsible for giving the medical advice input in to the statement.

Care of the Spacer Devices

After use they should be washed in warm soapy water, and allowed to dry naturally in the air. The spacer device once dry they should be stored carefully.

Training

It is anticipated that policy implementation will include a commitment to staff training.  This will include individual schools and individual teachers as is necessary. Training to support the policy will be provided and will require commitment from the Health Authority, Local Hospital Trust and Education Authority.  Dissemination to all levels within the school is required.