Asthma in Schools

This briefing, produced in association with Asthma UK, is intended to give information to school staff, which will support the uninterrupted education in schools of children with asthma.

It is estimated that one in ten children in the UK suffer from asthma. That equates to around 1.1 million children, around two in every classroom. This briefing is intended to provide basic information for school staff. Details of more comprehensive guidance are listed in the Further Guidance section at the end of this document.

What is asthma?

Asthma is a condition of the air passages, the small tubes that carry air in and out of the lungs. When a child or young person comes into contact with an asthma trigger the muscles around the small air passages tighten and the linings of the air passages become inflamed and irritated, making it difficult to breathe. Often thick sticky mucous is produced. Children and young people with asthma may have airways that are almost always sensitive and easily irritated.

Individual children are affected by asthma in different ways.  Some children may have very occasional symptoms such as coughing, shortness of breath or a feeling of tightness in the chest, whereas others may suffer these symptoms more frequently and some may even have symptoms every day (or night). Children and young people with asthma that is not under control may cough at night which interrupts their sleep and can make them tired during the school day.

What is an asthma trigger?

A trigger is anything that irritates the airways and leads to asthma symptoms. There are many triggers and people may have different triggers because nobody’s asthma is the same. Some common triggers are:

• viral infections
• dust (house dust mite)
• pollen and moulds
• smoking (including secondhand tobacco smoke)
• furry and feathery animals
• exercise
• pollution
• emotion (laughter, excitement, stress)
• chemicals and fumes/perfumes
• changes in temperature.

Supporting students with asthma in school

Many school staff are willing to help children and young people to take their inhaler.  This is nevertheless voluntary, except in an emergency.  Where information or training is needed this should be provided in order for staff to be able to carry out their role.

At school most children will only need to take their inhaled medication. Every child with asthma should have their own named reliever inhaler in school, prescribed by their doctor or asthma nurse (with a prescribing qualification). Children and young people with asthma should have their inhaler either on them or nearby at all times. Inhalers should never be kept in a locked cupboard or drawer.

Asthma UK advises that all schools have an asthma policy and that all school staff have regular asthma training delivered by somebody who is suitably qualified.

Spare inhalers

Schools are allowed to hold a spare salbutamol inhaler for emergency use, provided that parental consent has been given for its use in an emergency, should the child’s own inhaler not be available. See guidance from the Department of Health (DoH) at end of briefing.

Key messages

• There is no legal or contractual duty upon teaching staff to administer asthma medication.
• All schools should have an asthma policy to support children with asthma.
• All school staff should have regular asthma training and this should cover use of the emergency inhaler, where there is one.
• Schools may keep a spare inhaler for use in an emergency situation where a child’s own inhaler is not available, provided parental consent has been given. (The DoH advice includes a model consent form for use by schools.)

Drawing up school policies and individual plans

Given the number of students and pupils with asthma in schools it is important that, in addition to establishing a general school asthma policy, schools follow the guidance issued by the Department for Education (DfE) - Supporting pupils at school with medical conditions at school - regarding individual health care plans. (See details at end of briefing.)

The main purpose of an individual healthcare plan is to identify the nature and extent of support needed at school. Those who may be involved include the head teacher, the parent or carer, the child (depending on age and ability), the class teacher, support staff or the school health service or child’s GP.

Each individual plan should assess the need of the pupil or student and should give details of the severity of the condition, individual triggers, signs and symptoms. It should provide clear information about the arrangements for daily care including the type of medication, the dose, the route of administration and the access arrangements. The plan should provide details of what to do in an emergency, including contact details of parent/carers and child’s GP practice. The individual care plan must be reviewed on a regular basis, usually every academic year. Parents should be encouraged to keep the school informed of any changes in the condition promptly.

Asthma medication

Most pupils with asthma will use an inhaler to take their medication. There are different types of inhalers – relievers and preventers.

Reliever inhalers (usually blue)

The most common asthma medications seen in school are blue reliever asthma inhalers, used by the majority of pupils. Blue reliever inhalers give immediate relief from asthma symptoms by dilating the small airways, opening up the air passages and making it easier to breathe.

Preventer inhalers (usually brown but can be orange)

These type of inhaler prevent inflammation and swelling in the airways and mean that people will be less likely to react to their asthma triggers. Unlike reliever inhalers, they do not give immediate or quick relief when someone is breathless, and their protective effect builds up over time. They need to be taken every day as prescribed (normally morning and evening), even if the person is feeling well. Pupils who use a preventer inhaler still need to carry their blue reliever inhaler at all times because this is the inhaler which acts quickly to relieve symptoms when they come on.

If students or pupils do not have their emergency reliever inhaler to hand the chances of a medical emergency developing increase. Inhalers must therefore be readily accessible at all times.

If the child or young person is not able to carry their inhaler themselves it should be stored in an easily accessible place and clearly marked with the child’s name, in the original box and the pupil and staff should know where it is stored. Inhalers should also be rapidly accessible to students when they are doing PE or other activities which might trigger an attack. Most schools insist on provision of a spare inhaler which is kept in eg the school office or medical room in case of emergencies or in case the school is evacuated.

What to do in an asthma attack

An asthma attack can cause severe distress to the child or young person and can be a frightening experience for all those involved.

When a child or young person has an asthma attack they should be treated according to their individual care plan and according to school asthma or medical conditions policy.

Common signs of an asthma attack

The child or young person may be:

• coughing
• short of breath
• wheezing
• complaining of a tight feeling in the chest
• unusually quiet
• having difficulty speaking/completing sentences
• complaining of tummy ache (younger children).

What to do

• keep calm and reassure the child
• encourage the child to sit up
• make sure the child takes two puffs of their reliever inhaler immediately (preferably through their spacer)
• if there is no immediate improvement continue to give them two puffs of reliever inhaler (one puff at a time, remembering to shake between puffs)
• if they don’t feel better after taking their inhaler as above or if you are worried at any time call 999 for assistance
• if an ambulance does not arrive within ten minutes – repeat step 3

After a minor asthma attack

If the child or young person feels better after taking their reliever inhaler their normal activities should continue. The parent/carer should always be informed if their child has had an asthma attack or has been asking for their inhaler more than usual.

Important key messages

• Never leave a child who is having an asthma attack or send them away. Remember – bring the inhaler to the child, not the child to the inhaler.
• In an emergency school staff are required under the common law, duty of care to act as any reasonably prudent parent.
• Contact the parent/carer immediately AFTER calling 999.

Participation in school activities

The DfE advises that children with asthma should participate in all aspects of the school day, including physical activities. Having asthma should not normally prevent the sufferer from taking part in sports and games. Indeed, a number of famous athletes - such as gold medallist Paula Radcliffe - suffer from the condition. Some children may need to take their reliever medicines before any physical exertion. Warm-up activities are essential before any sudden activity especially in cold weather. Particular care may be necessary in cold or wet weather. However, children who feel unwell should never be compelled to take part in physical activities.

In all cases where a child’s condition appears to be adversely affecting their school work, the issue should be discussed with the child’s parents.

School trips and visits

It should be made clear that asthmatic children need to take their reliever inhaler with them on all out-of-school activities, whatever activities are involved.

The school policy should require staff to take the spare inhaler with them on any school trip or visit. Pupils on residential trips may need to bring their brown preventative inhaler with them, clearly labelled, so staff should be trained in correct use of the different types.

Checklist for NEU safety representatives

• Check that your school has an asthma policy as part of its whole school policy on medicines and medical needs, and that where applicable this policy reflects any relevant local authority policy. The asthma policy should include important information and set out specific actions to be taken. Asthma UK has produced a model policy.
• All staff - especially those involved with PE activities - should have training or receive information about asthma once a year. In particular they should be able to recognise symptoms of an attack, know about asthma medications and what needs to be done in the event of a child having an attack.
• Comprehensive and regularly updated individual health care plans should be available for each child with asthma in the school. Staff need to be fully aware of which children suffer from asthma in the school, and have ready access to their individual health care plans.
• The school environment should be as ‘asthma friendly’ as possible, with as many potential asthma triggers removed as possible.

Further guidance

School asthma cards, information and posters for young people to encourage them to be active with their asthma can be downloaded from Asthma UK.

To answer any questions about asthma call the Asthma UK helpline on 0300 222 5800. This is staffed by fully trained nurses from Monday to Friday, 9am-5pm. 

DfE guidance

Supporting pupils at school with medical conditions

DoH guidance

Information on the emergency use of inhalers in schools

Guidance for Wales