GP Dr Tonia Myers writes about the need to increase asthma awareness in London to avoid more tragic outcomes
Who would believe that in the 21st century children in the UK are still dying from asthma at an average rate of one child under 14 dying every month in 2016. Sadly, the vast majority of these deaths were potentially preventable.
So why do these children die? Learning from the National Review of Asthma Deaths (2014) identifies common themes;
- Multiple A&E attendances, without appropriate follow up
- Frequent unmonitored prescriptions for reliever bronchodilator inhalers, without a request for an inhaled steroid preventer
- No evidence of use of a spacer device, or of teaching and reviewing inhaler techniques
- No evidence of a Personalised Asthma Action Plan (PAAP)
Better asthma awareness and support in schools
With an average of three children in every classroom having asthma (1:11 of all children) the importance of schools and school nurses in the management of children with asthma cannot be overstated.
For me, the light bulb moment came at a recent workshop run by Healthy London Partnership when one of the school nurses present described how she had discovered dozens of ‘blue puffers’ in a drawer in a school office, with no personalised asthma plans or spacer devices.
It is the duty of care of a school to have policies and procedures for looking after children with asthma and other long-term conditions. Schools can sign up for the Asthma Friendly Schools Programme which includes a commitment to holding a register of children with asthma and having a management plan for each child.
Since 2015, schools are allowed to hold an emergency bronchodilator inhaler and spacer device to use if a child has an asthma attack and has lost their inhaler. The HLP’s Asthma Toolkit is a great way to support schools and promote greater awareness around these initiatives.
The School Nursing Service is now commissioned by Public Health which is itself managed by the Local Authority. Although all local authority schools should have an allocated school nurse, the reality is that these are few and far between due to cuts in the public Health budget. In some areas, school nurses are only commissioned to provide their minimum statutory responsibilities such as school vaccinations. Their capacity to support schools to manage children with long term conditions is often very limited.
It would be good to see how community nurses who look after individual children and school nurses who look after the school as a whole can work together to facilitate a consistently safe environment for asthmatic children in schools. Schools need to have a clear asthma policy which includes an easy to access copy of the PAAP kept safely with the child’s individual inhaler and spacer device. More schools should be encouraged to sign up to the ‘Asthma Friendly Schools Programme’.
Improving awareness for children, young people and parents
A key priority is to educate and empower parents and young people to understand and manage their own condition or that of their childs so that they can take responsibility for their care. A great start is to direct them to the Asthma UK website or the London asthma toolkit parents and carers page.
Every asthmatic child should have a spacer to use with their salbutamol. If they have a sudden attack or acute wheeze they should take 10 puffs and go to the nearest hospital, by ambulance if necessary.
The importance of having a follow up appointment after an acute attack cannot be overstated. Parents and carers must be instructed to actively contact their surgery and ask for an emergency appointment which should be available in all practices.
Parents and children must have an up to date action plan (PAAP) which they understand. They must keep a copy at school and carry this ‘passport’ physically or electronically to all GP and outpatients appointments and importantly A&E or out of hours visits. HLP is soon to launch an app which will go a long way to help achieving this priority.
About the author
Dr Tonia Myers FRCGP is a GP & clinical director for children, Waltham Forest CCG and GP rep for Healthy London Partnership’s Children and Young People Clinical Leadership Group.