1. Managing Asthma in the school setting

2. Objectives raise awareness re: what is asthma who has asthma
asthma triggers
Signs and symptoms
Treatment
Guidance for the use of Emergency Salbutamol Inhalers in Schools

3. Who does it affect? 5.4 million people have asthma in the UK, 1
asthma affects one in five households.
1 in 11 children & young people in UK have asthma 1
Three people die every day in the UK because of asthma 1
It is one of the most frequent causes of absence and the most common reason for pupils needing to take medicine during school 1
‘86% of children have been without their own inhaler because it was lost, forgotten, broken or had run out.’ 2

4. On average, 2 children in every class are likely to have asthma.

5. What is Asthma? Asthma is a condition of the airways It is variable
It cannot be cured, but it can be controlled
Airways are ‘hyper-responsive’
In response to a trigger the airways narrow as the muscles around them tighten.
They become swollen, inflamed, and produce mucus which give asthma symptoms.

6. Airways

7. 3

8. TRIGGERS Chemicals & fumes Sprays - deodorants & perfumes
Cigarette smoke
TRIGGERS
Viral infections
Pollen & grass cuttings
House dust mites

9. Triggers Contd. Mould & damp Stress & emotion Weather & air quality
Exercise – this is one trigger to manage rather than avoid
dust from flour & grain

10. Exercise and asthma Increase fitness levels gradually
If exercise makes pupil’s asthma worse – use blue inhaler before warm-up
Always warm up & down thoroughly at start and end
Try to avoid other triggers, eg newly cut grass, dust, cold air, smoke, pollen
Always make sure reliever inhaler is with them 4 10

11. Exercise and asthma
If a child has symptoms while exercising they should STOP, take reliever and wait until they feel better (at least 5minutes) before starting again 4
Some forms of exercise are better tolerated than others
Recognize and respect the child’s limits

12. Asthma Medications Relievers Preventers Relieve tightness
Reduce inflammation and help prevent asthma episodes
Used correctly will help reduce the need to use reliever inhalers
Can be brown, beige, orange, red, purple
Not every child with asthma requires preventer inhalers
Usually you should not see preventers in school
Relieve tightness
Used during an asthma attack
May be used before exercise
Usually blue
Every child with asthma symptoms should have a reliever inhaler

14. How to use inhalers & spacers
Visit for interactive inhaler demo +
Metered dose inhaler
turbohaler
spacer

15. How to use a small spacer device on a child

16. Legislation:
1st October 2014 The Human Medicines Regulations (2014) - allows UK schools to keep a salbutamol inhaler for emergency use.
The change allows an emergency salbutamol inhaler to be used if pupils prescribed inhaler not available.

18. A copy of the guidance can be accessed here:

19. All parents should provide a spare reliever for the school. (Ref
All parents should provide a spare reliever for the school. (Ref. Supporting Pupils with Medicine Needs).
Source :‘GUIDANCE FOR THE USE OF EMERGENCY SALBUTAMOL INHALERS IN SCHOOLS’

20. N.B.
There is no compulsory requirement for schools to hold an inhaler for emergency use.
Schools who choose to keep an emergency inhaler should establish a policy or protocol for using it
Source :‘GUIDANCE FOR THE USE OF EMERGENCY SALBUTAMOL INHALERS IN SCHOOLS’

21. A Policy Should Include:
Arrangements for storage, care and disposal of the inhaler and spacer.
A copy of the asthma register with the emergency inhaler.
Written parental consent for use of the emergency inhaler.
Source :‘GUIDANCE FOR THE USE OF EMERGENCY SALBUTAMOL INHALERS IN SCHOOLS’

22. Supply:
Schools can buy inhalers from a pharmaceutical supplier at a cost.
Inhaler is approx. £4 and a spacer approx. £10
A stock of 5 is recommended as adequate for a typical school.
Supplier will need a request signed by the principal stating the name of the school, the quantity required and the purpose of use.
Source:‘GUIDANCE FOR THE USE OF EMERGENCY SALBUTAMOL
INHALERS IN SCHOOLS’

23. Emergency Kit Contents:
Salbutamol metered dose inhalers
At least 2 single use plastic spacer devices
Instructions on how to use the devices
Inhaler batch no. and expiry with monthly checks recorded
Note of arrangement for replacing
List of children who can use the device
Record of administration
Source:‘GUIDANCE FOR THE USE OF EMERGENCY SALBUTAMOL INHALERS IN SCHOOLS’

24. Storage and Care
It is recommended that 2 named members of staff have responsibility for:
Monthly checks to ensure device is working, is in date and has sufficient doses.
Replacing when expiry date approaching.
Replacement inhalers and spacers are always available.
Source:‘GUIDANCE FOR THE USE OF EMERGENCY SALBUTAMOL INHALERS IN SCHOOLS’

25. 5. Stored below 30oC and not in direct sunlight.
4. The emergency kit is kept safe and in a suitable centrally located place. NOT locked away.
5. Stored below 30oC and not in direct sunlight.
6. Kept separate from pupils own spare inhaler. 7. It is clearly labelled to avoid confusion.
The inhaler and spacer should be single person use to avoid cross-contamination.
Source:‘GUIDANCE FOR THE USE OF EMERGENCY SALBUTAMOL INHALERS IN SCHOOLS’

26. “The emergency inhaler and spacers should be kept separate from a child’s own inhaler (which they should carry with them) and their spare inhaler (which for Primary Schools should be stored in a nearby location to the pupil preferably the child’s individual classroom and a central unlocked room for Post Primary schools). The emergency inhaler should also be clearly labelled to avoid confusion with a child’s inhaler. An inhaler should be primed when first used (e.g. spray two puffs).
To avoid possible risk of cross-infection, the plastic spacer and inhaler should not be reused. “
Source

27. Disposal Return to a pharmacy to be recycled OR
The school can register online for free as a
low tier waste carrier.
Source:‘GUIDANCE FOR THE USE OF EMERGENCY SALBUTAMOL INHALERS IN SCHOOLS’

28. A Child prescribed an alternative reliever inhaler i. e
A Child prescribed an alternative reliever inhaler i.e. terbutaline (bricanyl) can use salbutamol if their own is not accessible as it will help to relieve their asthma symptoms and could save their life.
Children with asthma should be able to demonstrate to their teacher how they use their inhaler
Source:‘GUIDANCE FOR THE USE OF EMERGENCY SALBUTAMOL INHALERS IN SCHOOLS’

29. School should: Keep an asthma register
Seek written consent from parents which should be updated regularly. 3.
Record where and when attack happened and how much medication was administered.
A written letter should be sent home so information can be passed on to the GP 3

30. Note:
There is NO contractual responsibility for staff to administer medicine to pupils.
Any staff member can volunteer and can then become a designated member of staff identified in the asthma policy.
Source:‘GUIDANCE FOR THE USE OF EMERGENCY SALBUTAMOL INHALERS IN SCHOOLS’

31. Responsibility of ALL staff:
Be trained to recognise symptoms
Be aware of asthma policy.
Be aware of asthma register and be able to check if a child is on it.
Be able to access child’s inhaler.
Know who the designated staff member is and how to access their help.
Source:‘GUIDANCE FOR THE USE OF EMERGENCY SALBUTAMOL INHALERS IN SCHOOLS’

32. Designated Staff Recognise the symptoms of an asthma attack.
Respond appropriately when requested to help another member of staff.
Recognise when emergency action is necessary.
Know how to administer a salbutamol inhaler through a spacer.
Make appropriate records of asthma attack.
Source:‘GUIDANCE FOR THE USE OF EMERGENCY SALBUTAMOL INHALERS IN SCHOOLS’

33. Dealing with an asthma attack

34. Dealing with an Asthma Attack
Stay calm
Encourage the child or young person to sit up and slightly forward. Do not hug or lie them down.
Make sure the pupil takes two puffs of reliever (blue) inhaler immediately
Reassure the child
Source: (accessed 21/08/18)

35. 61 If there is no immediate improvement :
Continue to make sure the pupil takes one puff of blue reliever inhaler every minute for five minutes or until their symptoms improve.
Source: (accessed 21/08/18) 61

36. the symptoms do not improve in 5-10 minutes;
Call 999 urgently if:
the symptoms do not improve in 5-10 minutes;
the pupil is too breathless or exhausted to speak;
the child or young person's lips are blue;
if you are in any doubt.
Continue to give the child one puff of their blue reliever inhaler every minute until the ambulance or doctor arrives.
Source: (accessed 21/08/18)

37. How the school can help Asthma identified on school health form
Ensure pupils have access to
their reliever inhaler
Be aware of pupil’s triggers
Plan for school visits
Good communication with parents
Know what to do in a emergency
Attend update sessions

38. Questions to ask yourself
Does our school have an asthma policy.
Who are the children in school who have asthma? Where are their inhalers kept? Are they on the asthma register?
Do I know what to do if I suspect a child is having an asthma attack?
Do I know the triggers of the children I come into contact with regularly?

39. References (accessed 28/8/2017)
1 (31/5/13) 2
(accessed 28/8/2017) 3 4 5
Addendum:Guidance for the Use of Emergency Salbutamol Inhalers in Schools
6http:// 7

40. Additional Resource: free to access module on asthma available here:
Further Information on Asthma Inhalers can be found here: an

41. Contact Details Dawn King Sharon McElroy
Children’s Respiratory & Allergy Nurse Specialist
Sharon McElroy