Call a doctor or the ambulance urgently if:
Asthma in PE and school sports
Full participation in PE and sports should be the goal for all but the most severely affected children with asthma.However, many children with asthma will experience asthma symptoms during exercise. Teachers taking PE classes have an important role in supporting and encouraging pupils with asthma.
- make sure that they know which children have asthma
- be encouraging and supportive to pupils with asthma
- remind children whose asthma is triggered by exercise to take a dose of reliever medication a few minutes before they start the class
- encourage children with asthma to do a few short sprints over a five minute period to warm up
- make sure children bring their reliever inhalers to the gym, the sports field or the swimming pool
- make sure that children who say they need their asthma medication take their reliever inhaler and rest until they feel better
- speak to the parents if they are concerned that a child has undiagnosed asthma (or ask the form teacher to)
- make time to speak to parents to allay their concerns or fears about children with asthma participating in PE
What to do when a child with asthma joins your class
Even if your school does not have an asthma policy, there are measures that should be taken when a child with asthma joins your class:
- If the school does have a policy, make sure you are familiar with it.
- Ask the parents about their child's asthma and current treatment.
- This information should be recorded in the school records.
- Allow the child free access to their reliever medication. This means allowing the child to carry it on them either in their pocket or inhaler pouch. If, after discussion between the parents and the doctor or nurse, it is believed that the child is too young to do this, it should be kept in the classroom in an easily accessible place.
Reliever inhalers should not be locked in the teacher's drawer or kept in a central office
Some children need a discreet reminder to take medication, especially before exercise. Remember some children are shy about taking medication in front of others. Developing positive class attitudes towards pupils with medical conditions will help.
- Remind the child to carry his or her medication at all times, including on school trips, and include this information on school circulars and in advice to parents. Always inform the parents if the child has had an asthma attack and used their reliever medication. If you are worried about a child who appears to have 'severe' asthma, it may be helpful for teachers to consult either the school nurse or doctor, or the child's own GP through their parents.
- If the child is taking time off school or is tired in class – which could be because of asthma symptoms during the night disturbing sleep – the teacher should firstly talk to the parents, and then the school nurse and special educational needs co-ordinator. Some children with asthma may be considered to have special educational needs and require extra support.
- The teacher, school nurse and special educational needs co-ordinator or learning support and special educational needs department should talk to the parents and discuss strategies and support to help the child.
How to develop a good school asthma policy:
A school asthma policy can be a stand-alone policy or incorporated into part of another school policy, for example the Health and Safety, first aid or general health policy.
The principles of a school asthma policy
The following information is to enable you to develop an asthma policy appropriate to your school. Every school is different so every policy will vary slightly. However every policy should incorporate the following principles:
- Recognizes that asthma is an important condition affecting many school children, and
- Welcomes all pupils with asthma,
- Ensures that children with asthma participate fully in all aspects of school life including PE
- Recognises that immediate access to reliever inhalers is vital
- Keeps records of children with asthma and the medication they take
- Ensures the school environment is favourable to children with asthma
- Ensures that other children understand asthma
- Ensures all staff who come into contact with children with asthma know what to do in the event of an asthma attack
- Will work in partnership with all interested parties including all school staff, parents, governors, doctors and nurses, and children to ensure the policy is implemented and maintained successfully
Example of a school asthma policy
An asthma policy should outline how each of these points will be implemented within a particular school. Each school will need to develop and agree their own policy. This is an example of a school policy in a primary school in England:
Sample School asthma policy
This policy has been written with advice from the Department for Education and Employment, National Asthma Campaign, the local education authority, the school health service, parents, the governing body and pupils.
This school recognises that asthma is an important condition affecting many school children and positively welcomes all pupils with asthma.
This school encourages children with asthma to achieve their potential in all aspects of school life by having a clear policy that is understood by school staff, their employers (the local education authority) and pupils. Supply teachers and new staff are also made aware of the policy. All staff who come into contact with children with asthma are provided with training on asthma from the school nurse who has had asthma training. Training is updated once a year.
Immediate access to reliever inhalers is vital. Children are encouraged to carry their reliever inhaler as soon as the parent, doctor or nurse and class teacher agree they are mature enough. The reliever inhalers of younger children are kept in the classroom in a spice rack. Parents are asked to ensure that the school is provided with a labelled spare reliever inhaler. The class teacher will hold this separately in case the child's own inhaler runs out or is lost or forgotten. All inhalers must be labelled with the child's name by the parent. School staff are not required to administer medication to children except in an emergency, however many of our staff are happy to do this. School staff who agree to do this are insured by the local education authority when acting in accordance with this policy. All school staff will let children take their own medication when they need to.
At the beginning of each school year, or when a child joins the school, parents are asked if their child has asthma. All parents of children with asthma are given a National Asthma Campaign school card to give to their child's GP or asthma nurse to complete and return to the school. From this information the school keeps its asthma register which is available for all school staff. Cards are then sent to parents on an annual basis to update. If medication changes in between times, parents are asked to inform the school.
Taking part in sports is an essential part of school life. PE teachers are aware of which children have asthma from the asthma register. Children with asthma are encouraged to participate fully in PE. Teachers will remind children whose asthma is triggered by exercise to take their reliever inhaler before the lesson and complete a warm up of a couple of short sprints over five minutes before the lesson. Each child's inhalers will be labelled and kept in a box at the site of the lesson. If a child needs to use their inhaler during the lesson they will be encouraged to do so.
The school environment
The school does all that it can to ensure the school environment is favourable to children with asthma. The school does not keep furry and feathery pets and has a non-smoking policy. As far as possible the school does not use chemicals in science and art lessons that are potential triggers for children with asthma. Children are encouraged to leave the room and go and sit in the secretary's office if particular fumes trigger their asthma.
Making the school asthma - friendly
The school ensures that all children understand asthma. Asthma can be included in key stages 1 and 2 in science, design and technology, geography, history and PE of the school curriculum (for more details see Section 7). Children with asthma and their friends are encouraged to come to the club that is run at lunch times once a month by our school nurse who has had asthma training.
The club is associated to the National Asthma Campaign's Junior Asthma Club and educates children about asthma in a fun, interactive way.
When a child is falling behind in lessons
If a child is missing a lot of time from school because of asthma or is tired in class because of disturbed nights sleep and falling behind in class, the class teacher will initially talk to the parents. If appropriate the teacher will then talk to the school nurse and special educational needs co-ordinator about the situation. The school recognises that it is possible for children with asthma to have special educational needs because of asthma.
All staff who come into contact with children with asthma know what to do in the event of an asthma attack. The school follows the following procedure, which is clearly displayed in all classrooms:
- Ensure that the reliever inhaler is taken immediately
- Stay calm and reassure the child
- Help the child to breathe by ensuring tight clothing is loosened
After the attack
Minor attacks should not interrupt a child's involvement in school. When they feel better they can return to school activities.
The child's parents must be told about the attack
Call the child's doctor urgently from the secretary's office using the asthma register to find out the number of the child's GP 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 the doctor is unobtainable, call an ambulance
Draft letter for headteachers to adapt
If you are planning to use the school card you will need to send the card to the parents so they can ask the child's doctor to fill it in.
Below is a sample letter that you may like to adapt.
I am pleased to advise you that this school takes its responsibilities to pupils with asthma very seriously. With advice from the Department for Employment and Education, the National Asthma Campaign, the local education authority, the school.health service and the governing body, we have recently established a new School Asthma Policy for use by all staff.
As part of accepted good practice, we are now asking all parents of pupils with asthma to help us to complete a School Asthma Form for their son and/or daughter. Please take this form to your doctor/nurse for completion and return it to me at the school.
The completed form will have details of the pupil's current treatment and also what steps to take if they should have an asthma attack at school. The card will help school staff to ensure that pupils with asthma receive the best possible treatment at all times.
The School Asthma Form should be updated regularly by the doctor/nurse, stating whether or not the treatment has changed. I look forward to receiving the completed form. Thank you for your co-operation in this important matter.
Your questions answered:
Dealing with medication
Q Where should the school keep reliever medication?
Immediate access to reliever medication is essential. Delay in taking reliever treatment, even for a few minutes, can lead to a severe attack and in very rare cases has proved fatal.
As soon as a child is able, allow them to keep their reliever inhaler with them at all times, in their pocket or in an inhaler pouch. The child's parents, doctor or nurse and teacher can decide when they are old enough to do this (usually by the time they are seven).
Keep younger children's inhalers in an accessible place in the classroom such as in a spice rack or box. Make sure they are clearly marked with the child's name. At break time, in PE lessons and on school trips make sure the inhaler is still accessible to the child.
Reliever inhalers must never be locked up or kept in a central room away from the child.
Q What happens if a child takes too much reliever medication?
Reliever medication is extremely safe. Although reliever inhalers should be treated as medication, teachers need not worry that a child may overdose on their reliever inhaler. Parents should be told when a child has used their reliever inhalers.
Q What happens if a child without asthma experiments with another child's reliever inhaler?
This will not be harmful. Reliever medication acts to dilate the airways. If a child takes very many doses, they may experience an increased heartrate or tremor, but this will not cause any long term effects. Of course you should talk to the child firmly about this as all medication should be treated with respect.
Q Do inhalers expire after a given amount of time?
Yes they do. Parents should be responsible for ensuring that their child's medication is within the expiry date (medication usually lasts about two years). A named person within the school should be responsible for checking the expiry dates of spare reliever inhalers.
Q What happens if the child forgets their reliever inhaler?
Parents should be asked to provide a spare reliever inhaler labelled with the child's name. This should be kept by the school in an accessible place in case their own runs out or the child forgets or loses their reliever inhaler.
Q Should schools have one emergency reliever inhaler so they don't have to keep a lot of spares?
In the U.K., the National Asthma Campaign would like to see an emergency reliever inhaler and spacer kept in every school accompanied by a clear protocol on how and when to use it. Current law is that each inhaler is prescribed for an individual patient only and cannot be used by anyone else. However, some areas such as Cornwall, Devon and Southampton do have emergency reliever inhalers in some schools in their areas. The charity is campaigning on this issue.
Q Should a child with asthma use another child's inhaler if they experience
asthma symptoms and their reliever (or spare) is not to hand?
Reliever inhalers are prescribed for use by an individual child only. As such they should not be used by anyone else. For this reason the U.K.'s National Asthma Campaign is legally unable to recommend this practice. If children with asthma have immediate access to their reliever inhaler and have a spare as back up kept in an accessible place, this situation should not arise. In an emergency situation when a pupil is having a severe asthma attack, using another child's reliever inhaler is preferable to being unable to give any medication. This should only ever happen in an acute emergency situation.
Questions about record keeping
Q. Why is an asthma register important?
It is important to identify all children with asthma and make sure they keep reliever medication within the school. This enables all school staff and supply teachers to be aware which children have asthma within the school.
Q. How often should the register be updated?
A member of school staff should have responsibility for the asthma register. Part of the procedure is checking that spare reliever inhalers are not out of date (this is usually within two years). Every year, ask all parents to tell you if their child has asthma (see the draft letter to parents enclosed).
It is the responsibility of parents to provide the school with details of what medication the child is taking during the school day. The National Asthma Campaign produces a school asthma form that they can give to parents to give to their child's GP to complete and return to the school. A sample school asthma card is enclosed.
Questions about children with more severe asthma
Q What should happen if a child with asthma is falling behind with work because of time off school?
Many children do miss school because of their asthma or are tired in class because they have had a disturbed nights sleep. This could be because:
- the child has severe asthma or the asthma is not well controlled because:
- the child has not been prescribed the appropriate medication
- the child is not using the appropriate inhaler technique
- the child is not taking their medications as prescribed
- the child is not avoiding, or able to avoid, their asthma triggers