Preventing asthma deaths in school children: 3 things to know

With deaths from asthma attacks the highest they have been in a decade, GP Robin Carr blogs about three things you need to know that can reduce the risk of death from asthma in school-aged children, and shares a film ‘Preventable’, made with teenagers about preventing asthma deaths in schools.

Take-home points

Deaths from asthma attacks are the highest they have been in a decade, but most asthma deaths in school-aged children are preventable. • Preventable is a film made with teenagers about how to prevent deaths from asthma attacks in schools. • Three things are key in preventing deaths from asthma: o All people with asthma need an inhaled steroid in order to prevent asthma attacks and death from asthma o Many people given a pressurised meter dose inhaler (pMDI or puffer) do not take it correctly o Personalised Asthma Action Plans (PAAP) save lives.

Deaths from asthma attacks are the highest they have been in the last decade and have increased by more than 33% over the last ten years, according to Asthma + Lung UK’s analysis of data from The Office for National Statistics (ONS).

5 years ago, almost to the day, I wrote a blog about asthma in schools – how we had seen the beneficial effects of teaching teachers about asthma and how this had a positive effect on the knowledge and preparedness for asthma in those schools. Nothing could have prepared me for the comment posted shortly after, and has been in the front of my thinking since 2017.

“It breaks my heart knowing my son has struggled because his teacher didn’t know how to help him with his pump. I hope this idea takes off as it will help ease my worry a great deal.”

In 2014, the National Review of Asthma Deaths (NRAD) Why Asthma still Kills was published. It showed how so many of these deaths, especially in school-aged children, were preventable. The chilling point then, as now is ‘almost all the asthma deaths in school-aged children are preventable’.

For decades we have been doing the same thing over and over again and this is the result, maybe this was time to change the way in which we sent out the same messages? Working with a local secondary school together we made ‘Preventable’. Watch it below.

Three things you need to know about asthma

I have had a chance to talk with lots of people about asthma in schools and one key thing the film addresses, is that many people with asthma, their parents and their teachers, didn’t know three key messages:

Let’s take a look at these.

Inhaled steroids: let’s treat the problem, not the symptoms

For far too long we have approached this condition from a symptomatic point of view. Do you cough, have a wheeze, or feel short of breath? If you take a reliever medication that removes those symptoms, no matter how temporary, maybe this was a good thing. We saw it as a minimal treatment for mild illness. How wrong could we have been. Overuse of short acting beta agonist (relievers) actually increases the chance of attack, and there really is no such thing as “mild” – this terminology is from 50 years ago, but now a great deal more is known about asthma and how it is an inflammatory condition which requires an anti-inflammatory treatment. A bit like only giving painkillers to someone having a heart attack! You want to treat the problem, not the symptoms.

Use a pressurised meter dose inhaler (pMDI or puffer) correctly

Many people given one do not take it correctly. Asthma + Lung UK say it could be as many as 1 in 6 people with asthma. Certainly my experience of meeting people and talking about how they use their inhalers bears this out.

Use a spacer

“Since seeing your film Robin I never go out without a spacer”. Was a spontaneous comment from someone who has taking this medication all their life, and did not know that you only get 1/10th of the dose even if you are good at it, but with a spacer it is nearly 3 times the amount.

The size of spacer is entirely up to you. The older ones are bigger, but big or small they all have been shown scientifically to do the job. The smaller ones are easier to carry around with you at school, or in a sports bag. In the film Nathan has a small volume spacer device.

Inhale slowly and steadily

The other classic one is the speed at which you inhale it. When you fire a puffer the medication rushes out and you are tempted, and we are often taught (wrongly) to snatch at it, take a rapid breath in to catch all that medicine before it’s too late. Wrong, wrong, wrong. Almost all of it ends up on the back of your throat and is swallowed. It’s a complete waste of time, and for some it gives them a hoarse voice or a sore mouth. If you are prescribed a puffer, make sure you also have a spacer, and the inhalation is slow and steady.

There are some brilliant online videos about inhaler technique. Never be caught out ever again. Watch  ‘How to use a pMDI inhaler’ on the Asthma + Lung UK website and you can also find out more on the Right Breathe website.

Personalised Asthma Action Plans (PAAP) save lives

This startling fact has been known for the whole time I have been a doctor (ages). It is in all the NICE guidelines and every educational programme about asthma, but for some reason, only about 1 in 3 people in England and Wales have one. In Northern Ireland, it is twice this number. It is very sad to know that many of those who died from asthma, did not have one. My experience of speaking with children, adults and teachers is one of not knowing they need one.

This very simple scientifically proven piece of paper or card, or on your phone has a few very important things on it.

  • What are you like when you are well, and what to do to keep well
  • What to do when you are unwell
  • When to call 999 if you are not getting better.

It’s not rocket science it is life-assuring common sense. When you talk with someone who has a PAAP they say that they now feel confident to look after their asthma and what to do if it starts to deteriorate.

Talking with teachers is the same. It is quite a responsibility to have a class of children who are in your charge, when 3 or more might have asthma. If you know what to do, better still you already know they have asthma, and have a copy of the PAAP with you, it stops being a ticking time bombshell and becomes one of the calm adult responses a teacher can carry out in the full reassurance they are following the plan.

In ‘Preventable’, the teacher is given Nathan’s PAAP, she already knows he is at risk of an asthma attack because he is on the school’s Asthma Register, she will have had some training during the teacher inset day. So she is ready to make the correct decision, following the PAAP instruction for an emergency, and she calls for help early when Nathan failed to improve.

Where to get your PAAP

Typically, you get one from your asthma nurse or your GP. It is personalised to you which is key. You can help by downloading one from Asthma + Lung UK and taking it with you when you have your annual check-up, or after an asthma attack. They are available in many languages as well as English.

  1. Asthma action plan for adults
  2. Asthma action plan for children
  3. Asthma action plans in languages other than English

Bridging the gap between what we know and what we do

Preventable is a film made by school-aged children as their way of try to address the gap between what we know, and we do. Watch it. Think about it. Then do it.

You never know this might save someone’s life, from being yet another preventable asthma death.

Say enough to these preventable asthma deaths.

References (pdf)

Join in the conversation on Twitter with @CochraneUK and @CochraneAirways or leave a comment on the blog. 

Please note, we cannot give specific medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right to not publish any we consider offensive. Cochrane UK does not fact check – or endorse – readers’ comments, including any treatments mentioned.

Dr Carr has nothing to disclose.



Preventing asthma deaths in school children: 3 things to know by Robin Carr

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

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