Whole school approach to asthma in schools

Click on the links to access information, guidance and resources that can be applied to a whole-school approach, including an audit tool and an action plan.

Try these 'quick wins' before thinking about anything else to get you started and see the difference you could make:

• Identify a member of staff to be your asthma champion! See further NHS guidance in this 'Asthma Friendly Schools Guide' from Humber and Yorkshire Health and Care Partnership (page 8).
• Review your Asthma register to check it is correct and up to date. Check all CYP on the register have a personal asthma action plan (PAAP).
• Share this 'Preventable' video with staff, which highlights the difference that school staff can make to a CYP experiencing an asthma attack.

Audit tool

Use the whole-school approach audit tool (Word doc, 920 KB) to identify areas of good practice and identify areas for improvement. The action plan will provide you with guidance and resources (Word doc, 937 KB) for every area to ensure you achieve a measurable impact. If you need any bespoke support and guidance, or have a CYP at risk of pulmonary exacerbation (PEX), we are happy to help and can be contacted at inclusionandsend@norfolk.gov.uk.

This guide suggests a whole school approach to supporting children with asthma and raising awareness of asthma. Schools should have robust systems and processes in place to help support children and young people (CYP) with asthma and explore the option to become an asthma friendly school.

Supporting CYP with medical conditions is a statutory requirement for schools in England.

Schools and settings play a vital role in supporting the wellbeing of children with asthma and reducing barriers to their educational attainment.

A whole school / setting approach to asthma can:

• Reduce stigma
• Promote confidence for staff and CYP in the support provided at school
• Address needs in a holistic way

Find more information about becoming an Asthma Friendly School and a helpful checklistFind more information about becoming an Asthma Friendly School and a helpful checklist.

Further signposting:

• The #AskAboutAsthma campaign highlights the simple changes to CYP's care that will make a big difference to how they experience their asthma. Led by NHS England, the aim is for every person involved in the care of a child or young person with asthma - from GPs to parents/carers, teachers and youth group leaders - to know about the four asks that can help every person to manage their condition and live full, active lives. Find out more on the Transformation Partners NHS website!
• See advice from Beat Asthma around personalised asthma action plans (PAAPs), how to use an inhaler with a spacer as well as more specific situations including pets in schools, sports day / exercise and school trips.
• Schools can register with Schools' Air Quality Monitoring for Health and Education (SAMHE) to help improve indoor air quality. Schools receive a free air quality monitor that measures carbon dioxide (CO2), volatile organic compounds (VOCs) particulate matter (PM), temperature and relative humidity. Teachers and CYP can access their data through an app, seeing how air quality changes over time.

School leaders must ensure that the school's asthma policy is read and understood by all members of staff including teachers, teaching assistants, support staff and catering staff. School leaders must review the asthma policy annually and conduct an annual review of the safe management of asthma in the school.

Leaders and governors must be aware of the potential triggers, signs and symptoms of asthma and know what to do in an emergency. They must know which children or young people (CYP) have asthma and be familiar with the content of their personal asthma action plan (PAAP).

See key actions for leaders and governors, in line with the asthma friendly schools guide checklist (page 9):

• Identify an Asthma Champion
• Compile an asthma register, ensure this is updated regularly and accessible to staff
• Develop an asthma policy
• Ensure all CYP have immediate access to their emergency medicines (including spacers) - should be kept with the child or in an accessible place
• When inhalers are kept in school, the Asthma Champion will check expiry dates at least every 6 months and reminds parents to provide another inhaler prior to expiry
• Keep an emergency inhaler and spacer in school. The Department of Health has published a protocol which provides further information at Emergency asthma inhalers for use in schools (GOV.UK)
• Request copies of a CYP's PAAP from parents/carers
• Have a School Wide Asthma Emergency Plan that can be used in the absence of a PAAP
• Ensure staff complete two-yearly asthma training
• Create your own bespoke clean air plan by choosing the recommended air pollution tackling actions and using the suggested advice and resources to help your school become a clean air school, including:
  • Reduce air pollution from your own operations
  • Tackle air pollution at the school gate
  • Educate the next generation to help them and their families make cleaner air choices
  • Become a local leader on air pollution, working with local partners to improve air quality in the local area

What are rights/legalities regarding asthma?

See guidance and legal requirements below:

• Supporting pupils at school with medical conditions (DfE)
• Emergency inhalers in schools (Department of Health)
• Legal requirements (Beat Asthma)

Internal air quality

• DfE guidelines on internal air quality in schools give information on relevant health and safety legislation, and when internal air filtration systems may be appropriate.

You should have a general asthma policy in place which is accessible for all staff, children and young people (CYP) and families.

Ensure your policy outlines:

• An asthma register of CYP who have asthma
• An information record for each CYP, with details about their asthma triggers and medication
• Knowledge about where each CYP keeps their inhaler and how they can get it when they need it
• Asthma training for all staff with responsibility for CYP who have asthma
• A clear plan to follow in the event of a CYP having an asthma attack
• Emergency contact details

Please see an example Asthma in School policy (guide) (PDF, 392 KB).

When considering behaviour and absence policies, be aware that asthma may impact on behaviour and absence when poorly managed and adjust your policies as appropriate.

Discuss with children and young people (CYP) on the asthma register whether they feel supported in school for their asthma.

Example questions might be:

• Do you know who the asthma champion is?
• Do you have a PAAP and do your teachers know how to access this?
• Do you feel supported at school with your asthma?
• Do you have any worries about your asthma?
• Do you go to your doctors every year for a check on your asthma?

See guidance in this padlet (in the 'What do I need to do - CYP voice' section) on collecting CYP voice.

Further guidance for supporting individual CYP including what to do if a child or young person (CYP) is having an asthma attack can be found in the associated Thematic Toolkit padlet for Asthma.

Ensure all CYP who have asthma have a personal asthma action plan (PAAP): see this example from Asthma+ Lung UK.

• Ensure all CYP know the details of your Asthma champion and know how to contact them.
• Beat Asthma has website for CYP where they can find all the information they will need to fully understand their asthma, know how to recognise important symptoms and know how their treatment should be to get the best possible control of their asthma. There is also advice for how to look after asthma in schools and help their friends understand more about it too.
• The MySpira app is designed to support CYP with diagnosed asthma to understand all the things they need to know about their condition and encourage good inhaler technique. It is best suited for 6-13 year olds and includes 8 fun modules. The app combines augmented reality and gameplay to offer the very best asthma education. The app is validated and safe, and has been developed with close assistance from asthma specialists.
  How to download:
1. Download MySpira from your mobile device's app store
2. Type in the following code when prompted: 62025117b8df4
3. Follow the modules to complete the training
4. Complete the asthma plan and enjoy the bonus game!
• This short, animated video will help CYP to understand why using a spacer is necessary to help get the medication deep into the lungs - where it is needed most!

Key points:

• It is the responsibility of parents on admission to school to inform of any health needs including asthma. Schools should make it clear to parents to inform school of any changes such as a new diagnosis of asthma.
• Parents/Carers should be routinely contacted before a CYP starts school to ask about asthma.
• Ensure your asthma policy is available for parents to review.
• Staff/Asthma Champion should ensure that contact is made with parents/carers when an inhaler is used in school (whenever possible).
• Ensure any use of emergency inhalers, asthma attacks are communicated to families. Signpost to GP for review after a significant asthma attack or if reliever inhaler is used more frequently than usual.

Links to to share with families:

• Education for Health offers a free online course about asthma for parents/carers of children and young people with diagnosed asthma.
• Just One Norfolk has lots of general information about asthma and wheezing, helpful for school staff and for families.
• Moving on Asthma provides guidance on managing asthma at school for families (and older CYP).
• Asthma+ Lung UK provides advice and support for families to help their child stay well, including guidance on asthma action plans.

Use opportunities such as Science and Personal Social Health & Economic (PSHE) education to raise children's and young people's (CYP) awareness about asthma. Teachers should talk about the steps CYP can take to protect and support their own and others' health and wellbeing, including simple self-care techniques, prevention of health and wellbeing problems and basic first aid.

Primary school

By the end of primary school, students should know:

• Health education:
  • How and when to seek support including which adults to speak to in school if they are worried about their health
  • How to make a clear and efficient call to emergency services if necessary

High quality resources - Primary

• KS2 Emergencies & Calling For Help Lesson Plan {St John Ambulance)
• KS2 Asthma Lesson Plan (St John Ambulance)
• This video from Newham London - My Hero travel pack - provides easy to understand information about inhalers, spacers and peak flow measurements for CYP, staff and families. It also highlights the importance of storing asthma medication properly in a 'kitbag'.

Secondary school

By the end of secondary school, students should know:

• Science curriculum:
  • The impact of exercise, asthma and smoking on the human gas exchange system

High quality resources - Secondary

• KS3 Asthma Lesson Plan (St John Ambulance)
• KS4 - A film about asthma called 'Preventable', created by teenagers for teenagers
• This video from Newham London - My Hero travel pack - provides easy to understand information about inhalers, spacers and peak flow measurements for CYP, staff and families. It also highlights the importance of storing asthma medication properly in a 'kitbag'.

Air pollution

More than a quarter of all British schools and colleges are located in areas which have dangerously high levels of air pollution. See below resources for teachers including lesson plans:

• What is air pollution - Year 2
• What is air pollution - Years 3 & 4
• What is air pollution - Years 5 & 6
• Air Pollution - Teacher's Pack (eco-schools.org.uk)
• Tackling air pollution at school (TAPAS) have produced videos explaining how ventilation works and how maths and science can be used to help us understand ventilation and air quality
• A collection of action-focused teaching resources covering a broad range of clean air campaigns to help your CYP bring clean air to your school

All staff can complete this free Education For Health eLearning training, designed for anyone who supports children and young people (CYP) with asthma. The course is aligned to the Tier 1 Capabilities set out in the National Bundle of Care for Children and Young People with Asthma and successful completion of the eLearning certifies you as having achieved the capabilities for Tier 1.

Please also see  Asthma in Schools training resource (PDF, 2 MB) for more information.

• Ensure your asthma policy is reviewed annually.
• Ensure the asthma register is updated regularly.
• Keep an accurate record of each occasion a CYP is given or supervised taking their inhaler.
  • If recording takes place in more than one location i.e., classroom and office - the record is amalgamated to clearly reflect frequency of use. Ideally there should be one record.
• Details of the supervising staff member, CYP, dose, date and time are recorded.
• Parents will be informed if a CYP uses their inhaler at any time unless there is routine use which is clearly stated in their PAAP such as prior to sports.
• If a CYP refuses to use their inhaler, this is also recorded, parents are then to be informed as soon as possible.
• Keep an asthma register so that you can identify and safeguard CYP with asthma; this is held in the classroom and school office.

What can trigger an asthma attack?

Asthma triggers irritate the airways or worsen the inflammation in the airways. The following triggers can cause asthma symptoms or start an asthma attack:

• Infections, usually those caused by a virus (e.g. colds or flu)
• Allergens, most commonly from house dust mites, pets or pollen
• Exercise, especially in cold weather
• Strong emotions, such as excitement, fear, or anger
• Irritants, such as air pollution
• Smoking
• Exposure to mould
• Changes in the weather
• Pressure on chest
• Food additives, such as tartrazine (an artificial food colouring), or food allergens, such as peanuts (sensitised or allergic individuals can have a very severe allergic reaction)
• Certain medications some people may be allergic to some drugs (e.g. aspirin)

When the airways have been inflamed for a long time, they become extra-sensitive. This means that they react faster and more strongly to various triggers, such as allergens, viruses, dust, smoke and stress. See more guidance on the ginasthmas.org website.

Why is it important to raise awareness and educate about asthma?

Awareness and education go hand in hand in creating safe and supportive environments for CYP with asthma. When asthma is in control and education is in place, CYP can more easily participate in their education with less limits to their physical activity.

What can we do to reduce the incidence of asthma attacks?

You can assess your indoor air quality to reduce triggers for asthma in school.

Schools can register with Schools' Air Quality Monitoring for Health and Education (SAMHE) to help improve indoor air quality. Schools receive a free air quality monitor that measures carbon dioxide (CO2), volatile organic compounds (VOCs) particulate matter (PM), temperature and relative humidity. Teachers and CYP can access their data through an app, seeing how air quality changes over time.

Knowing a CYP's triggers and removing as many as possible from the school environment can also improve a CYP's breathing and possibly reduce the need for medication.