Avoid a back to school asthma attack

Every year, there’s a spike in asthma attacks in children across the UK when they go back to school. As a parent, you might be worried about how they’ll adapt to being back at school after the long summer break. Find out how to make sure your child’s asthma is well managed and cut their risk of a back to school asthma attack.  

• Every September, there’s a rise in the number of children in the UK who are rushed to hospital due to their asthma. There are a few possible reasons why children are at higher risk of asthma symptoms and asthma attacks after returning to school:
• Lots of children come down with colds when they go back to school – this is one of the biggest triggers for people with asthma
• If your child has a dust mite allergy, being inside more as the weather changes could make their asthma flare up
• Seasonal allergies, such as mould in autumn and pollen in spring and summer could also set off asthma symptoms
• Preventer inhaler routines get easily disrupted over the holidays, so children's airways can be more sensitive to triggers when they go back to school
• Schools are typically deep cleaned over the summer and exposure to cleaning products can trigger asthma attacks
• Going back to school can be an exciting but often daunting time for children. We know that emotions like fear, stress or excitement can trigger asthma symptoms. So can emotional responses like laughing or crying
• For some children, going back to school means being more active, which can trigger asthma symptoms
• Going to secondary school can mean new journeys to school and new subjects like chemistry or design technology, that can increase triggers

When children get COVID-19, their symptoms are generally milder than when adults get COVID-19.

It’s unclear if COVID-19 could be a trigger for asthma attacks.

For most people with well-controlled asthma, COVID-19 doesn’t appear to be a trigger However, COVID-19 is a respiratory infection and we know that other respiratory infections, such as colds and flu, can trigger an asthma attack in some people.

Data shows that age is by far the most important factor influencing a person’s risk of becoming seriously ill with coronavirus. Very few children develop severe symptoms of COVID-19, even if they have an underlying health condition.

You can read more about the main factors that increase the risk of catching and becoming seriously ill with coronavirus on our 'COVID-19 - What should people with asthma do now?' page.

• The number one priority is to make sure your child is taking their preventer medicine every day, as prescribed. This will help calm the inflammation in their airways and reduce the risk of an asthma attack. You can watch our inhaler videos to make sure that your child is using the right technique. And you can also share the videos with the school too
• Ask your doctor's surgery for an extra reliever inhaler (usually blue), and give it to your child's school. This should preferably be in its original packaging, so the school has the prescription label that comes with it. Send in a spacer too, if your child uses one. You should make sure that you and your child know where this is being stored. It should always be easily accessible and not stored in a locked cupboard
• Download and complete an Asthma School Card with your GP or asthma nurse and give it to the school, so they know what to do if your child gets breathless or starts coughing and wheezing. It will also let them know about your child's triggers
• Make sure your child’s written asthma action plan is up to date and that it has been shared with your child’s school. If your GP or asthma nurse is not yet running face-to-face asthma clinics because of coronavirus, ask for a telephone or video consultation.
• Arrange for your child to have an asthma review, as this will help to pick up any early symptoms. This might be done in person, over the phone or via a video call
• If your child is old enough, you can support them by making sure they can take their inhaler properly by themselves. Watch a video on how to correctly use an inhaler
• Check the school’s policy for needing to tell parents when an inhaler is used. If your child is in secondary school, your child should be telling you when they use their inhaler. If your child is in secondary school, make sure they know to tell an adult if they have had to use their inhaler and it hasn’t helped, or if they’ve used it and their symptoms have come back. It's also good to have a chat with younger children about them telling a grown up when they feel unwell

By involving your child in their asthma care, you are more likely to help them develop good habits that will help keep their asthma under control and cut their asthma attack risk

More tips on how to prepare for your child’s return to school if they have asthma or suspected asthma

Year 7 can be a risky time for children with asthma, because of the amount of change a child experiences in the transition from primary to secondary school. Moving up to secondary school means a new environment, with the potential for new triggers.

These triggers can include:

• a new journey to school, using different transport
• stress relating to change, including new friends, teachers and subjects
• moving around different classrooms and a larger school all day
• starting new subjects, like science and design and technology
• When a child moves up to secondary school, your child will need to take greater responsibility for their asthma in the school day. This means it’s important to talk to your child, and work with them to make sure:
• that they can take their own inhaler, with a spacer if needed, so they can be as independent as possible
• that if your child is getting symptoms or using their reliever inhaler three or more times per week, then you should book a review with your child's GP.

Children may also feel self-conscious about having asthma or embarrassed about getting their inhaler out in front of their classmates. They may also find that they have trouble fitting their inhaler and spacer into their bag. They could talk to a nurse about a smaller, more portable, spacer or even a different inhaler type, which might not need a spacer.

1. Needing to take their reliever inhaler three or more times a week
2. Coughing and/or wheezing, or saying their chest hurts
3. Breathlessness – if they’re pausing for breath when talking or struggling to keep up with friends, that’s a sign
4. Waking up at night because of their asthma symptoms

Younger children might say their tummy hurts as well - get to know your child’s individual asthma signs.

One or more of these signs mean that your child is at risk of an asthma attack and you need to take urgent action.

• When they get symptoms, follow your child’s asthma action plan. Their symptoms should ease. If they don’t, or their reliever inhaler isn’t lasting for four hours, call 999 and follow our asthma attacks advice for children.
• Even if their symptoms ease, make a same-day appointment with your child’s GP. If the surgery is closed, call 111 for advice.

All children should be able to get to their inhaler quickly. Ideally, primary school children should have their inhalers in the classroom, while secondary school children can carry their inhalers. Some older primary school children may carry their own inhalers, but this is at the discretion of the head teacher.

If a child needs to take their inhaler, an adult should be watching them take it, rather than sending them away. Watch our short videos on how an inhaler should be used, if you’re not sure.

Some children may need help to take their inhaler. If you’re not happy to do this, it’s important to recognise symptoms of an asthma attack and get someone else to help the child. You can find free online accredited training on supporting children with asthma through Education for Health.

Some children may not be able to speak if they’re having an asthma attack. Being unable to complete a full sentence is one sure sign that someone is having an asthma attack and needs emergency help.

It can be useful for these children to have an asthma buddy, who can tell the teacher on their behalf if they can’t say so themselves. Read about what to do if a child under 12 has an asthma attack.

Emergency inhalers

The school's own emergency inhalers should only be used when their usual inhaler isn’t accessible. It isn’t meant to be taken outside or on trips, to save the effort of taking the child’s named inhaler.

Emergency spacers should be thrown away after one use, not washed and reused. This is because the spacers are single use.

Under normal circumstances, the metered dose inhaler can be cleaned – see the Inhalers in School Guidance for more details. However, due to COVID-19, it may be safer to throw away both the spacer and the inhaler after they are used, rather than washing it. You can get advice on this from your School Nurse and Local Infection Control Team.

You may be concerned about cost and waste, but the school’s emergency inhaler should rarely need to be used if all children have access to their own inhaler and spacer.