Empowering asthmatics

Children can cope with their breathing difficulties if the school helps them to understand the cause of the illness and listens to their views on treatment

How does it feel to have asthma at school? Over a million children can answer that question from first-hand experience, which is why the National Asthma Campaign is holding a conference for teachers and educational health professionals at Stoke-on-Trent, Staffordshire, today. The aim is to encourage schools to develop practical, consistent ways of helping pupils control their disease.

The key to treating asthma successfully is empowerment. Empowerment is the antidote to panic and the opposite of being out of control. The more an asthmatic child can take charge of his or her illness, the more relaxed that child will be and the better the asthma as a result.

There are two parts to this process. The first is the empowerment of knowledge, making sure that the child understands what happens in asthma, and especially what special factors trigger his own attacks. The second is the empowerment of treatment: the child rapidly becomes an expert who can most accurately gauge what medication he ought to take, and when.

The role of the school is to help in this empowerment. When teachers are comfortable with what asthma is, comfortable with the varied ways in which treatment is given, aware of the danger signs, and conscious of the need to be alert to what the child is saying about the symptoms, this minimises the risks and maximises control of the disease.

Asthma occurs when the tubes conveying air in and out of the lungs become constricted, irritable, inflamed, and full of mucus. There are basically two types of treatment. The relievers, such as salbutamol, stop the spasm, and open up the tubes. The preventers, such as steroid inhalant sprays, stop the inflammation which triggers off the process in the first place. It is a useful rule of thumb to think of relievers as controlling today's asthma, while preventers control tomorrow's.

Modern treatment concentrates on regular use of the preventers, leaving the relievers to mop up what symptoms remain. Each child should have an individual plan for altering the amount and type of medication in a smooth and progressive fashion. A child who can confidently control his asthma like this loses his anxiety, and for this reason alone the intensity of attacks will reduce.

There are a number of different types of inhalers, and it is helpful if teachers know how each works. Medication should always be kept near at hand, especially when doing games. Time is of the essence in an asthma attack: there is no point in keeping the inhalers locked up in the main office when the child having the attack is at the far end of the school field.

What are the big mistakes that schools can make? There are two, and they are equal and opposite. The first is to treat an asthmatic child as some form of leper, forbidding him to do games.

This isolates him emotionally, as well as rendering him less fit and less capable of dealing with an asthma attack when one comes.

The second mistake is to refuse to recognise that a child is having an attack, and to insist that he continues what he is doing. Children are usually accurate assessors of their disease and it is important that teachers listen to them.

Not surprisingly, the key to asthma empowerment is education. The National Asthma Campaign has packs available which schools can purchase, as well as an Asthma Helpline.

Many GPs now have practice nurses specifically trained in asthma care, who can take seminars on Baker Days. As far as asthma and schools are concerned, there is now no excuse for ignorance.

The National Asthma Campaign can be contacted via its head office at Providence House, Providence Place, London, N1 0NT.

Its 24-hour information line is on 0171-971 0444 and you can speak to an asthma nurse on the Asthma Helpline on 0345 01 02 03 (calls charged at local rates)n

The writer is a general practitioner.