London Asthma Friendly Schools Guide 2024

By Reena Rabheru-Dodhy – Senior Primary Care Pharmacist, SWL ICB

Asthma is the most common long-term medical condition in children. It is an inflammatory condition that affects the airways. With appropriate management, the quality of life of a child with asthma can be improved to allow them to fully integrate into school life, and to participate in all activities including physical education.

The purpose of the revised London Asthma Friendly Schools Guide is to enable schools to manage children and young people with asthma effectively in a school environment. The revised guide will be published later in Autumn 2024.

Some of the recommendations covered in this guide include:

School responsibilities

• Ensure each child has an individual or personalised asthma action plan or have a school-wide plan.
• Each school should have an up-to-date medical conditions /asthma policy.
• Children and young people should have immediate access to their inhalers and spacers, ideally in the classroom. It is the school’s responsibility to ensure staff know where the inhalers and spacers are kept.
• In the event of an asthma attack, the inhaler and spacer should always be taken to the child.
• Schools should ensure they have at least two emergency asthma kits available. Larger or multi-site schools may need more.
• Schools should recognise the impact of exposure to air pollution inside and outside the school building on children and young people, and work with Local Authorities to reduce exposure to air pollution.

Parent responsibilities

• Provide the school with an up to date asthma action plan from their doctor or specialist healthcare professional, if that is the school’s policy.
• Provide the primary school with in date inhalers with spacers, which are labelled with the child’s name and in the original packaging. Secondary school children should take their inhaler and spacer (if needed) to school every day. If spacers are used regularly, they will need replacing annually.
• Parents must inform the school of any changes to their child’s condition.

Emergency asthma kits

Schools should have an adequate supply of emergency kits and know how to obtain supplies from their local pharmacy.

Each emergency kit will contain at least one salbutamol inhaler and spacer. Due to infection control, the spacer device, once used, must be replaced. If a disposable spacer is used, this should be thrown away after use and the SABA inhaler also disposed of sustainably and replaced (see below).

Disposal of inhalers

Proper disposal of inhalers is crucial for safety and environmental health. Metered dose inhalers contain hydrofluorocarbon gases – potent greenhouse gases which contribute to climate change. Inhalers returned to pharmacies for safe disposal are incinerated at high temperatures, this destroys the propellant gases, so they do not escape into the atmosphere.

School responsibility: a designated staff member is responsible for regularly checking the expiration dates of inhalers kept at the school. The staff member should arrange for the disposal of expired inhalers at a community pharmacy, or return them to parents and encourage them to dispose of inhalers in this way.

Air pollution

Asthma sufferers are particularly vulnerable to the negative effects of air pollution. About two thirds of people with asthma tell us that breathing in low quality air aggravates their condition and increases their chance of having an attack.

Indoor pollution can be improved through the following:

1. Ventilation and air quality: Ensure classrooms and indoor spaces are well-ventilated. Use air filters and cleaning devices that comply with Department for Education guidelines and are regularly maintained.
2. Allergen control: Minimise the presence of common allergens like house dust mites, dampness, and mould.
3. Animal policy: Avoid keeping warm-blooded animals indoors to reduce allergen exposure.
4. Vacuum cleaners: Use HEPA-filtered vacuum cleaners that can remove 99.97% of small particulates, reducing the resuspension of dust and allergens.
5. Chemical management: Be cautious with cleaning products and materials used in various school activities. Choose low volatile organic compound products and ensure staff are aware of students’ asthma triggers.
6. Moisture control: Regularly inspect and address any signs of dampness or mould to prevent asthma triggers.

Outdoor pollution can be improved through the following;

1. Active travel campaigns: Encourage walking, cycling, or scooting to school to reduce car emissions around the school premises.
2. School streets: Work with local authorities to implement car-free zones during drop-off and pick-up times to lower exposure to vehicle emissions.
3. Anti-idling policies: Enforce no-idling policies for vehicles near the school to reduce the release of toxic pollutants.
4. Smoking ban: Prohibit smoking throughout the school grounds to maintain air quality.
5. Education and awareness: Educate the school community on the importance of reducing car use and the benefits of cleaner air.

By addressing both indoor and outdoor pollution, schools can significantly reduce asthma triggers and create a healthier environment for children and staff.