GPs warned to prepare for back-to-school asthma spike

As children return to childcare and school, GPs are being urged to help prepare patients with asthma for the transition.
 
Australia has one of the highest rates of asthma in the world, with one in nine children diagnosed with the respiratory condition. Flare ups are known to surge during February, when approximately 20–25% of children’s hospital admissions for asthma occur.
 
Marg Gordon, a registered nurse and Asthma and Respiratory Educator at the National Asthma Council Australia, told newsGP that GPs have an important role to play in prevention.
 
‘GPs can help get children asthma-ready for school by asking parents about their child’s asthma control experience over summer, whether they have an up-to-date asthma plan and medications, and by conducting a full asthma check-up,’ she said.
 
The increased risk of an asthma flare up can be the result of not taking medication as prescribed during the summer holidays, as well as the stress of returning to school, the change in environment and exposure to allergic triggers, as well as being in close contact with classmates.
 
Given the disruption to healthcare services as a result of the coronavirus pandemic, Ms Gordon says there are fears parents and carers may have become complacent.
 
‘I’m based in Victoria where we went through the long spells of lockdown and, in fact, for some kids with asthma they’ve had reduced viral triggers; they weren’t going places, and their personal hygiene was much better,’ she said.
 
‘So those kids potentially have been very well over last year. But, of course, then a little bit of complacency sets in and people can forget that especially with back to school and kids mingling again, that can all change.’
 
While the Australian Asthma Handbook recommends all people with asthma have an asthma action plan, data shows that one third of Australian children aged up to 14 years and 76% of those aged 15 and over do not have one – statistics that Ms Gordon says are very worrying.
 
‘This has been a topical point for a long time [as] we all know that action plans are useful,’ she said.
 
‘We know that they help parents and carers know what to do, they can prevent visits to the doctor and, certainly, visits to the hospital – but not every child does have one.
 
‘Schools and childcare centres ask for them, so it’s a really great time to remind everyone in the healthcare system to get ready and be prepared to do them.’
 
Even if a child has mild asthma that is currently well-controlled, Ms Gordon says having an action plan should be non-negotiable.
 
‘Because we just don’t know with children,’ she said.
 
‘The triggers of their asthma might be obvious; lots of kids get asthma around viral triggers, so common coughs and colds. But other kids get asthma unrelated to that.
 
‘This is where the action plan is really important because the symptoms of asthma can come on quite quickly. So everyone looking after that child needs to know what to do.
 
‘An asthma plan can help people recognise a change in symptoms and how that child is; how to change medication to manage that and guidance on when to call the doctor, when to go to the hospital and when to call an ambulance.’
 
The National Asthma Council recommends that children be reviewed for their asthma at least twice a year, and Ms Gordon says given the concerns around children’s return to school, there’s no better time than the present.
 
‘We are urging doctors to check the best practice clinical recommendations in the Australian Asthma Handbook to ensure each child is assessed and managed as per the guidelines,’ she said.
 
To help GPs prepare paediatric patients, the National Asthma Council has issued the following clinical tips based on best practice asthma care:

• when children with asthma present for any reason, ask about their asthma and whether they are ready for asthma when at school
• make sure each child has an up-to-date written asthma action plan and the child and/or parents understand how to follow it
• remind parents to get their child back into their asthma routine before the school year starts, including taking preventer medications every day, if prescribed
• encourage parents to get their child to use a spacer with their inhaler
• conduct a full asthma check-up before the school year starts, or before activities like sports or other physical activities commence, to ensure asthma is as well controlled as it can be
• take every opportunity to check that the child and/or parents are using inhalers correctly and that medications are not out of date

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