Asthma medication management in primary schools

The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR53

Asthma medication management in primary schools

By J. Jones, D. Millson and P. Black

Introduction Asthma is the most common chronic disease of childhood with estimates that one in eight children are diagnosed, an incidence which is rising.¹ Surprisingly although model asthma policies are available for voluntary use by school staff,^2,3 there is no statutory national policy with respect to medicine administration within schools.⁴
The aims of the study were to identify problems that may result from current practice in schools, make recommendations for future asthma medication management, and investigate the influence of the available guidelines upon access to bronchodilator medication by pupils.

Method Following approval by the local ethics committee and director of education, a 34-question, postal questionnaire, was distributed to all 104 state primary schools of one local education authority (LEA) in England during the spring term of 1999. Any staff member involved in medicine administration could complete the questionnaire. Results were collected and analysed using a computer database.

Focal points

Asthma medication management varied greatly between schools
Primary school pupils faced many problems accessing their bronchodilator medication
Schools used local guidelines in preference to either of the nationally available documents
Teaching and school staff, health professionals, parents and pupils, as well as education authorities and national bodies, need to change current practices
There are opportunities for pharmacist involvement in this area

Results A response of 53.8 per cent was obtained. Although written medicine administration policies were found in 38 (69 per cent) of the schools, written asthma policies were found in only eight (15 per cent) schools; three of these prevented children from carrying their own reliever inhalers. Schools' awareness of model asthma policies is summarised in Table 1.

Table 1

Thirty-two (61 per cent) of the respondents were ancillary staff not teachers, and 46 per cent (24) had personal experience of asthma. However, only 41 per cent (21) had previous asthma training, and a desire for training was identified. A record of pupils with asthma was maintained in 77.8 per cent (43) of the schools. One in 11 pupils were known to be asthmatic.
The following problems with access to inhalers were identified:

Only 40 per cent of children had immediate access to reliever inhalers
In 21 schools (41 per cent), inhalers were used at regular times, mainly at lunchtime (18 schools) (eg, "Children use inhalers at 12 noon")
Schools were not found to keep spare inhalers
Steroid inhalers were found in 25 (46.4 per cent) of the schools
Pupils faced physical and other barriers to inhaler access, such as central storage and locked cupboards (five schools) (eg, "Inhalers are kept in a cupboard in the secretary's office" and "Children ask teacher for their inhaler, which is sometimes in the medical cupboard, which is locked in the office").

Communication problems identified were as follows:

Verbal communication about medicines was common
Parents were the sole information source in 43 (83 per cent) of the schools
Pharmacists were not viewed as a source of information
Only 16 per cent of inhalers were labelled with full and clear instructions.

Discussion The National Asthma Campaign suggested that schools were seriously endangering the lives of children with asthma by preventing easy access to bronchodilator inhalers.⁵ This study provides support to the campaign's conclusion that "nationally the impact of Department for Education and Employment guidance on the day-to-day management of asthma and the care of asthmatic pupils has been low."
Improved communication is probably the key to solving the problems found. Awareness of the situation children with asthma face at school is important for all health professionals when prescribing or providing counselling for them and their parents. Changes in practice by all involved with the care of these patients are essential.

Department of medicines management, University of Keele

References

1. Anderson HR, Butland BK, Strachan DP. Trends in prevalence and severity of childhood asthma. BMJ 1994;308:1600-4.

2. Department for Education and Employment and Department of Health. A good practice guide, supporting pupils with medical needs. London: Stationery Office; 1996.

3. School pack. London: National Asthma Campaign, 1997.

4. Bannon MJ, Ross EM. Administration of medicines in school: who is responsible? BMJ 1998;316:1591-3.

5. Danger zone? The National Asthma Campaign's report on asthma management in schools. London: National Asthma Campaign; 1999.

The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000 Pharmacy Practice Research Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR53