Inhalers, schools and GPs

[Rosienose]

Hi
my 8 year old son has cough variant asthma. He is required to leave an inhaler with school, and also with the afterschool club he attends, not one in his bag, but one inhaler in a ziplock bag, plus a spacer handed in to school & another handed in to the after school club. So throughout the year I need to replace those 2 and also the one he has to keep at home/with us, and the GP is making a fuss about this. What does everyone else do and is the GP ok about it. This is all being exacerbated now that the guidelines on blue inhalers is changing and they do not what children to be using them more than 3 times a week. We also use a brown inhaler twice a day but obviously only need one of those.

Just interested in others experiences with inhalers in multiple settings for those under 11.

You should only need one brown inhaler as that is morning and night so kept at home.
I'm not sure why the others need replacing regularly as each inhaler has around 200 puffs in and they are not intended to be used on a regular basis. How often are you requesting them from the GP?

DD has well managed very mild asthma but I haven’t had any issue with accessing multiple inhalers. She needs one of the blue ones for each parents house and one kept at school - so 3 at a time but they aren’t regularly used. She has the brown ones too which are used twice a day and we need 2 of those at a time.

She only had an asthma review in Nov and they haven’t changed her off the blue ones which I was surprised about.

My daughter has cough variant asthma too and has the brown inhaler twice a day. With that, she never needs the blue one anymore although obviously we have one as an incase. She is in year 5 and allowed to keep it in her bag so it goes with her everywhere

will the new rules on asthma affect children with cough variant asthma that is really well managed like mine do you know?

The school and afterschool insist they need the blue as he has asthma. And even though we don’t “need” to give him the blue either generally as his asthma is controlled by the brown we also too have a blue at home as per her asthma plan in case of any emergency

Also inhalers have an expiry date!

They usually have a use by date of several years, why do they need replacing all the time?

I wish I knew. They aren’t being rolled out very well imo

My teenage son has the new inhaler which stays in a waterproof bag in his bag all the time with his EpiPens (he’s allergic to nuts and peanuts)
He only has one.
Previously he had a blue inhaler at school, one for home and one for his allergy kit.

My gp does not question the need for extra inhalers when I explain they are for school. I would be annoyed if they did! The inhalers we recieve generally have a year expiry date so every year they need replacing

My kids carry their inhaler with them at all times. It’s not handed into the school office. The specialist wrote a letter saying in the event of an asthma attack, they’d be too unwell to go to the office to get the inhaler, sending another child to collect it would be too risky, and a teacher can’t abandon a whole class to go and fetch an inhaler. In addition, what if they are outside on the sports field? That’s usually very far from the office. The school rolled over and my kids just carry their inhalers with them wherever they go in their school bag.

Thank you all.

The blue inhaler has 12 months expiry date. I don’t know why the expiry or not is being called into question, I wouldn’t be posting this if each inhaler was available indefinitely would I?

I absolutely would abandon my whole class in an emergency! We also take inhalers out to the sports field etc. If a child is old enough and responsible enough I think it's great if they carry their own though.

I didn’t used to leave any with school but at her asthma review they told me off and said she should have it at school just in case even though she hasn’t used the blue one for more than 12 months.
So I had to request 3 at once but there was no issue having them.

She started the inhalers at 3 when she had a spate of illnesses and said she “probably has asthma” and then at 5 said yes she does because she responded so well to the brown inhaler. But she has never had any form of test. She is 6 now.

They haven’t called it cough variant but googling it that is what she must have as she has only ever had recurring coughs and chest infections, never wheezing or breathlessness.

How old are the children? Any with special needs or behavioural issues?
My kids knew how to use their inhalers from kindergarten onwards. There is no reason for them to have to be turned into a school office. It’s not like anyone can overdose on them accidentally.

My DD is only Y1 (6) and doesn’t usually have a school bag. Her school is tiny though, only 60ish kids and 3 classes. The school isn’t much bigger than our house so the school office where they are kept is a few metres away. She absolutely isn’t ready to carry medication unsupervised. She’d potentially play with it, let others use it, take it excessively or lose it.

The blue one I picked up this week has a 2029 expiry on it so perhaps they vary a lot?

I think in that case the inhaler should be in the classroom with her teacher as at that young age, they don’t tend to move from class to class? But stay with one teacher all the day long from class to lunch to playground?

My kids were diagnosed at 6mos (USA), so by age 4 they were very independent with inhalers. I have heard the UK doesn’t diagnose asthma until much later?

I think it’s always 12 mos from the first puff.
This is the after opening expiration as compared to shelf life expiration.

I was told they don’t usually diagnose here before 5 but I am not sure if that is right. Something to do with being able to perform the tests. But DD has never been tested. They diagnosed based on the massive improvement the brown inhaler made (she went from being permanently ill with chest infections and coughs to cough free).

I’m perfectly happy with the school office holding the inhalers given she hasn’t used it in 13 months and never at school, it’s not likely to ever be used.

I have a wicker basket on my desk with inhalers for the children in my class. They just have to tell an adult when they use it. Basket goes in bag for PE, outside play and trips. My class are year 3 and have total control and understanding of when they need to use it! Their adult gets told at the end of the day if they have used it. They should have open access to it in school, not be in an office!

Except that recent research shows it’s those with mild asthma that are more likely to die of a surprise catastrophic asthma attack than those with severe asthma. Mild asthma is a misnomer
“However, patients with mild asthma can experience an underappreciated exacerbation burden, which places them at increased risk for accelerated lung function decline and oral corticosteroid exposure with associated adverse events (1–5). Furthermore, 30–37% of acute asthma episodes, 16% of near-fatal asthma episodes, and 15–27% of fatal attacks occurred in patients reporting symptoms less than weekly or only with exertion in the preceding 3 months (9, 11). Finally, many patients with mild asthma are managed solely with SABAs, which provide only symptom relief, without treating the underlying airway inflammation that is contributing to symptom burden and exacerbation risk (12–14). Therefore, mild asthma is not a benign disease for many patients, and the recent Global Initiative for Asthma (GINA) (15) update advocates reconsideration of its definition to more fully encompass associated risks and allow better communication with patients. The current American Thoracic Society (ATS) classification of asthma severity is based on the degree of treatment needed to control asthma (16, 17), which often excludes consideration of exacerbation frequency.”
https://pmc.ncbi.nlm.nih.gov/articles/PMC10263130/

This paradox is why the inhaler rules are changing everywhere to stop the blue inhalers and have everyone use the inhalers that have do long acting anti-inflamatories.

Y3 and of course there are special needs, slightly above the national average. I imagine most teachers have had to leave classes in an emergency. As I said, I think it's great if children have the capacity to look after their own inhaler.

You should be able to have one inhaler at school and after school as it should be able to move with your child. The GP should understand that schools are a nightmare for insisting on extra ones staying. It is worth asking if there is a better option that doesn't need replaced every 12 months though.

As a side note - inhalers should never be left in the school office, it's worrying to see that mentioned more than once on the thread. The inhaler should always be in close proximity to the child.

Working in schools for over 20 years I've had this discussion/debate/row with many a HT. As a child my inhaler was kept in the office and that was fine because one of the two office staff were always there... except on the day one was sick and the other was off passing on a message so while I was having a massive asthma attach a few meters away my inhaler was locked in the office. No matter how small the school or how the staff apparently never leave the office it shouldn't happen.

It was drummed into me in hospital after, at the age of 7, that there should never be any doors between me and my inhaler. It should always be easily reachable.

Yes I gave you a thumbs up. :) leaving a class of kids to fend for themselves shouldn’t ever be required, but I can see it as a last resort.

Most infants that wheeze will grow out of it by the age of 5. Obviously doctors will treat any symptoms with inhalers but you won’t generally find a diagnosis of asthma on medical notes until children are older and they know it isn’t just a case of need to get bigger so their airways are wider.

It’s much less common to find that inhalers are in the school office than it was but there are still some schools that are behind the times. They ought to be wherever the child is. That is usually in a box in the classroom that is taken with the class to PE or on trips.