Asthma Triggers: Preventing Exposure at School

As an allergy-aware school it’s imperative all staff know the common asthma triggers and how exposure can be prevented. Staff also have a duty to know how to respond if a pupil’s symptoms worsen.

Written by Nina Ferraro MSc, RNC

How do asthma triggers worsen asthma symptoms?

The lungs and airways of people with asthma are more sensitive, and when an allergen is inhaled an inflammatory response takes place. The lining of the airways can become swollen, irritated and inflamed, and thick mucus can build up in the airways. This causes the symptoms of coughing, wheezing and irritation.

Small bands of muscles in the airways can also start to tighten and spasm, causing chest tightness and breathlessness which can lead to difficulty breathing and an asthma attack.

3 common asthma triggers and how to help prevent exposure:

1. Exercise

Regular exercise improves asthma symptoms by opening the airways and making breathing more efficient. Sometimes however, physical activity can trigger asthma symptoms or an asthma attack.

One of the primary goals of treatment is to enable the pupil with asthma to exercise as normal. Unless the pupil is currently experiencing asthma symptoms or they have a cold, exercise should continue to be encouraged.

Because exercise can trigger asthma symptoms or an attack, PE teachers need to be aware of which pupils have asthma, their potential triggers and they need to know what to do in the event of an asthma attack.

Some of these preventative strategies may include:

• Before exercise it is essential to provide a gradual warm up. This allows the body to adjust slowly and become accustomed to airflow during exercise and cope better with the body’s increased demand for oxygen.
• PE staff should ensure pupils with asthma have easy access to their reliever inhaler at all times throughout activity.
• If a pupil has exercise-induced asthma, it will state in their asthma management plan that they must use their reliever inhaler 10 – 15 minutes before exercise. Using the reliever inhaler before warming up can prevent the onset of an asthma episode.
• During exercise it is important to watch out for asthma symptoms such as coughing, wheezing, difficulty breathing, or complaints of a tight chest. Younger pupils may describe this as a tummy ache.
• If symptoms develop during physical activity, the pupil should stop the activity, take their reliever inhaler and sit and rest until breathing returns to normal. Symptoms should improve within 10-15 minutes.
• After physical activity, cool down exercises must be provided. Asthma symptoms can occur up to 30 minutes after exercise therefore the pupil must have easy access to their reliever and spacer post-exercise.
• Teaching peer-perception and ensuring other pupils are aware of exercise-induced asthma and how to respond in an emergency.

2. Pollen & pollution

During the spring and summer terms the pollen count increases, meaning asthmatic pupils triggered by pollen may experience worsening symptoms. There are different types of pollen which can trigger asthma, although grass pollen is the most common affecting up to 95% of affected people.

For schools based in urban areas with higher levels of air pollution, the combination of increased pollution levels during warmer weather and a high pollen count means pupils with asthma are at higher risk. This is because pollution and pollen molecules stick together and stay in the air for longer and there is less wind during the summer months to move these particles away.

If a pupil has a sensitivity to pollen and it is known to trigger their asthma, strategies to minimise exposure should be discussed between the pupil, parent and/or carer and teacher. Any preventative strategies should be included in their IHCP.

Some of these preventative strategies may include:

• If a pupil takes antihistamines, these should be commenced 2-4 weeks prior to the usual time their pollen-induced symptoms start. This means when the high pollen count begins, they already have antihistamine build-up in their bloodstream and are less likely to be triggered.
• Seating the pupil with pollen sensitivity away from open windows in classrooms.
• Keeping class room windows shut if pollen count is high.
• If the pupil is experiencing symptoms allowing them to stay inside during playtime and being given an option to do indoor PE.
• Where possible, grass cutting should be carried out at the end of the school day.
• Encouraging hand washing after outside activities.
• Teaching peer-perception and ensuring other pupils are aware of pollen sensitivity and asthma exacerbation.

3. Colds & viruses

Common colds and viruses can trigger asthma symptoms in pupils with asthma and increase airway sensitivity to other triggers. It’s important that schools keep in mind that colds and viruses are more common during the winter months, although vigilance should be maintained throughout the year. The return to school after holidays is a particularly high-risk period as pupils mingle together and re-introduce germs.

Pupils both with and without asthma may return to school after being unwell with a viral induced wheeze management plan of weaning salbutamol. This may mean that salbutamol requires administration throughout the school day at certain intervals. It is important that a member of staff supervises or administers salbutamol to these pupils in accordance with the management plan.

Some pupils with asthma can become very unwell with a common cold or virus, and it is important that if a pupil has a history of chest infections or viral-induced hospital admission that this is discussed and included in their IHCP.

Preventative strategies to reduce the risk of colds and viruses circulating at school may include:

• Advising parents to keep their children at home if they are unwell.
• Promoting regular hand-washing throughout the school community.
• Instructing pupils and staff to avoid touching their faces and to sneeze and cough into their elbow or a tissue that can be disposed of.
• Regular disinfection and cleaning of classrooms, surfaces, books and toys.

The Author has made every effort to ensure the accuracy of the information contained within this article. The Author does not accept any liability or responsibility for any inaccuracies or for any diagnosis made, or actions taken based on this information.

It is strongly advised that all school staff attend Asthma, Anaphylaxis and Allergy Awareness training to understand what to do in a medical emergency.

TEACH run specific courses covering in detail how to support pupils with asthma and allergies. Our team are highly experienced specialist nurses who will tailor the training to your needs.

Please visit www.teachealth.co.uk, info@teachhealth.co.uk or telephone: 020 8720 6635 for more information about our courses.