All children benefit from exercise – including those with asthma. Understanding the condition can help teachers support those who suffer from it, says Jill Wyatt

Research suggests that up to one third of children with asthma may miss out on PE or other sport about once a week because of their condition, despite compelling evidence that exercise is good for them. There is no reason why an asthmatic child, given proper medication, support and appropriate adjustments to their activities, should not enjoy the full range of physical activities on offer at a school.

So what can PE teachers do to ensure that this happens? The answer is, of course, to arm themselves with as much information as possible about the condition, how it affects individual children and what actions are required to help prevent or treat an asthmatic attack.

What is asthma?
Asthma is a common disease affecting about five million people in the UK. Episodes, which can be mild, moderate, or even life threatening, often start in childhood. Around one in 15 children have the condition but it can strike for the first time at any age.

Asthma affects the airways – the tubes carrying air in and out of the lungs. People with asthma have sensitive airways which become irritated in some situations (see box  on triggers). The irritation causes the airways to narrow and sometimes produce more mucus than usual, both of which make it difficult to breathe.

Asthma varies from person to person and often from season to season. This is why physical education teachers and coaches need to understand what asthma is and what the individual needs of their pupils are. Vigorous exercise will cause symptoms for most young people with asthma if it is not well controlled. Some will experience symptoms only when they exercise.

Asthma can’t be cured, but it can be controlled so that attacks can be prevented. Only about one third of children with asthma will go on to have problems as an adult, as it often gets better or disappears during teenage years.

Common triggers for asthma

Most pupils will be aware of the things that may trigger an asthma attack – some can be avoided and others either can’t or shouldn’t be. They include:

  • exercise – running or playing hard – especially in cold weather
  • upper respiratory infections, colds or flu
  • laughing or crying hard
  • pollen, animal dander from pets with fur or feathers, dust and dust mites
  • cockroach droppings
  • moulds.

Other irritants may include cold air, strong smells and chemical sprays, weather changes and tobacco smoke.

Medications and equipment
Many asthma medications, which both help prevent and/or treat the condition, are delivered by metered dose inhalers – which are highly effective. Most asthmatics will know how to use them but may need support during an attack. So here’s how a pupil should be using them. They should:

  • take off the cap and shake the inhaler
  • stand up, breathe out
  • start to breathe in, pushing down on the top of the inhaler and keeping breathing in slowly for three to five seconds
  • hold their breath for 10 seconds and then breathe out.

Note: Dry powder capsules are used differently. Pupils who use a dry powder inhaler will need to close their mouth tightly around the mouthpiece and breathe in very fast.

A peak flow meter is a small device that measures how well air moves out of the airways. Monitoring peak flow helps a student determine changes in his or her asthma and identify appropriate actions to take.

Each student will have his or her personal best peak flow reading. This number should be noted in the student’s asthma plan or school health file. A peak flow reading less than 80 per cent of the student’s personal best indicates the need for action. A student should avoid running and playing until the peak flow reading returns or exceeds 80 per cent of the personal best.

The dos and don’ts of looking after asthmatic pupils in your care

Do

  • talk with the student to learn his or her concerns about asthma and activity
  • offer reassurance that you understand the importance of appropriate modifications or activity limits
  • develop a shared understanding about the conditions that require activity modifications or medications
  • consult with the school nurse, parent/guardian, or healthcare provider to find ways to ensure that the student is safe, feels safe, and is encouraged to participate actively
  • ensure that the asthma plan and the school’s emergency plan for all pupils with asthma is easily accessible so that all staff, substitutes, volunteers, and aides know what to do in case of need
  • remember that you are not a medical expert; if in doubt about the seriousness of a pupil’s asthma attack, call for help.

Don’t

  • ignore a pupil’s report of their own condition, even if you suspect that it indicates a desire for attention or a desire not to participate in an activity. At the least it may indicate that they need more assistance and support from you in order to become an active participant

What do I need to know?
Every pupil in your care who suffers from asthma should have an asthma management plan.Depending on the pupil’s needs, the plan may be a brief information card or a more extensive individualised health plan. A copy of the plan should be on file in the school office or health services office, with additional copies for the pupil’s teachers and coaches. The plan – as well as the pupil’s asthma medications – should be easily available for all on- and off-site activities before, during and after school.

The plan should include a brief history of the pupil’s asthma, including:

  • asthma symptoms
  • information on how to contact the pupil’s healthcare provider, parent/guardian
  • doctor’s and parent/guardian’s signatures
  • list of factors that make the student’s asthma worse
  • the student’s personal best peak flow reading if the student uses peak flow monitoring
  • list of the student’s asthma medications
  • a description of the student’s treatment plan, based on symptoms or peak flow readings, including recommended actions for school personnel to help handle asthma episodes.

How can I help?
At times, programmes for pupils with asthma may need temporary modification, such as varying the type, length, and/or frequency of activity. At all times, students with asthma should be included in activities as much as possible. Remaining behind in the gym or frequently sitting on the bench can set the stage for teasing, loss of self-esteem, unnecessary restriction of activity and low levels of physical fitness.

Getting control of asthma means recognising, avoiding and controlling asthma triggers, and teachers can help in this respect by, for example, scheduling maintenance procedures that involve strong irritants for times when pupils are not in the area and the area can be well ventilated.

It should also be possible to adjust schedules for those pupils whose asthma is worsened by pollen or cold air. A midday or indoor physical education class may allow more active participation.

Students with asthma need understanding from both teachers and their peers in dealing with their asthma. If they are teased about their condition, they may be embarrassed, avoid using their medication or cut class. Teach asthma awareness and peer sensitivity. As pupils learn more about asthma, they can more easily offer support instead of barriers to their classmates with asthma.

Some of the other ways you can help are more obvious:

  • ensure that pupils with asthma have convenient access to their medications
  • enable students to carry and administer their own medications if the parent/guardian, healthcare provider and school nurse so advise
  • include adequate warm-up and cool-down periods; these help prevent or lessen episodes of exercise-induced asthma
  • modify physical activities to match current asthma status – for example, if running is scheduled, the pupil could walk the whole distance, run part of the distance or alternate running and walking.

As all experienced teachers know, any condition or problem that makes a pupil stand out from their peers can cause them to opt out of situations that highlight it in some way. With sensitivity and imagination from those around them, there is no reason why pupils with asthma should feel the need to withdraw in this way. If a temporary but major modification to their activity is required, it should still be possible to keep them fully involved in whatever sport their contemporaries are involved in. Ask the student to act, for example, as a scorekeeper, timer, or equipment handler until he or she can return to full participation – being involved at any level is better than being left out or left behind.

What to do if a pupil has an asthma attack

Almost inevitably, PE teachers will encounter situations where asthmatic pupils need help because they are coughing or wheezing or having difficulty in breathing. Prompt action is required. This is what to do:

  • stop the pupil’s current activity
  • follow their asthma management/action plan
  • help them use their medication
  • observe for effect.

Get emergency help if the pupil fails to improve or:

  • is hunched over, with shoulders lifted, and straining to breathe
  • has difficulty completing a sentence without pausing for breath
  • has lips or fingernails which are turning blue.

Sources of inspiration
It is understandable that some pupils who suffer from asthma may feel that their sporting activities should be restricted – after all, an attack can be in the least unpleasant and at worst extremely frightening. It’s worth pointing out to them that there a huge number of famous sports people – in all fields – who share their condition. These include:

  • Paula Radcliffe – long-distance runner.
  • Paul Scholes – Manchester United’s star midfielder.
  • Alexandra Rowell – Oxford Young Sportsperson of the Year, 2003 and GB international modern pent-athlete.
  • James Thie – UK middle distance runner, Great Britain team member since 1998, as well as Welsh record holder in the 1,500m, one mile and 2,000m. Recent achievements include fourth in IAAF World Indoor Championships (2004) sixth (2005) and ninth (2007).
  • Nancy Hogshead – retired freestyle swimmer from the United States, who won the gold medal in the women’s 100m freestyle at the 1984 Olympics in Los Angeles.
  • Bill Koch – international cross-country skier, who developed a new style of skiing .
  • Greg Louganis – Olympic champion diver.
  • Dominique Wilkins – basketball player; one of the most prolific scorers in NBA history.
  • Jim Ryun – track athlete, the last American to hold the mile run world record.

…and many, many others. They come from diverse fields: swimming, track and field, cross-country skiing, diving, basketball, and long-distance running.

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