Asthma

Policy

This policy informs schools about their responsibilities for supporting students with asthma.

Summary

• Schools have a responsibility to support students diagnosed with asthma by:
  • having a local school level asthma policy (staff login required)
  • having an Asthma Action Plan for each student diagnosed with asthma
  • providing their staff with the appropriate level of training (see below for details) regarding asthma management
  • providing and maintaining an asthma emergency kit with equipment to manage asthma emergencies.
• A student with an Asthma Action Plan only requires a Student Health Support Plan if their asthma:
  • is not well-controlled as identified by a health practitioner in the Asthma Action Plan, and
  • needs individualised medical or health-related supervision, care or adjustments at school.
• Schools should follow advice and warnings from the department’s Security and Emergency Management Division associated with a potential thunderstorm asthma event.

Details

For each student diagnosed with asthma, schools must have a written: Asthma Action Plan completed by the student’s medical practitioner and provided by the student’s parents or carers.

A student with an Asthma Action Plan only requires a Student Health Support Plan (DOCX) if their asthma:

• is not well-controlled, and
• needs individualised medical or health-related supervision, care or adjustments at school.

If any student enrolled at the school has been diagnosed with asthma, schools are required to have a local asthma policy that addresses:

• staff asthma awareness training
• asthma emergency kit content and maintenance
• medication storage
• management of confidential medical information.

A downloadable Asthma policy template (staff login required) for Victorian government schools is available on the School Policy Templates Portal. Schools can modify the template to suit their local circumstances.

Schools should also undertake the following actions:

• ensure that staff are provided with training to assess and manage an asthma emergency – refer to the ‘Staff training’ section below for further information
• ensure staff with a direct student wellbeing responsibility (for example, nurses, physical education or sport teachers, first aid and school staff attending camp) have completed an accredited Emergency Asthma Management (EAM) course at least every 3 years
• follow advice and warnings from the department associated with a potential thunderstorm asthma event
• provide and maintain an asthma emergency kit with the equipment required for managing an asthma attack.

Asthma attack

Important – if a student is experiencing an asthma attack.

Immediately call 000 and ask for an ambulance and state a student is having an asthma attack if:

• the student is not breathing
• the student is having a severe or life threatening attack:
  • reliever medication not working at all
  • cannot speak a full sentence
  • extreme difficulty breathing
  • feeling asthma is out of control
  • lips turning blue
• the student is having an asthma attack and a reliever is not available
• the student is known to have anaphylaxis – follow their Anaphylaxis Action Plan, then give asthma first aid
• at any time the student’s condition suddenly worsens or is not improving
• staff are otherwise concerned about the student’s health and safety.

Further information is included in the Guidance tab with a procedure for how to treat a student for an asthma attack

Where a student is diagnosed with asthma, the student is required to bring their own prescribed reliever medication to school. This should be stored in their asthma kit with a copy of their Asthma Action Plan and their spacer.

Strategies

Communication

Schools should provide information to all school staff, students and parents or carers about asthma and the school’s local asthma policy.

Asthma Australia also has Asthma First Aid posters available to schools for free, which should be displayed in the following places:

• staff room
• sick room
• areas where asthma attacks are likely to occur or be treated.

Regularly communicate with the student’s parents or carers about the student’s asthma or any changes in health. In particular, the frequency and severity of the student’s asthma symptoms and use of medication at school.

Emergency response plan

Procedures which each school develops for an emergency response to a severe or life threatening asthma attack for all in-school and out-of-school activities.

The procedures, which are included in the school’s local asthma policy, differ from the instructions listed on the student’s individual Asthma Action Plan.

Individual asthma action plans (for each student diagnosed with asthma)

Parents or carers must provide the school with an Asthma Action Plan completed by the student’s medical practitioner. The plan must outline the student's known triggers and the emergency procedures to be taken in the event of an asthma flare-up or attack.

It is considered good clinical practice for parents or carers and the student’s general practitioner (GP) to review a student’s Asthma Action Plan:

• on a regular basis, or
• whenever a significant change in asthma symptoms occur.

The school must review the Asthma Action Plan:

• when updated information is received from the student’s medical or health practitioner
• if there is a change in needs or level of support, including where a student is learning to independently manage their condition
• when the school, student, parents or carers have concerns about the support being provided.

Otherwise, schools are recommended at least annually to review the Asthma Action Plan, and communicate with the parent or carer to:

• if available, provide updated medical or health advice
• review and provide written confirmation that the Asthma Action Plan is current.

If it is agreed between the parent or carer and the student’s treating health team that annual review of the plan is not required, it is up to the principal’s discretion whether to request updated medical information. Refer to the Health Care Needs policy for more guidance about obtaining timely and current medical or health advice.

Asthma Action Plans can take many forms and schools should accept them from medical practitioners where they contain the following information:

• the prescribed medication taken and when it is to be administered (for example, on a regular basis, as premedication to exercise or it if the student is experiencing symptoms)
• emergency contact details
• contact details of the student’s medical or health practitioner
• details about deteriorating asthma including signs to recognise worsening symptoms, what to do during an attack or medication to be used.

Visit Asthma Australia for example template Asthma Action Plans that can be used in Victorian schools.

For more information about asthma action plans, refer to Better Health Channel – Asthma action plans.

Student Health Support Plan

If a student has asthma that is not well-controlled, and needs individualised supervision, care or adjustments other than what is described in the school’s local asthma policy, schools must develop a Student Health Support Plan (DOCX).

Refer to the Health Care Needs policy for more information about developing a Student Health Support Plan.

Epidemic thunderstorm asthma

Be prepared to follow advice from the department, when the risk of epidemic thunderstorm asthma is forecast as high including:

• act on advice and warnings from the department's Emergency Management Division associated with a potential thunderstorm asthma activity, and implement a communication strategy to inform the school community and parents or carers
• implement procedures to avoid exposure, such as staying indoors with windows and doors closed
• implement emergency response procedures and follow individual asthma action plans as needed.

Refer to the Resources tab for further information.

Annual asthma briefing for all staff

Schools may wish to conduct an annual asthma briefing at the beginning of the school year on:

• the school's asthma management policy
• causes, symptoms and treatment of asthma
• the identities of students diagnosed with asthma and where their medication is located
• how to use a puffer and spacer
• the school's general first aid and emergency response procedures
• the location of, and access to, reliever medication that has been provided by parents or carers or the asthma emergency kits.

Reducing asthma triggers

To reduce asthma triggers schools can:

• mow school grounds out of hours
• plant a low allergen garden
• limit dust, for example, having the carpets and curtains cleaned regularly and out of hours
• examine the cleaning products used in the school and their potential impact on students with asthma
• conduct maintenance that may require the use of chemicals, such as painting, during school holidays
• turn on fans, air conditioning and heaters out of hours when being used for the first time after a long period of non-use.

Student asthma kit

Where an enrolled student is diagnosed with asthma, the child is required to bring their own prescribed reliever medication. This should be stored in their asthma kit with a copy of their Asthma Action Plan and their spacer at a location determined and described in the school’s local asthma policy.

The student’s personal spacer should be washed monthly or cleaned as required:

• wash the spacer in warm soapy water
• do not rinse the spacer
• leave it to air dry
• wipe the mouthpiece before use.

The student’s spacer should be replaced if contaminated with blood or vomit.

Encourage participation in camps and special events

Schools must ensure:

• parents or carers provide enough medication (including preventer medication) for the student if they are going away overnight
• enough asthma emergency kits are available for the camp or excursion needs
• they follow the department’s excursions policy and guidance on collecting medical information prior to camps and excursions – refer to the Excursions guidance chapter Student medical information.

Managing Exercise Induced Bronchoconstriction

If a student has Exercise Induced Bronchoconstriction (EIB), schools should ensure that they allow adequate time for the following procedures before, during and after exercise.

Before:

• blue or blue-grey reliever medication to be taken by student 15 minutes before exercise or activity (if indicated on the students’ Asthma Action Plan)
• student to undertake adequate warm up activity

During:

• if symptoms occur, student to stop activity, take blue or blue-grey reliever medication, only return to activity if symptom free
• if symptoms reoccur, student to take blue or blue-grey reliever medication and cease activity for the rest of the day. This is known as ‘two strikes and out’

After:

• ensure cool down activity is undertaken
• be alert for symptoms

If a student has an asthma attack during, or after exercise or activity, follow their Asthma Action Plan if easily accessible, or commence asthma first aid. Always notify parents or carers of any incidents or medication usage.

Staff training

General school staff training

All school staff should undertake non-accredited training in asthma first aid management for education staff through Asthma Australia.

Staff should complete the free 1-hour asthma education session at least every 3 years – this can be through a school visit or online training module available to all schools:

• Asthma First Aid for Schools – for individual school staff, at no cost to schools.

Targeted school staff training

The following school staff should undertake accredited training in asthma management by a Registered Training Organisation:

• staff working with high-risk students with a history of severe asthma
• staff with a direct student wellbeing responsibility such as nurses, first aid officers and camp organisers
• staff in high-risk teaching areas, such as physical education or sports teachers, home economics or cooking teachers.

The following accredited asthma management course is recognised for Victorian schools:

• 22702VIC Course in the Management of Asthma Risks and Emergencies in the Workplace.

Training is face-to-face and accredited for 3 years, paid by each school.

If a staff member has not yet completed training, the principal is responsible for developing an interim arrangement for student supervision. This includes documentation in any individual Student Health Support Plans (DOCX).

Training should take place as soon as practicable after the student diagnosed with asthma enrols, preferably before the student’s first day at school.

Asthma emergency kits

Schools must provide and maintain at least 2 asthma emergency kits:

• one to keep at the school
• one to take as a mobile kit for activities such as excursions and camps.

It is recommended that large schools have an additional kit for every 300 students. See the Locations section below for further advice regarding placement of asthma emergency kits.

Contents

Asthma emergency kits must contain:

• at least one blue or blue-grey reliever medication such as Airomir, Asmol, or Ventolin
• at least 2 spacer devices (for single person use only) to assist students to inhale the blue or blue-grey reliever medication (ensure spare spacers are available as replacements)
• clear written instructions on asthma first aid, including how to use the medication and spacer devices, and steps to be taken in treating an asthma attack (see the Guidance tab for further information)
• a record sheet or log to collect details of when the kit is used and ensure the kit is maintained, such as the number of puffs administered using the kit’s reliever medication – record sheets (PDF) can be downloaded from Asthma Australia.

Note: If schools are using the Lite-Aire Disposable Cardboard spacer in their asthma emergency kits, the school needs to be aware that the imagery is printed in refined soy ink. Although the risk of developing an allergic reaction to refined soy ink is low, there is still a risk and the risk should be taken into account when developing Individual Anaphylaxis Management Plans for students diagnosed with soy allergy and asthma.

Schools are not required to provide a nebuliser for students. If a student is prescribed a nebuliser, they should bring their own to school. Parents or carers can obtain information on the use of nebulisers from the manufacturer (all nebulisers are labelled with the manufacturer's name)

Complete asthma emergency kits can be purchased from Asthma Australia or the components through retail pharmacies.

Regular checks

A nominated staff member should be responsible for maintaining the asthma emergency kits, including:

• ensuring all contents are maintained and replaced when necessary
• regularly checking the expiry date on the canister of the blue or blue-grey reliever puffer and replacing it if expired or low on doses
• replacing spacers in the asthma emergency kit after each use (spacers are single person use only). Once used, the spacer can be given to that student or thrown away
• previously used spacers should be disposed of.

Note: Schools can legally purchase a blue or blue-grey reliever puffer for first aid purposes from a pharmacist on the written authority of the principal.

Cleaning requirements

Asthma spacers are single person use only. To avoid infection transmission via mucus, spacers and masks must only be used by the 1 student. They should be stored in a dustproof container.

Blue or blue-grey reliever medication 'puffers' in the asthma emergency kit may be used by more than 1 student, as long as they are used with a spacer. If the medication delivery device (for example, puffer) comes into contact with someone’s mouth it cannot be reused by anyone else and must be replaced.

A guide to cleaning puffers is available on the Guidance tab.

Locations

Asthma emergency kits should be located strategically around the school and readily available in an asthma emergency. Mobile asthma emergency kits are also required for:

• the office or administration area
• yard duty
• excursions or sports days
• camps.

Definitions

Asthma
Asthma is a long-term lung condition. For further information on asthma, refer to the Resources tab.

Asthma Action Plan
A plan completed by a student’s medical practitioner which outlines the student's known triggers and the emergency procedures to be taken in the event of an asthma flare-up or attack.

Flare-up or exacerbation
A worsening of asthma symptoms compared with the student’s usual range of day-to-day variation. It is described on the Asthma Action Plan ranging from a mild flare-up, to a severe or emergency asthma attack that needs urgent asthma first aid.

Nebuliser
A machine that converts liquid medicine into a fine mist that can then be inhaled.

Preventer medication
A medication used on a regular basis to prevent asthma symptoms and reduce the frequency and severity of asthma attacks. It helps get a student’s asthma under good control.

Puffer
A pressurised metered dose inhaler (pMDI). The medicine contained in the inhaler is in a fine mist. When you press the canister, this mist is released, and you breathe in to deliver the medicine to your airways.

Reliever (blue-grey) medication
A medication used to provide relief from asthma symptoms within minutes. This is usually Airomir, Asmol or Ventolin.

Spacer
A holding chamber device that makes it easier to take asthma medication from the type of puffer. A spacer can also make it easier to coordinate breathing in and pressing your puffer.

Well-controlled asthma
A clinical assessment by the student’s health practitioner that a student’s usual asthma is under good control, whether with or without a preventer. Refer to Asthma Australia’s Asthma Action Plan for a detailed description.

Related policies

• Allergies
• Anaphylaxis
• Decision Making Responsibilities for Students
• Excursions
• First Aid for Students and Staff
• Health Care Needs
• Managing and Reporting School Incidents (Including Emergencies)
• Medication

Guidance — asthma attacks, cleaning asthma puffers and key information

This guidance contains the following chapters:

• Treating an asthma attack
• Puffer cleaning guide
• Asthma – key information

Treating an asthma attack

This procedure describes how to treat a student having:

• an asthma attack
• difficulty breathing for an unknown cause, even if they are not a known to have asthma.

Note: For a student who is not a known to have asthma, this treatment:

• could be lifesaving, if the asthma has not previously been recognised
• would not be harmful, if the cause of breathlessness was not asthma.

Warning: Immediately call 000 and ask for an ambulance and state a student is having an asthma attack if:

• the student is not breathing
• the student is having a severe or life threatening attack:
  • reliever medication not working at all
  • cannot speak a full sentence
  • extreme difficulty breathing
  • feeling asthma is out of control
  • lips turning blue
• the student is having an asthma attack and a reliever is not available
• the student is known to have anaphylaxis – follow their Anaphylaxis Action Plan, then give asthma first aid
• at any time the student’s condition suddenly worsens or is not improving
• staff are otherwise concerned about the student’s health and safety.

Delay in treatment may increase the severity of the attack and ultimately risk the student’s life.

First time asthma attack

If a student appears to be having difficulty breathing but has not been diagnosed with asthma, the school staff should follow asthma first aid procedures. This should include immediately:

• locating and administering the reliever medication from the asthma emergency kit
• after the first 4 doses of reliever medication call 000 for an ambulance
• continue giving 4 doses of reliever medication every 4 minutes whilst waiting for the ambulance to arrive.

Step 1 – Sit the person upright

• Be calm and reassuring
• Do not leave them alone
• Seek assistance from another teacher (or reliable student) to locate the student's Asthma Action Plan and an asthma emergency kit if required. If the student’s Asthma Action Plan is not immediately available, use asthma first aid as described below

Step 2 – Give 4 separate puffs of blue or blue-grey reliever puffer

• Shake the blue or blue-grey reliever puffer
• Use a spacer if you have one
• Put one puff into the spacer
• Student draws in medication from the spacer
• Note: give 2 doses if using Bricanyl inhaler instead of blue or blue-grey reliever puffer

Step 3 – Wait 4 minutes

• If there is no improvement, give 4 more separate puffs of blue or blue-grey reliever as per step 2 and wait 4 minutes (or give 1 more dose of Bricanyl inhaler)

Step 4 – If there is still no improvement call 000 and ask for an ambulance

• Tell the operator the student is having an asthma attack
• Keep giving 4 separate puffs, every 4 minutes until emergency assistance arrives (or 1 dose of Bricanyl inhaler every 4 minutes)

Step 5 – If asthma is relieved after administering asthma first aid stop the treatment and observe the student

• Notify the student’s emergency contact person
• Record the incident in eduSafe Plus as per the Managing and Reporting School Incidents (Including Emergencies) policy
• Record in the asthma emergency kit record or log if the kit has been used, such as the number of puffs administered using the kit’s reliever medication

Puffer cleaning guide — after every use

1. Remove the metal canister from the puffer. Do not wash the canister.
2. Wash the plastic casing.
3. Rinse the mouthpiece through the top and bottom under running water for at least 30 seconds. Wash mouthpiece cover.
4. Air dry then reassemble.
5. Test the puffer to make sure no water remains in it, then return to the asthma emergency kit.

Asthma – key information

People with asthma have sensitive airways which react to triggers, causing a ‘flare-up’. In a flare-up, the muscles around the airway squeeze tight, the airway swells, becomes narrow and there is more mucus. This makes it harder to breathe. An asthma flare-up can come on slowly (over hours, days or even weeks) or very quickly (over minutes). A sudden or severe asthma flare-up is sometimes called an asthma attack.

Symptoms

Symptoms of asthma can vary over time and often vary from person to person. The most common asthma symptoms are:

• breathlessness
• wheezing (a whistling noise from the chest)
• tight feeling in the chest
• a persistent cough.

Symptoms often occur at night, early in the morning or during/just after physical activity. If asthma is well controlled, a person should only have occasional asthma symptoms.

Triggers

A trigger is something that sets off or starts asthma symptoms. Everyone with asthma has different triggers. For most people with asthma, triggers are only a problem when asthma is not well controlled with medication. Common asthma triggers include:

• exercise
• colds/flu
• smoke – including cigarette smoke and wood smoke from:
  • open fires
  • burn-offs
  • bushfires
• weather changes such as thunderstorms and cold, dry air
• house dust mites
• moulds
• pollens
• animals such as cats and dogs
• chemicals such as household cleaning products
• deodorants – including:
  • perfumes
  • after-shaves
  • hair spray
  • aerosol deodorant sprays
• food chemicals/additives
• certain medications (including aspirin and anti-inflammatories)
• emotions such as stress and laughter.

Epidemic Thunderstorm Asthma

Every year during grass pollen season there is an increase in asthma and hay fever symptoms. During this season there is also the chance of an epidemic thunderstorm asthma event. Epidemic thunderstorm asthma events are thought to be triggered by an uncommon combination of high grass pollen levels and a certain type of thunderstorm, resulting in large numbers of people developing asthma symptoms over a short period of time.

Those at increased risk of epidemic thunderstorm asthma include people with asthma, people with a past history of asthma, those with undiagnosed asthma (i.e. people who have asthma symptoms but have not yet been diagnosed with asthma) and also includes people with hay fever who may or may not have asthma. Having both asthma and hay fever, as well as poor control and self-management of asthma increases the risk further.

For more information, refer to the Better Health Channel.

Medication

Most students can control their asthma by taking medication. Asthma medication is normally:

• taken via a metered-dose inhaler (puffer) preferably in conjunction with a spacer device or via a breath-activated dry powder inhaler
• provided by the parents/carers or the student, and may be self-administered
• self-managed by the student at secondary level

Below is a description of the common forms of asthma medication. For more information about asthma medicines, refer to Asthma Australia.

Reliever

• Provides relief from symptoms within minutes
• Used in an asthma emergency
• Should be easily accessible to students at all times
• Is preferably carried by the student
• Is normally blue or grey in colour
• Includes common brands such as Ventolin, Bricanyl, Airomir and Asmol

Note: Most relievers can be purchased from a pharmacy without a prescription - schools must have a letter of authorisation from the principal to purchase reliever medication for the school's Asthma Emergency Kits.

Preventer

• Used on a regular basis to prevent asthma symptoms and reduce the frequency and severity of asthma attacks
• Usually autumn or desert colours (brown, orange, rust or yellow)
• Prescribed by a doctor

Combination preventer

• Combines a preventer with a long acting reliever in the same device
• Includes common brands such as Seretide and Symbicort
• For students aged 12 or over, some combination medications may be used in an asthma emergency if documented on the student's Asthma Action Plan
• Usually white/red or purple in colour
• Prescribed by a doctor

Important: school staff should refer to the student’s Asthma Action Plan to determine how to this use medication in an asthma emergency.

Preventers and combination preventers should not be taken to school unless:

• the combination medication has been prescribed as a reliever medication
• the student is attending a school camp or overnight excursion, and will be required to take the medication as prescribed, whilst in the care of the school.

Types of asthma attacks

Below is a description of the symptoms of different types of asthma attacks. Symptoms will vary from student to student.

Mild/moderate attack

• May have a cough
• May have a wheeze
• Minor difficulty in breathing
• Able to talk in full sentences
• Alert, able to walk/move around
• Have normal skin colour

Severe attack

• Cannot speak a full sentence in one breath
• Obvious difficulty in breathing
• Sitting hunched forward
• Tugging in of skin over the chest and throat
• Lethargic (children)
• Sore tummy (young children)
• Reliever medication is not lasting as long as usual

Life threatening

• Unable to speak, or 1-2 words per breath
• Drowsy/confused
• Collapsed, exhausted, unconscious
• Wheeze and cough may be absent
• Gasping for breath
• Discolouration (turning blue)
• Not responding to reliever medication

Resources

Local policy template for schools

• A downloadable Asthma policy template (staff login required) for Victorian government schools is available on the School Policy Templates Portal. Schools can modify the template to suit their local circumstances.

Student plans

• Asthma Action Plan – for parents or carers to provide to the school, completed by the student’s medical practitioner (schools note: some medical practitioners may develop their own asthma action plans, and these should be accepted by schools where they contain the information required by this policy)
• Student Health Support Plan (DOCX) – required only if a student has asthma that is not well-controlled, and needs individualised supervision, care or adjustments

Staff training

• General staff training – Asthma First Aid for Schools – mandatory 1-hour asthma training session for all individual school staff, at no cost to schools. To be completed online or face-to-face at least once every 3 years
• Targeted school staff training – 22556VIC Course in the Management of Asthma Risks and Emergencies in the Workplace – for staff with higher-level responsibilities or in higher-risk settings, this training is face-to-face and accredited for 3 years. Paid for by each school
• National Asthma Council Australia – schools in the inner-west local government areas of Maribyrnong, Hobsons Bay and Brimbank have access to additional free asthma training. This course provides training tailored to the specific context of inner-west Melbourne. This course is optional, and does not replace the required general and targeted school staff training above

Asthma emergency kits

• Asthma Australia – Asthma Emergency Kits
• Asthma Australia: Asthma Emergency Kit Log (PDF) – free template to monitor when kit contents have been used, and supports kit maintenance
• Asthma Australia: Asthma First Aid Poster

Useful websites for further information

• Asthma Australia – resources for Victorian schools
• Better Health Channel – Asthma action plans
• Better Health Channel – Thunderstorm asthma
• Better Health Channel – Thunderstorm asthma multicultural resources in a number of community languages