School-age children and their parents will benefit from knowing that many deaths of young people from asthma are preventable, says Dr Robin Carr. He suggests the use of a film made in a school to get key messages across to young people, families, friends and teachers.
When I became a GP in the market town of Yeovil, Somerset, in 1988, people were still talking about the death of a local 12-year-old from asthma some years before. I was interested in asthma and was motivated to try to do something to help.
But I do fear that the last 30 years has made no difference at all. In 1988, the death toll from asthma was about 1,200 per year, and in 2019, 1,400 died. In 2019, Asthma UK said that deaths from asthma attacks were the highest they had been in the last decade and they had increased by more than 33% over the past 10 years.
How can that be? We have some amazing medications, double and triple therapies; we know so much more than before, but has this all been a waste of time?
In 2014, the National Review of Asthma Deaths (NRAD) was published that showed in sharp focus what the problem was and how so many of these deaths, especially in school aged children were preventable. There was nothing in this document that you and I did not already know: significantly, that ‘almost all the asthma deaths in school aged children are preventable’.
The DH response to the publication of NRAD, was to, in 2015, enable short-acting beta-agonist inhalers to be held in schools. This was a voluntary code of practice and was not adopted by all schools. Moreover, anecdotal reports of puffers in locked cabinets, or teachers not being taught how to use pMDIs, were quite common. The situation was exacerbated by difficulties for parents in getting an ‘extra set for school’, the onerous documentation around getting and keeping them, and the ‘medical legal’ position of using them in an emergency for a named individual. Of course, schools have so many ‘must-do’ tasks already given to them.
Preventable: A film about asthma in schools
When I described this situation to a group of teenagers in a state secondary school in Oxford, the students were inspired to want to help. The amazing outcome of this was that student members of the Cherwell School Film and Drama club – with some medical help – made a film called Preventable, aimed at their peers, young people and parents.
The film was made by school-age kids for school-age kids and their parents. The evidence-based messages within the film were informed by Dr Mark Levy, medical director of NRAD and a member of the Global Initiative for Asthma (GINA). Reviews and changes were made after it was seen by paediatric respiratory consultants, Asthma UK, South Central Ambulance Trust and several GPs.
There are two versions of Preventable, both available on YouTube, and both are freely available for sharing:
- The main film is found at: https://m.youtube.com/watch?v=poAS5rStfW0&feature=youtu.be
- The NHS England (London) Children and Young Peoples programme asked if we could make a shorter version. This went out with their Christmas newsletter and has proved very useful to the nurses in the Healthy London Partnership area. Their #Ask About Asthma resources are available from their website.
- A second version of the film (https://youtu.be/w2hKmzH4b4s) is aimed more at health professionals and for teaching. It is a little shorter; can be paused and restarted to discuss the points raised. This version can also be used for patient education.
The film can be distributed on social media and used in class as a Personal Social Health Economic (PHSE) lesson. It could also be used as a teaching module for teachers themselves: Cochrane has published a review looking at intervention in schools and teaching teachers about asthma, and it makes a difference.
Key messages in the child-, parent- and teacher-facing film:
- Asthma attacks are preventable.
- All asthmatics need to be taking an inhaled steroid.
- Blue inhalers are relievers only. If you have one, let your friends and teachers know, and tell them where you keep it.
- If you have a pMDI, it must be used with a spacer.
- Tell the school or a friend you have asthma.
- All asthmatics need a Personalised Asthma Action Plan (PAAP), and a copy can be kept at school with the asthma register.
- Call early for help: call 999.
- You must have a review with your asthma nurse of GP after every asthma attack.
Key messages in the health professional version: (which can also be used for patient, parent or teacher education)
- Inhaled corticosteroids (usually brown) prevent asthma attacks and should be prescribed to all asthmatics.
- Reliever inhalers (usually blue) are only meant for emergency use.
- An asthma attack means something has gone wrong; a review needs to happen after each attack. It needs to be done by a trained individual and to cover the following:
- Is the attack over?
- What went wrong?
- What needs to change?
- What modifiable risk factors need fixing?
- Everyone with asthma should have a Personalised Asthma Action Plan (PAAP).
- Inhaler technique should be checked every time an asthma patient consults a healthcare professional.
- Healthcare professionals caring for people with asthma should be appropriately trained.
- When you see an asthma sufferer struggling for breath, call 999.
How the film is being used
The film has already been of great interest to several local organisations and links have been sent to all the Oxfordshire County Council affiliated schools. Secondary schools in England are now independent and in Oxfordshire schools have got together in groups, and the River Learning Trust, based in Oxford has distributed it across their members. Cherwell School, where the students who make the film are from, is a lead member in this organisation. The Diocese of Oxford has sent the link to all the Church of England affiliated schools. Oxfordshire Hospital School was one of the very first to enthusiastically adopt the link to be used on their medical needs in schools pages.
In addition, a local GP surgery is sending the link to the film to select patients when organising their annual checks. It is too long to be used in the consultation, but is useful as a piece of follow-up information to reinforce the interventions of a follow up visit.
School nurses may wish to use it as a teaching aid for their teachers as there is an enthusiastic desire to know more about managing a common condition in the classroom. It can be used as a PHSE educational session in the classroom itself.
Education for Health, a charity which focuses on educating healthcare professionals around respiratory and other long-term conditions, will also be using the video as part of their teaching material across their university and CPD accredited courses to support healthcare professionals understand their role in managing asthma effectively.
Could you use the film too?
The health professional version of our film is shortened, and the bullet pointed part at the end is aimed at those leading asthma teaching sessions, face to face or virtual.
Some surgeries have been sending the link with electronic reminders for annual checks as a focus for the appointment, or afterwards to emphasis points raised in the check-up. Patient groups or practice websites can use the links to the film and follow links for their personal use.
For those who have a school responsibility, Preventable can be a useful tool to introduce the areas of importance to focus on. Parent groups might encourage their schools to have it on the school website as a resource. Teaching staff can use the longer version for PHSE classes and have Q&A sessions at the end, both for reducing stigma and increasing awareness.
Please do use this innovative and evidence-based film in your area as you see fit, and maybe this will play a small part in preventing one of those preventable asthma deaths.
- Preventable, main version https://m.youtube.com/watch?v=poAS5rStfW0&feature=youtu.be
- Preventable, teaching edition https://youtu.be/w2hKmzH4b4s
- Asthma UK https://www.asthma.org.uk/about/media/news/press-release-asthma-death-toll-in-england-and-wales-is-the-highest-this-decade/
- National Review of Asthma Deaths 2014 https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills
- NRAD Key findings and recommendations https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwi9-qjMpKX1AhUMQUEAHSPQA2wQFnoECA4QAw&url=https%3A%2F%2Fwww.rcplondon.ac.uk%2Ffile%2F870%2Fdownload&usg=AOvVaw12i3khWGNtqWhdqQ0Baii0
- Kings Fund Health care priorities https://www.kingsfund.org.uk/publications/articles/transforming-our-health-care-system-ten-priorities-commissioners/summary
- Evidently Cochrane https://evidentlycochrane.net/asthma-in-schools-teachers-save-lives/
- Ask About Asthma https://www.healthylondon.org/our-work/children-young-people/asthma/askaboutasthma-2021/Global Initiative for Asthma (GINA) https://ginasthma.org
- Asthma UK (AUK) https://www.asthma.org.uk
- Right Breathe https://www.rightbreathe.com
- Oxfordshire Hospital School https://medicalneedsinschools.co.uk/
- Education for Health www.educationforhealth.org
Conflicts of interest: We received no money for the pharmaceutical industry. We received £50 from one donor in a crowd funding exercise; other costs were met within house. The school, staff, pupils, filming and editing time, cameras, ambulance and paramedics, doctors and peer reviewers all gave their time for free.