In Australia, 1 in 9 people suffer from asthma, a chronic lung-condition which causes inflammation and constricting of a person’s airways. While asthma can have minor effects if appropriately managed, severe conditions can interfere with daily life or lead to life-threatening attacks. Symptoms can flare up with little notice, with attacks potentially triggered by exercising, catching a cold or simply breathing in smoke or cold air.

With no cure, fatal asthma attacks are an all-too-common occurrence.

Asthma deaths still common

Less than a month ago, School Governance reported on the coronial inquest into the tragic death of a young girl in her NSW home from an asthma attack. Evidence suggested that the girl had over-exposure to allergens, with allegations that her home was infested with rodents and mould. In that sad case, the death was due to asthma which could have been prevented if the girl had not been subject to neglect.

After a ‘freak’ thunderstorm in Melbourne last November, 9 people died and more than 8500 were hospitalised from asthma-related illnesses. Breathing difficulties resulted from the combination of high temperatures, humidity, strong winds and an increased pollen count.

In Manchester, UK last April, an 18-year-old schoolgirl suffered a fatal asthma attack while on a tram. The girl and her friends had successfully dashed up three flights of stairs to board the tram as it was about to depart, but collapsed fighting for breath and later suffered a cardiac arrest.  At a recent inquest into her death, evidence suggested she had taken 8 antihistamines on the morning of her death to combat exam anxiety.

These incidents may be worlds apart, with disparate ages, asthma triggers and locations. However, the very breadth of these characteristics demonstrates the significant challenges faced in achieving effective asthma management – attacks can occur with very little warning and appropriate treatment will vary between individuals.

Hence, it is no wonder that many remain uncertain of the extent of asthma’s severity or the best way to minimise the dangers. This is no better represented than in the school setting; asthma is the most common childhood condition in Australia, and every year the number of asthma flare-ups rises significantly when children return to school after Christmas.

In an effort to promote greater understanding and more consistent Asthma Management, the Victorian Asthma Foundation has consulted with the Department of Education and Training (DET), Catholic and Independent Schools to develop Asthma Action Plans specifically for Victorian schools.

The Victorian Asthma Action Plans

The National Asthma Council of Australia (NACA) recommends that every person with asthma have an asthma action plan tailored to their individual circumstances. Despite this, research suggests that only 20% of asthmatics aged 15 and over and 41% of asthmatic children have an asthma action plan. Additionally, there are a number of different action plan templates available, each with a different ‘look and feel’ and requirements for action. For example, there are different templates for education and care services, for Indigenous Australians and for when an asthma sufferer is using a particular kind of combination medication.

As a result of attempting to navigate these different template formats, the DET approached the Asthma Foundation of Victoria to resolve the confusion and uncertainty experienced by school staff and parents.

The new Action Plans have been developed to assist staff in identifying student asthma signs and symptoms and the severity of the potential asthma attack. Different action will be required depending on whether the asthma attack is mild/moderate, severe or life-threatening.

There are now 6 different Asthma Action Plans, which are categorised by the type and dosage of the child’s prescribed reliever medication:

• Salbutamol when using a puffer and spacer – health professional to insert dose;
• Salbutamol when using a puffer and spacer – 4x4 procedure;
• Salbutamol when using a puffer alone – health professional to insert dose;
• Bricanyl Turbuhaler;
• Symbicort Turbuhaler; and
• Symbicort Rapihaler.

The first four Action Plans above were emailed to schools on 18 November 2016 and the Victorian Asthma Foundation predicts the 2 ‘Symbicort’ Action Plans will be distributed by the first week of Term 2 2017, pending pharmaceutical confirmation.

While ultimately any student's action plan provided to a school which has been prepared in association with a doctor will be sufficient to meet a school's obligations, these new Action Plans are the preferred template for school asthma management.

Asthma and the law

Schools have a clearly articulated duty to ensure that students under their care are not exposed to reasonably foreseeable risks. As the most common condition suffered by Australian children and with the vast variety of asthma triggers - including pollen and exercise - the potential for asthma attacks is clearly a reasonably foreseeable risk. Hence, schools have an obligation to take reasonable steps towards asthma management.

The extent of a school’s obligations towards asthma management is far less clear-cut than the responsibilities of health practitioners, and currently varies depending on the age of the child, whether the school is government or non-government and the jurisdiction in which the school is located.

‘Early Education’ Schools

Under the Education and Care Services National Law (National Law) and Regulations, which governs approved education and care services (including early education providers), at least one educator for each provider must have undertaken current approved emergency asthma management training. Further explanation of the National Law can be found here.

This requirement has been extended for non-government schools in Western Australia. Under the Registration Standards for Non-Government Schools, Standard 4.2 requires that where there the school has pre-kindergarten and kindergarten children, unless otherwise approved by the Director General, there must be staff on the premises with current approved emergency asthma management training. This seems to go beyond the National Law, which doesn’t apply to schools with no preschool program.

Queensland and Victoria

In Queensland, the purchase and administration of typical asthma reliever medication - S3 salbutamol or S3 terbutaline – requires completion of an Asthma First Aid training course approved by the Department of Health.

Government schools in Victoria should ensure all staff with a duty of care for students have current training to assess and manage an asthma emergency and have completed the free Asthma Education Session. Additionally, staff with direct student wellbeing responsibility (such as nurses and sport teachers) should have current emergency asthma management training. The contents of this policy are also recommended to all Victorian non-government schools by Independent Schools Victoria (ISV) and the Catholic Education Office (CEO).

Other schools

Asthma Australia recommends that all school staff complete Asthma First Aid Management Training.  The course provides current information on asthma management in schools and trains staff on the national protocol for first aid treatment of asthma attacks.

Future Ministerial Order

School Governance has been advised that the Minister for Education may soon make a Ministerial Order specifically for Asthma Management. While its contents remain unclear, compliance with previous Ministerial Orders on Anaphylaxis Management and the Child Safe Standards is a registration requirement for Victorian schools under Part IV of the Education and Training Reform Act 2006 (Vic).

Schools looking for an indication of what may be required under a future 'Asthma Management Order' should consider the contents of Ministerial Order No. 706: Anaphylaxis Management in Victorian schools, which included requirements for schools to:

• have an Individual Management Plan in place for each anaphylactic student;
• implement anaphylaxis prevention strategies;
• detail an anaphylaxis communication plan;
• update their emergency response procedures;
• ensure appropriate staff training is undertaken; and
• complete an annual risk management checklist.

What should schools do going forward?

The Victorian DET is expected to release new Guidelines for Asthma Management, together with the Ministerial Order, in the coming weeks. It is also expected that the CEO and ISV will also soon respond to these changes and, based upon their consultation in the Victorian Asthma Action Plans, and previous support of DET policies, they will likely either support or mandate the Guidelines.

If this process bears any similarity to the similar release of Anaphylaxis Guidelines last year (see previous School Governance articles here and here), then it is possible that legislative change may also occur to create legal requirements for schools’ management of asthmatic students.

All schools have a legal duty to take reasonable steps to protect students from reasonably foreseeable risks. Therefore, all schools – not just those governed by the National Law or registration requirements – have a duty to take steps to ensure the safety of students suffering from asthma. The most obvious way to meet this duty is to become recognized as an ‘Asthma Friendly’ service by your local Asthma Foundation, or simply to implement the criteria. Essential criteria necessary to reach this standard include:

• implementing and communicating an asthma management policy;
• ensuring sufficient staff have current first aid and asthma management training and that safe medication practices are in place;
• having accessible and well-stocked Asthma Emergency Kits;
• collecting complete Asthma Action/Care Plans from all asthmatic students; and
• having procedures to minimize potential asthma triggers, such as cleaning protocols to reduce dust.

Does your school have procedures for managing the safety of asthmatic students?