Alarming new research suggests that, even though Australia has been successful in curbing the rate of asthma deaths and hospitalisations, we are growing increasingly complacent about the risks posed by asthma.

A study was conducted by the Woolcock Institute of Medical Research (Study) surveying almost 2,700 people with asthma. It found that 39% of people only used reliever medication to treat their symptoms, instead of preventative medication to treat their underlying condition. Of these reliever-only participants, nearly a quarter had required urgent healthcare for asthma in the previous year, meaning they had to seek last-minute treatment for a dangerous flare-up.

With one in nine Australians suffering from asthma, these statistics suggest that nearly a million people are not treating their underlying condition. While a proportion of asthma sufferers only have a mild or infrequent condition, if we extrapolate these statistics out, over 200,000 people may have required urgent healthcare in the last 12 months, placing themselves at serious risk from an asthma flare-up.

Back in June, Ian Craig, chief operating officer of Asthma WA, said they were “losing this war” on asthma due to complacency. The Study seems to confirm that assessment.

The Victorian asthma experience

Victorians know all too well that asthma flare-ups can occur with little notice and can result in fatalities.

It has been nearly a year since a freak Melbourne thunderstorm caused the deaths of 10 people and the hospitalisation of more than 8500 others. The storm on 21 November 2016 was caused by a combination of high pollen, strong winds and moisture in the air.

One of the victims had no documented history of asthma. Further, Melbourne pharmacies at the time were reportedly inundated with people seeking reliever puffers, many of whom were experiencing their first asthma attack. As many as one-third had not been previously diagnosed with asthma. The facts of this incident indicate that these weather conditions can affect anyone, even if they don’t have a history of asthma.

A coronial investigation has commenced into the tragedy, but Coroner Paresa Spanos has drawn attention to changes which have already been made to ensure this tragedy doesn’t happen again. These changes include new ambulance dispatch policies and a Department of Health and Human Service campaign to raise awareness about thunderstorm asthma.

The Bureau of Meteorology will also be sending thunderstorm asthma alerts to Victorians using data from Deakin University’s annual AIRwatch pollen count which began on 1 October.

New Asthma Guidelines for Victorian Schools

Victoria continues to lead the way in its approach to asthma management and although limited to Victorian, the approach by this State to asthma management can be considered best practice for preventing and managing the risks of asthma around Australia.

Back in March, School Governance reported on the introduction of new Victorian Asthma Action Plans, developed to assist school staff in identifying the signs and symptoms of asthma, and recognise the severity of potential attacks. At the time, we noted that new Guidelines for Asthma Management would soon be released.

In June 2017 the Asthma Schools Guidelines Victoria 2017 were released by Asthma Victoria. The Guidelines were developed to assist all Victorian schools in planning for, and supporting students with asthma. They are structurally similar to the Anaphylaxis Guidelines for Victorian Schools (Anaphylaxis Guidelines), which all schools must legally comply with under Ministerial Order 706.

The Guidelines are stated to support schools in complying with legislation, most critically the:

• Education and Training Reform Act 2006, specifying that schools must safeguard the health of students
• Occupational Health & Safety Act 2004, requiring schools to ensure sufficient staff are trained in first aid.

The Guidelines are directly relevant for Victorian schools, and they are only compulsory for government schools. The Asthma Guidelines are not mandatory for non-government schools, but both Catholic Education Commission of Victoria and Independent Schools Victoria have recommended that schools comply with the Guidelines.

Under the Guidelines there are minimum requirements to meet the Victorian Department of Education and Training’s School Policy Advisory Guide, and other recommendations for schools to further support children with asthma.

Minimum requirements include:

• having a school asthma management policy which includes prevention strategies to minimise the risk of a severe/life-threatening asthma attack, and emergency response procedures
• requiring relevant school staff to undertake asthma first aid management training
• developing a Communication Plan to provide information to staff, students and parents about asthma and the school’s Asthma Management Policy
• purchasing at least two Asthma Emergency Kits
• undertaking regular review of students’ reliever medication and Asthma Emergency Kits.

Recommendations by the Guidelines include:

• conducting an annual briefing for all school staff on asthma management
• developing individual asthma Risk Minimisation Plans for each student diagnosed with asthma
• following safe storage procedures for reliever medication
• completing an annual asthma Risk Management Checklist to monitor compliance.

School Asthma Supervisors

One key omission from the Guidelines is the role of a school supervisor for asthma. Under the Anaphylaxis Guidelines, there is a recommendation that two staff members are appointed as School Anaphylaxis Supervisors, whose main role is to undertake competency checks on staff that have completed online anaphylaxis training. While there is no requirement for competency checks to be undertaken at the school level for asthma, given that there are certain roles for designated/nominated staff members under the Guidelines - such as conducting the annual asthma briefing - schools should also consider appointing a number of Asthma Supervisors. Possible roles for the Asthma Supervisor include:

• liaising with the Principal in developing individual asthma risk minimisation plans and prevention strategies
• communicating with school staff on training requirements
• assisting with record keeping and reviewing reliever medication
• leading staff and induction briefings
• providing regular advice and guidance about allergy and asthma management.

What does this mean for schools?

Under the Disability Standards for Education 2005 (Cth), all schools have an obligation to make reasonable adjustments to accommodate students with disabilities. Asthma, similarly to anaphylaxis, would likely fall within the definition of disability, not only for the purposes of the Equal Opportunity Act 2010 (Vic), but also under the national Disability Discrimination Act 1992 (Cth), due to the wide range of physical conditions that would be captured by the broad definition. Hence the obligation to make reasonable adjustments, such to avoid unlawfully discriminating against students with asthma, would exist for all Australian schools.

As the Guidelines state, all school staff also have a duty of care to take reasonable steps to protect a student in their care from risks of injury that are reasonably foreseeable.

The most obvious way to do this is to become recognised as an ‘Asthma Friendly’ service or to implement such criteria. One of the essential criteria for meeting this standard is implementing and communicating an Asthma Management Policy.

All schools should consider using the Guidelines as a resource to assess and review their current management practices, and to develop their Asthma Management Policy. Doing so will ensure they are not being complacent about the risks posed by asthma and have appropriate policies and procedures to ensure the safety of students suffering from asthma.

How does your school handle asthma management?