Back to school 2024: Top Tips on managing asthma through the September peak

As back-to-school time approaches, it is important that children’s asthma is under control as frequency of A&E visits and hospitalisations increase during September.(1-3)?This article looks at the reason for this increase, and 10 top tips for supporting children and parents with their asthma management.

Asthma is the most common chronic childhood illness, and every year more than 1 in 5 children in the UK miss school due to asthma-like illnesses.(4,5) 33% of children with asthma have reported missing school because of it.(6) According to Asthma & Allergy Network, up to 25% of all asthma-related hospitalisations in children occur in September.(3)?Exacerbations spike almost as soon as the month begins and continue into October, with the peak week being the 38th week of the year.(1) This trend is seen across the Northern Hemisphere including the UK, USA, Canada, Mexico, and Finland.(2)

What causes it?

The return to school can expose children to multiple asthma triggers.(3) This includes indoor allergens such as dust mites and mold, and high levels of aeroallergens, typical for summer months.(1-3) Respiratory viruses are a main cause for exacerbations in this period, as groups are mixing in large numbers again, circulating colds and flu.(1-3) There is also a potential lapse in asthma control over summer holidays as they are traditionally a time when medication is neglected, but if children don’t keep up their treatment, they’re more at risk from these sudden triggers in September.(1,3)

What’s the advice?

To make sure patients are prepared, you may want to encourage patients to take their medication as prescribed and avoid triggers through the summer holidays.(3) The NHS recognises the September peak with its #AskAboutAsthma scheme running from the 9th-15th September 2024. The theme is ‘helping children and young people with asthma to live their best lives’ and promotes getting an asthma action plan in place, ensuring correct inhaler technique, scheduling asthma reviews, and considering the impact of air pollution on lung health.(7)

Asthma & Allergy Network also offers 10 tips to help encourage patients and families to reduce the risk:(3)

1. Schedule an asthma check-up before the school year begins.
2. Review children’s asthma action plans and adapt for the time of year if necessary. Parents should share this with the school.
3. Make sure that your patients asthma medications are topped up.
4. Stress the importance of taking controller medications as prescribed.
5. Encourage patients to keep or carry medications at school, particularly quick-relief inhalers.
6. Use a peak flow meter for advance warning of any lung problems.
7. Promote frequent hand-washing – even young patients can do this.
8. Identify and avoid environmental triggers. If pollen is a problem, perhaps teachers could be advised so the child stays inside at peak times.
9. Use flu vaccinations where possible.
10. Educate your patients and patients parents on good asthma control throughout the year, even when symptoms seem well controlled.

Keep an inhaler next to your toothbrush

Routine is key. Asthma and Lung UK recommend tying inhaler medication routines into something else that your patients do every day, such as brushing their teeth.(8) This makes it easy to remember to rinse out and gargle afterwards too.(8) It’s about managing asthma for the long term and teaching children a good every-day routine to help them gain – and maintain – control over their condition.(8)

The main goal is to keep airway inflammation down to reduce the risk of exacerbations.(9) Infections such as colds and flu, and other common triggers in the September peak, can all contribute to asthma flare-ups.(1-3) Scheduling a check-up and checking a patient’s level of inflammation is simple10 but could make all the difference.

Airway inflammation can be assessed by using fractional exhaled nitric oxide (FeNO) testing. A FeNO value of >35 ppb in a child shows that airway inflammation is likely.(11) Using FeNO-guided asthma management to optimise therapy and adherence has been shown to reduce exacerbations by up to 50%, therefore keeping asthma under control.(9)?FeNO testing can be performed easily at the point-of-care in patients from the age of four with a hand-held device like the NIOX VERO?.(10) Results are available in less than two minutes, so you can take immediate action.(12,13)

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Incorporating FeNO testing into your asthma care routine can help ensure that your young patient’s asthma is under control(14,15) as they go back to school and during the September peak. FeNO allows you to check that patients’ medications are working and if they are adherent to their controller medications.(16) One test can give you an immediate insight into your patient’s condition.(13,17)

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If you would like to find out more about FeNO testing, check out our FeNO Learn app, or get back-to-school ready and Book a Demo of the NIOX VERO? today.

References:

1.??????? Larsen K, et al. The Annual September Peak in Asthma Exacerbation Rates. Still a Reality? Annals of the American Thoracic Society. 2016 Feb;13(2):231–9.

2.??????? Johnston NW et al. The September epidemic of asthma hospitalization: School children as disease vectors. Journal of Allergy and Clinical Immunology. 2006 Mar;117(3):557–62.

3.??????? Allergy and Asthma Network. 10 ways to stay healthy during the September asthma peak week. Available at: https://allergyasthmanetwork.org/news/10-ways-to-stay-healthy-during-september-asthma-peak/. Accessed: Jul 2024

4.??????? World Health Organisation (WHO). Asthma. Available at: https://www.who.int/news-room/fact-sheets/detail/asthma. Accessed: Jul 2024

5.??????? University of Brighton. Keeping children with asthma healthy and in school. Available at: https://www.brighton.ac.uk/about-us/news-and-events/news/2016/06-30-keeping-children-with-asthma-healthy-and-in-school.aspx Accessed: Jul 2024

6.??????? National Health Service (NHS). The Atlas of Shared Learning; Introducing asthma guidance and support for Shropshire Schools. 2019. Available at; https://www.england.nhs.uk/atlas_case_study/introducing-asthma-guidance-and-support-for-shropshire-schools/ . Accessed; July 2024.?

7.??????? Transformation Partners. #AskAboutAsthma 2024. Available at: https://www.transformationpartners.nhs.uk/askaboutasthma-2024/. Accessed: Jul 2024

8.??????? Asthma and Lung UK. Common concerns about asthma medicines. Available at: https://www.asthmaandlung.org.uk/conditions/asthma/treatments/concerns Accessed: Jul 2024

9.??????? Petsky HL et al. Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): a systematic review and meta-analysis. Thorax. 2018;73(12):1110-9.

10.? Alving K et al. Validation of a new portable exhaled nitric oxide analyzer, NIOX VERO?: randomized studies in asthma. Pulm Ther. 2017;3:207-218.

11.? Dweik RA et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FeNO) for clinical applications. Am J Respir Crit Care Med. 2011;184(5):602-15.

12.? NIOX LABEL

13.? Smith AD et al. Use of exhaled nitric oxide measurements to guide treatment in chronic asthma. N Engl J Med. 2005;352(21):2163-73.

14.? Petsky HL et al. Exhaled nitric oxide levels to guide treatment for adults with asthma. Cochrane Database Syst Rev. 2016;9(9):CD011440.

15.? Carroll WD. NIOX VERO: Individualized Asthma Management in Clinical Practice. Pulmonary Therapy. 2016;2:171-88.

16.? Ali H et al. The Potential of Fractional Exhaled Nitric Oxide as a Biomarker in Predicting and Optimizing Use of Treatment in Asthma. South East European Journal of Immunology. 2023;6(1):18-23.

17.? Hanania NA et al. Measurement of fractional exhaled nitric oxide in real-world clinical practice alters asthma treatment decisions. Ann Allergy Asthma Immunol. 2018;120(4):414-418.

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