This Science Week read about some of the advancements in the treatment & management of Asthma and Allergies relevant to school staff
TEACH - Training & Education Around Child Health
We are a team of Specialist Children's Nurses providing health training & support to educational & child care settings.
Written by Nina Ferraro Msc, RNC
The theme for this year’s Science Week is Connections, and after the past few years of necessary isolation this theme welcomes a year with more contact, experience and participation!
It’s been a busy and exciting few years in Asthma and Allergies research, despite the set-backs of the COVID-19 pandemic. Both Asthma and Allergies are increasing in prevalence globally and this has led to increased awareness within the scientific and policy communities.
Keep reading for a quick look at some advancements in Asthma and Allergies research, policy & practice that affects the management of pupils with asthma and allergies in schools.
New recommendations on the administration of adrenaline
The inquest into the tragic death of teenager Natasha Ednan-Laperouse in 2016 from Anaphylaxis revealed an important change to advice around the administration of adrenaline intramuscularly.
Natasha suffered an anaphylactic reaction and was given two intramuscular doses of adrenaline with adrenaline auto-injectors (AAI). Both were administered into the same thigh muscle. An expert in Allergies spoke at the inquest and suggested that the first dose of adrenaline that was administered into her thigh could have caused the small blood vessels in her thigh to constrict, which would mean localised blood flow would be temporarily reduced. This is a known effect of adrenaline. It was suggested that this could have impacted the second dose from entering the blood stream effectively.
The European Medicines Agency completed a review of all EU-approved AAIs in 2017 and concluded that further research should take place into blood stream absorption rates. These studies are underway and will inform future recommendations.
If a second dose of adrenaline is required during an allergic reaction, always give the second dose into the opposite thigh. AAIs can be administered through clothing, although it is best to avoid seams or bulky materials.
?Intramuscular injections and how they work
Adrenaline is the front-line treatment for anaphylaxis and AAIs were made available in the 1980s. Emergency management for suspected severe allergic reactions is to administer an AAI into the thigh for optimal uptake and effect. But why and how do intramuscular injections work?
Intramuscular injections deposit medication into the muscular tissue rather than the subcutaneous tissues that lie directly beneath the skin. Intramuscular injections administer medication into the bloodstream quickly, as muscle tissues have large blood supply systems.
The thigh muscle is used for the administration of AAIs because it is one of the largest muscles in the body and is easily accessible. Due to its size, the thigh muscle contains lots of blood vessels meaning the absorption of medication is faster. The thigh area is also recommended as there are no major blood vessels or nerves that can be damaged when administering an AAI.
Spacers are non-negotiable for Asthma patients
In 2014, a report was released called Why Asthma Still Kills. It highlighted multiple policy and practice areas that were falling behind in meeting the needs of children with Asthma. The UK has one of the highest child Asthma death rates in Europe, and the report concluded that the majority of these deaths are preventable. One of the areas where improvement was identified was inhaler technique, as better technique reduces the risk of Asthma attacks, exacerbation of symptoms, and hospital admissions.
There is an ever-growing body of research that time and time again highlights the importance of patients using a spacer to administer their inhaled medication, both for regular medication and in emergencies. This is particularly important for patients who may struggle to co-ordinate administration and inhalation, such as children, older people, and those with learning difficulties.
When an inhaler is placed directly in the mouth without the use of a spacer, the medication may end up on the back of the throat or the roof of the mouth, with only a small amount reaching the lungs.
Using a spacer device delivers the medication into the lungs much more effectively and helps children and young people to achieve greater control of their asthma.?
It is vital that all parents, teachers and carers can support children to use a spacer and practice good inhaler technique.
If you would like a free PDF file of this poster to hang up in your school, please email [email protected] and our team will send one to you.
Alternatively,?complete our programme enquiry form requesting a free How to use an Inhaler and Spacer PDF poster: https://teachhealth.co.uk/contact/
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Expansion of Remote Asthma Care
One of the positive outcomes of the Covid-19 pandemic was the shift from face-to-face to online virtual consultations. With the increase in use of virtual appointments, the future of Asthma and Allergies care will hopefully continue to provide more autonomy and accessibility options for patients. Families being able to access their specialist Asthma team remotely should improve Asthma outcomes.
Evidence shows that up to 90% of Asthma deaths are preventable, and early symptoms of Asthma attacks are not followed up or treated. Schools play a vital role in informing parents &/or carers when a child uses their emergency medication at school or when it expires or finishes so that an immediate asthma review can be booked with their GP preventing a possible deterioration in their asthma.
Is your school up-to-date with these evidence-based practice developments?
New evidence and research in asthma and allergies is constantly emerging and many schools struggle to keep up-to-date with important recommended changes.
The theme for this year’s Science Week is Connections and our team of specialist registered nurses at TEACH (Training & Education Around Child Health) are available to connect with you and answer any questions you may have on the management of pupils with asthma and allergies in schools.
Please complete our programme enquiry form: https://teachhealth.co.uk/asthma-allergy-friendly-school/
Or email us at [email protected].
We look forward to connecting with you!
The Author has made every effort to ensure the accuracy of the information contained within this article. The Author does not accept any liability or responsibility for any inaccuracies or for any diagnosis made, or actions taken based on this information.
It is strongly advised that all school staff attend Asthma, Anaphylaxis and Allergy Awareness training to understand what to do in a medical emergency.
TEACH run specific courses covering in detail how to support pupils with asthma and allergies. Our team are highly experienced specialist nurses who will tailor the training to your needs.
Please visit www.teachealth.co.uk, [email protected] or telephone: 020 8720 6635 for more information about our courses.
References:
Allergic Living. (2019). Should a second dose of epinephrine be injected into the opposite thigh? Available at: https://www.allergicliving.com/experts/should-a-second-dose-of-epinephrine-be-injected-into-the-opposite-thigh/ (Accessed: March 14, 2023).
Allergic Living. (2019). Why is epinephrine administered to the outer thigh and not the arm? Available at: www.allergicliving.com/experts/why-is-epinephrine-administered-to-the-outer-thigh-and-not-the-arm/ (Accessed: March 14, 2023).
De Keyser, H H., Szefler, S. (2020). Asthma attacks in children are always preceded by poor asthma control: myth or maxim?, Breathe (Sheff). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792762/ (Acessed: March 14, 2023).
Jones, H., Lawton, A., Gupta, A. (2022). Asthma Attacks in Children—Challenges and Opportunities, Indian J Pediatr. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8776553/ (Acessed: March 14, 2023).
Levy, M. et al. (2014). Paediatric asthma care in the UK: fragmented and fatally fallible, BJGP. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6650126/ (Acessed: March 14, 2023).
Royal College of Physicians. Why asthma still kills: the National Review of Asthma Deaths (NRAD) Confidential Enquiry report. London: RCP, 2014.
Vincken, W. et al. (2018). Spacer devices for inhaled therapy: Why use them, and how?, ERJ open research. U.S. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004521/ (Accessed: March 14, 2023).