Starting a new school with asthma – what to advise

Care from a knowledgeable and supportive general practice nurse (GPN) can be crucial when a child changes school, to enable them to stay well so that they can learn and achieve. In this way, GPNs are vital to improving a child's life chances and overcoming any social and emotional disadvantages.

Emma, aged 11, from a disadvantaged part of Greater Manchester is one such child. This article illustrates the challenges that she faced and the role of a GPN in her care. The events are real, but the description of her care has been added and the child's name changed.

GPNs are more than alert than most health professionals to the rise in number of exacerbations of asthma as children start school or go back to school each September.

There are several reasons for this:

Emma's GP practice prioritised asthma reviews for those at most risk, in children of school age during the late summer. The GPN was aware of Emma's frequent exacerbations, meaning courses of oral steroids and trips to A&E several times a year. The GPN knew that Emma's asthma triggers were anxiety and infections. Previously she had referred Emma to the asthma specialist nurse who had reviewed and changed her treatment. The GPN called Emma in as a high priority for an asthma review. This was done face to face rather than remotely, so that the GPN could see not only verbal but non-verbal cues and could review inhaler technique more easily. Emma's grandmother spoke of her concern regarding transition to secondary school, some miles from home and not round the corner, as her primary school had been. The GPN noted the anxiety in the grandmother and in Emma and focused the consultation on instilling confidence in Emma's self-management of her asthma, which to date had very much been managed by her grandmother.