Avoid a back to school asthma attack

Every year, there’s a spike in asthma attacks in children across the UK when they go back to school.

This year, there’s the added concern that children have been off for longer than usual because of the Covid-19 pandemic. Find out what the risks are and how to make sure your child’s asthma is well managed so you can cut their risk of a back to school asthma attack. 

On this page:

Why are children more at risk of asthma attacks when going back to school?

Every September, there’s a rise in the number of children in the UK who are rushed to hospital due to their asthma.  

There are a few possible reasons why children are at higher risk of asthma attacks after returning to school: 

  • Lots of children come down with colds when they go back to school – this is one of the biggest triggers for people with asthma
  • If your child has a dust mite allergy, being inside more as the weather changes could make their asthma flare up
  • Seasonal allergies, such as mould spores in autumn, could also set off asthma symptoms
  • Preventer inhaler routines get easily disrupted over the holidays, so children's airways can be more sensitive to triggers when they go back to school. 

Does getting COVID-19 increase the risk of children having an asthma attack?

This year, many children will be returning to school after the longer break caused by the coronavirus pandemic.

When children get COVID-19, their symptoms are generally milder than when adults get COVID-19.  

It’s unclear if COVID-19 could be a trigger for asthma attacks. What we do know is that COVID-19 is a respiratory infection and that other respiratory infections, such as colds and flu, can trigger an asthma attack.

Children with asthma could be at higher risk of serious illness if they catch COVID-19, particularly if they have severe asthma.

This is why it's very important for children to manage their condition as well as possible. This includes taking their preventer medicines as prescribed and following their asthma action plan.

The COVID-19 advice for schools is different in each of the four nations:

Schools guidance in England
Schools guidance in Northern Ireland
Schools guidance in Scotland
Schools guidance in Wales 

What should I do to prepare for my child’s return to school?

  • The number one priority is to make sure your child is taking their preventer medicine every day, as prescribed. This will help calm the inflammation in their airways and reduce the risk of an asthma attack.
  • Arrange for your child to have an asthma review, as this will help to pick up any early symptoms. 
  • Make sure your child’s written asthma action plan is up to date and that it has been shared with your child’s school. If your GP or asthma nurse is not yet running asthma clinics because of coronavirus, ask for a telephone or video consultation. 
  • Ask your doctor's surgery for an extra reliever inhaler (usually blue), and give it to your child's school. This should preferably be in its original packaging, so the school has the prescription label that comes with it. Send in a spacer too, if your child uses one.
  • Download and fill in an Asthma School Card to give to the school, so they know what medicines your child takes and when they need them.
  • If your child is old enough, you can support them to make sure they can take their inhaler properly by themselves. Watch a video on how to correctly use an inhaler.
  • Check that the school will tell parents when an inhaler is used. If your child is in secondary school, your child should be telling you when they use their inhaler. Make sure they know to tell an adult if they have had to use their inhaler and it hasn’t helped, or if they’ve used it and their symptoms have come back.

By involving your child in their asthma care, you are more likely to help them develop good habits that will help keep their asthma under control and cut their asthma attack risk. 

More tips on how to prepare for your child’s return to school if they have asthma or suspected asthma.

Why is it particularly important to monitor your child’s asthma care when they’re moving up to secondary school?  

Starting secondary school can be a risky time for children with asthma, because of the amount of change a child experiences in the transition from primary to secondary school.

Moving up to secondary school means a new environment, with the potential for new triggers.

These triggers can include:

  • a new journey to school, using different transport
  • stress because of changes like new friends, teachers and subjects
  • moving around different classrooms and a larger school all day
  • starting new subjects, like science, and design and technology.

When a child moves up to secondary school, your child will need to take a greater responsibility for their asthma in the school day. This means it’s important to talk to your child, to make sure they:

  • can take their own inhaler, so they can be as independent as possible
  • have an asthma review during the summer holidays, to make sure any symptoms are picked up.

Children may also feel more embarrassed about getting their inhaler out or may not be able to fit their inhaler and spacer into their bag.

They could talk to nurse about a smaller, more portable, spacer or a breath-actuated inhaler.

4 signs your child’s asthma symptoms are getting worse

  1. Needing to take their reliever inhaler three or more times a week
  2. Coughing and/or wheezing, or saying their chest hurts
  3. Breathlessness – if they’re pausing for breath when talking or struggling to keep up with friends, that’s a sign
  4. Waking up at night because of their asthma symptoms 

Younger children might say their tummy hurts as well - get to know your child’s individual asthma signs. 

One or more of these signs mean that your child is at risk of an asthma attack and you need to take urgent action.

What to do if your child’s symptoms are getting worse  

  1. When they get symptoms, follow your child’s asthma action plan. Their symptoms should get better. If they don’t, or their reliever inhaler isn’t lasting for four hours, call 999 and follow our asthma attacks advice for children.
  2. If their symptoms get better, make a same-day appointment with your child’s GP. If the surgery is closed, call 111 for advice.

Tips for teachers

All children should be able to get to their inhaler quickly. Ideally, primary school children should have their inhalers in the classroom, while secondary school children can carry their inhalers around with them.

Some older primary school children may carry their own inhalers, but this is at the discretion of the head teacher. If a child needs to take their inhaler, an adult should be watching them take it. How an inhaler should be used.

Some children may need help to take their inhaler. If you’re not happy to do this, it’s important to recognise symptoms of an asthma attack and get someone else to help the child. You can find free online accredited training on supporting children with asthma through Education for Health.

Some children may not be able to speak if they’re having an asthma attack. It can be useful for these children to have an asthma buddy, who can tell the teacher on their behalf if they can’t say so themselves. 

Emergency inhalers

Emergency inhalers should only be used when a child’s usual inhaler isn’t accessible. It isn’t meant to be taken outside or on trips, to save the effort of taking the child’s named inhaler.

Emergency spacers should be thrown away after one use, not washed and reused. This is because the spacers are single use.

Under normal circumstances, the metered dose inhaler can be cleaned – see the Inhalers in School Guidance for more details. However, due to COVID-19, it may be safer to throw away both the spacer and the inhaler after they are used, rather than washing it. You can get advice on this from your School Nurse and Local Infection Control Team.

You may be concerned about cost and waste, but the school’s emergency inhaler should rarely need to be used if all children have access to their own inhaler and spacer.


Last updated August 2020

Next review due August 2021

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