Respiratory specialist nurse Holly-Louise Catlin reflects on child asthma deaths and how some groups of asthma sufferers are more at risk than others.
One of the most striking findings of the recent report by the National Child Mortality Database (NCMD) on child deaths due to asthma was that children from the most deprived communities in England are four times more likely to die from an asthma attack than those in the least deprived.
It was a stark reminder of the close link between poor lung health and poverty – the UK has the worst death rate in Europe for lung conditions and they are more closely linked to inequality than any other major condition.
NCMD’s report reviewed the deaths of everyone under the age of 18 who died due to asthma between 1 April 2019 and 31 March 2023; 54 children in total.
It identified several common factors present in a high proportion of the cases, including living in areas with air pollution above levels recommended by the World Health Organization, exposure to cigarette smoke, over-reliance on reliever (SABA) inhalers and emergency hospital admissions in the year prior to death – all things that are more likely for those living the poorest communities.
On the Asthma + Lung UK helpline, we talk to parents every day concerned about their children’s asthma, many struggling to access asthma care or unsure as to when they should seek help for their child’s asthma symptoms. Lots of people we talk to don’t have a good understanding of their children’s condition and sadly, there is still a widespread complacency around the seriousness of asthma that continues to put people at risk.
It’s heart breaking that for children with asthma living in the most deprived communities those risks are even higher, and often beyond the control of their parents or carers.
The new NICE/BTS/SIGN asthma guidelines do offer hope for better asthma care – recommendations for clear diagnosis guidelines, treatment pathways with flexible treatment plans and closer follow-ups after a flare-up have the potential to keep children’s asthma safely controlled. But they need adequate funding, and an NHS workforce fully upskilled in asthma care to make sure they can be properly implemented and make a meaningful difference.
It’s vital that everyone in contact with patients with asthma, especially children and young people, understand the major changes to diagnosing and managing asthma. The entire team – not only respiratory nurses – need the skills to do the best for asthma patients at every opportunity.
At a time when the cost of living is making it tough for people to even heat their homes, and huge pressures on primary care mean people are struggling even to contact their GP as levels of winter illnesses soar, nurses in general practice and in the community can make a difference.
While there is real struggle for healthcare professionals to have enough time with each patient – there are steps we can take to ensure the risk to vulnerable children of having a serious or fatal asthma attack is reduced.
Annual reviews
We hear from lots of parents who are struggling to get their children appointments for annual reviews, but this is an unmissable opportunity each year to check in with a child, taking the time to check their symptoms and management of asthma, inhaler techniques and ensure their medication is right for them. The new asthma guidelines recommend that annual reviews are a minimum and suggest reviews more frequently if asthma is poorly controlled or someone is at high risk, and also after every flare-up.
Understanding asthma
It’s often the case that parents, carers and children themselves don’t have a good understanding of their asthma. This can be even more of a problem when parents are non-English speakers. As highlighted in the new guidelines, it’s really important to see every contact with a patient is an opportunity to help improve their understanding of their condition and provide education regularly, including how to manage personal asthma triggers, understanding their medicines, recognising symptoms early and what to do if their condition deteriorates.
Asthma action plan
We frequently talk to parents who aren’t sure when they should seek medical attention for their child, and as a result have delayed going to the doctor when their child has symptoms. An asthma action plan can really help with this. Make sure every child has an asthma action plan setting out vital information including which medicines to take when, and what to do if a child’s condition deteriorates. As children often come under the care of multiple people – parents, schools, grandparents, babysitters – it’s good to underline the importance of all the people responsible for the child’s wellbeing having a copy of their plan.
Check inhaler technique
The new NICE/BTS/SIGN asthma guidelines emphasise the importance of checking inhaler technique at any contact with a patient about their asthma. This is absolutely vital, and even more so as children get a bit older. Teenagers especially can have a tendency to get lax about inhalers, so reinforcing and checking at every opportunity could be a lifesaver.
Post exacerbation review
One asthma attack is a risk factor for another, possibly a more serious one, and we often get calls from parents worried about what to do after their child has had an asthma attack. Ensure parents or carers know that their child should have a follow-up with the GP in 48 hours of a hospital visit for an asthma attack or the same day if they managed their symptoms without a clinical assessment. They will also need a review soon after with the GP or asthma nurse to check symptom control, medication adherence and inhaler technique, update the asthma action plan, provide education to support self-management and help prevent future flare-ups.
Reliever inhaler overuse
Using two or more SABA inhalers per year is a key indicator of poorly controlled asthma. This can be difficult to spot with children, as they may have extra inhalers prescribed to keep as spares at school, or with other carers. It is really important for healthcare professionals to get down to the nitty gritty with a child and their parents or carers when it comes to SABA, to ascertain how often they are using it and if there is cause for concern.
Living conditions
When we’re talking to parents on our helpline who are concerned about their children’s asthma, talking about potential triggers for their asthma can be a way to gauge a bit more about their living situation and point them in direction of places they may be able to get help. Checking whether there is damp in the home, if it’s warm enough, if the child is exposed to cigarette smoke – all things that are more likely to be issues for children living in more deprived communities. While some of these things may be impossible to fix instantly, you can point people in the direction of organisations that might be able help, such as Shelter or Citizens Advice, while Asthma + Lung UK’s health advisers can help people understand what benefits they might be entitled to.
Holly-Louise Catlin is respiratory specialist nurse at the Asthma + Lung UK helpline
Asthma + Lung UK’s helpline team of respiratory nurses and health care advisors offer independent, confidential advice and support on lung health, and on financial issues including benefit advice. Contact them on 0300 222 5800 or by emailing [email protected]
