Abstract

The UK has one of the highest prevalence, emergency admission and death rates for childhood asthma in Europe. Two thirds of school aged asthmatics will have an asthma attack in school.
NRAD highlighted that in children, poor perception of risk of adverse outcome was an important avoidable factor in 70% of the deaths looked at, as well as poor prescribing practice, lack of a structured asthma review with a specialist and a lack of a PAAP. Recent reports and audits support this.
If we don’t change, we cannot expect different results.
Plan
Target primary school pupils with an asthma diagnosis or blue inhaler.
Encourage patient participation by conducting the reviews in a child-friendly environment (their primary school) with read/write access to the surgery PMR.
Expand pilot from one to all 52 primary schools in Pembrokeshire.
Aims
Address NRAD recommendations.
Educate and empower pupils, parents and teachers to enable them to self-manage their condition.
Improve quantitative and qualitative measures.
Every school to have an emergency reliever.
Outline
Group education sessions with staff and parents of target group.
• diagnosis,
• pathophysiology,
• good control,
• action and use of medication,
• adherence,
• inhaler technique,
• recognising and safely managing worsening symptoms

One-to-one review (parents present)
• diagnosis explanation
• condition assessment (C-ACT)
• treatment optimisation
• education
o condition
o medication
o inhaler technique
o self-management.
• Plan going forward.

Findings
Pupils and parents unclear about diagnosis.
Understanding of condition and medication was poor.
Few had an asthma action plan.
Outcomes
• improved quantitative outcomes
o 60% reported a clinically important difference in C-ACT
o Adherence & inhaler technique
o 100% PAAP digital/written issued
• improved qualitative outcomes (from feedback forms)
• emergency reliever policy written
Conclusion
Changing the setting and structure of the review has led to improved outcomes.