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10 top tips on managing asthma through the September peak

Lots of us are looking forward (or not!) to the long summer holiday when the schools are shut and the general pace of life slows down. The next couple of months is also a good time to prepare patients for the asthma peak in September. This article looks at training children in regular asthma management and 10 top tips to getting started.

Asthma is the most common chronic childhood illness, with 10.5 million school days missed each year in the US alone. According to Asthma & Allergy Network, 25% of all asthma-related hospitalisations in children occur in September.1 Exacerbations spike almost as soon as the month begins and don’t reduce until the middle of October.

What causes it?

The return to school exposes children to multiple allergens, from indoor mold and pet hair to pollutants from the school bus. Group are mixing in large numbers again, circulating colds and flu. The anxiety and stress of the new school year can also provoke symptoms. The summer holidays are traditionally a time when medication is neglected but if children don’t keep up their treatment, they’re more at risk from these sudden triggers in September.

What’s the advice?

To make sure patients are prepared, it might be timely to send a reminder to encourage them to take their medication as prescribed and avoid triggers through the holiday season. Asthma & Allergy Network offers 10 tips to help encourage patients and families to reduce the risk:

  1. Schedule an asthma check-up before the school year begins.
  2. Ensure medications are topped up.
  3. Long-acting medications should be taken as prescribed.
  4. Medications should be carried or kept at school, particularly quick-relief inhalers.
  5. Use a peak flow meter for advance warning of any lung problems.
  6. Promote frequent hand-washing – even young patients can do this so encourage communication with them to help them learn to manage their condition.
  7. Identify and avoid environmental triggers. If pollen is a problem, perhaps teachers could be advised, so the child stays inside at peak times.
  8. Use flu vaccinations where possible.
  9. Develop an asthma action plan and share it with the school.
  10. Maintain good asthma control throughout the year, even when symptoms seem well controlled.

“Keep an inhaler next to your toothbrush!”

Routine is key. “Keep an inhaler next to your toothbrush!” one expert said. It’s about managing asthma for the long term and teaching children a good every-day routine to help them gain – and maintain – control over their condition.1

The main goal is to keep airway inflammation down to reduce the risk of exacerbations. Infections such as colds and flu, and other common triggers in the September peak, can all contribute to asthma flare-ups. Scheduling a check-up and checking a patient’s level of inflammation is simple but could make all the difference.

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Clinicians can assess airway inflammation using fractional exhaled nitric oxide (FeNO) testing. A FeNO value of >35 ppb in a child shows that airway inflammation is likely.2 Using FeNO-guided asthma management to optimise therapy and adherence has been shown to reduce exacerbations by up to 50%.3 FeNO testing can be performed easily at the point-of-care in patients from the age of seven with a hand-held device like the NIOX VERO®. Results are available in less than two minutes, so clinicians can take immediate action.

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2. Dweik RA et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FeNO) for clinical applications. Am J Respir Crit Care Med. 2011;184(5):602-15.
3. Petsky HL et al. Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): a systematic review and meta-analysis. Thorax. 2018;73(12):1110-9.