Helping children to breathe easy

Medical matters:This week marks the beginning of the Rugby World Cup in France. The Irish team is an excellent one and, injuries and a difficult qualifying group permitting, looks set to have a good tournament.

Our first choice back line includes Peter Stringer, Ronan O'Gara and Dennis Hickie. As well as being top class sportsmen, all three have asthma. Not that you would ever suspect it watching O'Gara make a quick break before releasing Hickie for one of his trademark scorching runs to the try line.

All three players most probably developed asthma as children. I wonder how many kids starting primary and secondary school this week who have the common breathing condition aspire to sporting stardom?

The word asthma comes from the Greek aazein, meaning to breathe with an open mouth or to pant. It first appeared in Homer's Iliad and was used in a medical context by Hippocrates.

During the 19th century, asthma was rarely mentioned in medical publications, and it was the 1960s before airway inflammation was recognised as the underlying pathology. Typical symptoms include wheeze, cough and shortness of breath. But in milder cases, the disease can present subtly, with just a night-time cough or a slight wheeze when the person exercises.

Treatment involves, firstly, regulating the environment to reduce the presence of asthma triggers such as house dust mites, cigarette smoke and pet hair. Drug treatment is divided into two categories: preventer drugs designed to block airway inflammation before it occurs; and reliever drugs aimed at opening up the airways that have been narrowed by an attack. Inhaled drugs are the mainstay of asthma treatment and are delivered via plastic spacer devices in younger children.

The prevalence of asthma has increased in the past two decades; the rise has been especially marked in children. Latest figures suggest that 15 per cent of children aged 13-14 years in the Republic have asthma, while there are some 470,000 people with the chronic condition in the country.

Asthma is one of the main reasons for hospitalisation among children with a chronic illness and it is a leading cause of school absence. It may also restrict children's play activities and their participation in sports.

One of the big issues in children's asthma management is compliance with treatment. It is only natural for a child to forget to take preventer medication when they feel well and have no symptoms, forgetting that a major reason they remain well is because the preventer inhaler is doing a good job.

Research published this month in the medical journal Paediatrics found that parents' perceptions of treatment have a significant influence on whether children take their asthma medication as prescribed.

With just half of all prescribed preventive medication taken as directed, the study went some way to explain why this might be. It found that one in six parents was more concerned about the potential for asthma drugs to cause harm than they were convinced of their child's need for them. Parents were especially wary when the word steroid was used, in case the powerful drug caused long-term side effects.

If parents are the major influence on children's compliance with asthma medication, it stands to reason that teachers' attitudes to the condition will also play a role.

A study by the Asthma Society of Ireland found that 85 per cent of Irish schools have children with asthma on their books. But more than 80 per cent did not have specific guidelines on asthma management while eight out of 10 school staff said they would welcome more information to help them understand the condition.

Some 10 per cent of children experience asthma symptoms when they exercise. Teachers can encourage all but the most severely affected children to participate in PE classes. Some children will need a reminder to take a reliever about 10 minutes before starting exercise. And for those pupils inclined to use their asthma as an excuse not to participate, a reminder of their favourite athlete with asthma will help to nudge them in the right direction.

While it is the parents' responsibility to ensure that their child brings an inhaler to school, teachers must ensure the pupil has free access to their reliever medication. However, school staff have no legal or contractual duty to administer asthma drugs, although they may do so in an emergency.

The Asthma Society of Ireland (www.asthmasociety.ie) has published guidelines for school asthma management, including a recommendation that all pupils be taught about asthma. It contains practical information for both parents and teachers.

However, anecdotal evidence suggests that schools adopt an ad-hoc approach to common medical conditions such as asthma.

In addition, in-service training for teachers in the area is patchy. Is it time for the Departments of Health and Education to get together with the teaching unions and organisations such as the Asthma Society to agree a uniform approach to the management of chronic illness in our schools?

Dr Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets he is unable to reply to individual medical queries.