1. The Potential Severity of Asthma.
Asthma is a common condition, but its severity varies considerably and the occurrence of the condition can be episodic. This means that children can be well for long periods of time and then have sudden acute and potentially fatal relapses.
The major principle underlying the policy is immediate access for all children to reliever medication (see Section 3 which explains the difference between reliever and preventer inhalers).
Coaches, managers, helpers and parents who supervise and care for children with asthma are therefore asked to make themselves familiar with this policy.
2. Asthma Symptoms
Asthma is caused by a reversible narrowing of the airways to the lungs. It restricts the passage of air both in and out as you breath. The symptoms of asthma occur when the muscles around the airways tighten and the lining of the airway becomes inflamed and start to swell; this leads to a narrowing of the airways. The usual symptoms of asthma are:
- Shortness of breath
- Tightness in the chest
- Being unusually quiet
- Difficulty speaking in full sentences
- Sometimes younger children will express the feeling of tightness in the chest as a tummy ache.
The symptoms however are rapidly reversible with appropriate medication.
3. Types of Treatment
3.1 There are two types of treatment for asthma:
The reliever inhaler is commonly blue, but may come in different colours, shapes and sizes. It is the parents’ responsibility to provide the correct reliever inhaler. These treatments give immediate relief and are called bronchodilators because they cause the narrowed air passages to open up by relaxing the airway muscle. They do not however reduce the inflammation.
Preventers are a group of treatment that are designed to prevent the narrowing and inflammation of the airway passages and are often brown in colour. The ultimate objective is to reduce asthma attacks of any kind. These medicines should be taken regularly in the morning and evening, which can be done before and after football sessions. There is therefore no need for them to be brought to training sessions or matches as even if they are taken during an attack, they will not have an immediate effect. Preventer treatments are therefore solely the responsibility of parents or carer of the child.
THEREFORE THIS POLICY REFERS ONLY TO RELIEVERS.
3.2 The best way for people to take their asthma medication is to inhale them directly into the lungs. There are a variety of devices available and the asthma medication needs to be breathed in steadily and deeply.
3.3 Some younger children use a spacer device to deliver their aerosol inhaler, this maybe a volumatic or aerochamber. The aerosol is pressed into the spacer and the child breaths slowly and steadily for approximately 10 seconds. If the child is using an aerochamber and it whistles they are inhaling too quickly. Spacers are very useful for those who have difficulty co-ordinating their breathing and inhaler. The spacer device is also very useful in the case of an acute asthmatic attack. (‘see section 8 on managing an acute asthmatic attack’). Irrespective of the type of device, the medicine being delivered is a reliever.
4 The Physical Environment
Many environmental aspects can have a profound effect on a child’s symptoms at anytime. In relation to the football club the three main irritants may be:
a) Grass Pollen
Grass pollens are common triggers in provoking an exacerbation of asthma. Coaches should be mindful of the effect grass cutting may impact on children’s health as children may require extra vigilance.
Children with asthma should be encouraged to participate in football but players should be discouraged from playing or training where they are visibly suffering from asthma prior to starting sessions. Outdoor training in cold weather will only serve to exacerbate the condition and players should be advised not to train. Children with known exercise induced asthma will need to take their reliever immediately prior to exercise.
c) Change of weather/temperature
Changes of weather conditions can also trigger asthmatic episodes and coaches should be aware of this.
5. Access to Reliever Medication
1. Asthmatic children must have immediate access to reliever inhalers at all times and therefore every asthmatic child should always carry their own inhaler.
2. Children aged 11 years and above should all carry their own devices and self-administer their reliever medication except in cases of serious attacks (see Section 8) where players may need help from a supervising adult. Inhalers should be stored in a waterproof container where they are can be easily and quickly accessed. Inhalers themselves and the containers they are stored in both need to be labelled with the player’s name.
3. Parents must carry inhalers for younger children (aged 10 years and below). Where parents leave children solely in the care of coaches and other adults, inhaler and spacer devices must be left with the supervising adult and again should have the child’s name clearly marked on them and also on the waterproof container they are stored in. Parents are responsible for ensuring medication is ‘fit for purpose’ and in date.
4. In an event of an uncertainty about a child’s symptoms being due to asthma, TREAT AS FOR ASTHMA. This will not cause harm even if the final diagnosis turns out to be different.
6. Access to Reliever Medication Owned by Other People.
1. Where coaches/managers are aware of a player who has asthma, written consent should be sought from parents/carers to use other people’s preventer inhalers to treat their child in emergency situations. Parents/carers must also agree for their own child’s preventer inhaler to be used by other people. Again this only applies to emergency situations. This form is attached at the end of the document. The Club Welfare Officer should keep a copy of written authorisation. Coaches/Managers are responsible for gaining this authorisation from parents and carers.
2. Where inhalers have been used for other players in emergency situations the actual owner of the inhaler (or the parent of that child) needs to be notified. Manager/coaches should record incidents where children have recieved treatment from inhalers belonging to other people as this should not be happening frequently and is intended only for emergency situations. If a child’s inhaler is persistently absent and the child is a known asthmatic then the Club Welfare Officer needs to be informed. Inhalers should not be shared in non-emergencies.
7. WHAT TO DO IF A CHILD HAS AN ASTHMA ATTACK
If an asthmatic child in your care becomes breathless or wheezy or starts to cough:
1. Keep calm, it’s treatable. If the treatment is given at an early stage the symptoms can be completely and immediately reversible.
2. Let the child sit in a position they find most comfortable. Many children find it most comfortable to sit forwards.
3. Ensure the child has 2 puffs of their usual reliever.
4. STAY WITH THE CHILD. The reliever should work in 5 – 10 minutes
5. If symptoms have improved but not disappeared then give 1 puff of the reliever inhaler every minute for 5 minutes. Stay with the child.
6. Where inhalers have been administered and the parent is absent then a call home should be made to inform parents. Children should not continue to play football. Children should be closely monitored until they are returned to the care of parents/carers.
IF THE CHILD HAS WORSENED SEE SECTION 8.
8. MANAGEMENT OF A SEVERE ASTHMA ATTACK
HOW TO RECOGNISE A SEVERE ATTACK
-The reliever has no effect
after 5-10 minutes
-The child is either distressed or unable to talk
-The child is getting exhausted
-You have any doubts about the child’s condition
STAY WITH THE CHILD
1) Call 999 or send someone else to call 999 immediately – Inform them the child is having a SEVERE ASTHMA ATTACK AND REQUIRES IMMEDIATE ATTENTION.
2) Using the child’s reliever and spacer device give one puff into the spacer. Allow the child to breathe the medicine from the spacer. If the spacer device is an aeorochamber and it whistles ask the child to breath more slowly and gently. After one minute give another puff and allow the child to breathe the medicine. Repeat at not more than one minute intervals until the ambulance arrives.
3) Contact the parents and inform them what has happened.
9. RECORDING INCIDENTS
In line with the first aid policy coaches/managers are responsible for logging incidents where players have recieved preventer treatment.