We were interested in the review by Reading and colleagues.¹ In Wolverhampton we are fortunate in having had a schools asthma policy in place since 1994 which includes supplying emergency inhalers to schools for use when the pupil’s own inhaler is not available.

The policy was initiated by two hospital paediatricians with an interest in asthma and was quickly incorporated into the local Respiratory Care Group. The involvement of enthusiastic school nurses with a special interest and training in asthma and the support of the community paediatricians have been invaluable.

Initially, an approach was made to the Director of Education who was of the view that giving inhaled treatment to known asthmatics could be considered to fall within the school staff acting in loco parentis. Every state school in the borough was offered a visit from a hospital paediatrician and a children’s asthma nurse to present the theory and practise of using emergency asthma inhalers. Every school was supplied with a short acting β agonist (pMDI plus spacer), a protocol including dosage, and authorisation signed by a hospital paediatrician, community paediatrician, and the lead school nurse for asthma. An annual update is given to the school nurses and they (or the lead school nurse) in turn annually train or retrain the school staff as required.

Pupils with asthma are identified by the school nurse and each child given an individual asthma card with their emergency treatment detailed. Written consent for a named pupil to be given the emergency inhaler is obtained from the parent and authorised by a paediatrician. This is in effect the prescription. These individual, but standard, health care plans for children with asthma are not “a logistic nightmare” but straightforward to administer and conform to the joint health and education guidelines for supporting pupils with medical needs in school.²

A school nurse led audit in 2003 confirmed that all schools held a register of use, with a named person from the school staff being designated by the head teacher.

Although our policy may not comply strictly with the letter of the law, there is clear clinical responsibility and we ensure that all children with asthma have ready access to emergency treatment in school.