Inhaler Technique School Service Development Project


Greater Manchester Children and Young Person’s Inhaler Technique School Service Development Project

Summary:

GMLPC in collaboration with NHS England (Greater Manchester and Lancashire), is piloting the above service in schools in the GM area. The project is planned to run separately but concurrently in ten primary and ten secondary schools selected across GM to support a group of children and young people (CYP) prescribed inhalers for asthma, and their parents/carers. It is also an opportunity for school staff to find out more about inhaler use and asthma warning signs. Two workshops, 6-8 weeks apart, will be offered in each school for each group of Years 4-5 (primary) or Years 9-10 (secondary) pupils. Good inhaler technique should contribute to CYP obtaining more benefit from their inhaler(s) and subsequently demonstrating measurable improvement in asthma control and health outcomes/quality of life over that period.

Why do we need such a Service?

The following data from Asthma UK and other authors put the current situation into perspective:

* One in 11 children in the UK has asthma, and it is the most common long-term medical condition among children as a group;

* On average, there are 2 children with asthma in every classroom in the UK;

* 62% of CYP with asthma have had an asthma attack while at school;

* The UK has one of the highest prevalence rates of asthma symptoms in children worldwide, with Greater Manchester having the highest prevalence in the UK;

* In 2011 there were 18 deaths from asthma in CYP aged 14 and under in the UK;

* In 2011-12, 69 children in the UK were admitted to hospital as emergency asthma cases each day;

* In Greater Manchester, the highest rate of admissions per 100,000 children aged less than 16 varied from 287.7 (Wigan) to 507.4 (Manchester and Bury);

* Across all ages, an estimated 75% of hospital admissions for asthma are avoidable, and as many as 90% of the deaths from asthma are preventable.

The majority of adult patients demonstrate a poor inhaler technique, resulting in poor health outcomes and quality of life. During previous work we did in GM, most adult patients said they did not remember being shown how to use their inhalers. If CYP are not shown, and do not use their inhalers correctly, they gain little benefit from the treatment and this does not encourage adherence. Consequently, bad habits formed early in life continue into adulthood, leading to worse quality of life.

Parents (and carers/guardians) are partners in care. Their knowledge is important in the promotion of good outcomes through their involvement in when and how the inhaler device is used, hence the need to involve them in the training sessions.

With recent changes to Medicines Regulations and school medicines policies to enable salbutamol inhalers to be held as stock in schools for emergency use, the efficacy of this potentially life-saving medicine will be reduced if staff and pupils do not know the correct technique.

Interventions with children regarding inhaler technique have been shown to lead to a better chance of correct inhaler use, where: there are repeated instruction sessions, they are given the opportunity to demonstrate their inhaler use, and ask their own questions about their medication.

CYP may not attend routine review appointments in health care settings; by giving support in the familiar school environment we may encourage more CYP and families to engage, and then to seek out help when they need it.

Aim of the Service

To show a measurable improvement in the inhaler technique, adherence, and associated health outcomes, of CYP with asthma in primary and secondary school settings.

Objectives

* To assess, and if necessary improve, inhaler technique for each CYP during one school-based pharmacist-led workshop and one follow-up workshop

* To show a reduction at 8-week follow-up in asthma-related self- and/or parent-reported: Number of school days lost; A&E attendances; Emergency hospital admissions; GP / OOH appointments

* To assess, and improve if necessary, asthma control

* To show an improvement in quality of life at follow up – in terms of symptoms control, activity limitation and emotional function

* To assess, and increase if necessary, the self- and/or parent-reported adherence of CYP to their asthma therapy

* To increase the confidence of CYP, parents and teachers in the use of inhalers

If you are aware of any schools that may be interested in the programme please contact enquiries @gmlpc.org.uk with details