Opinion  

Carol White is an asthma nurse specialist at Asthma UK. She has been a nurse since 1983 and joined Asthma UK in 2004. Between 1993 and 2003 Ms White was a research nurse at the National Heart and Lung Institute where she worked on a longitudinal study of childhood asthma involved over 600 children and their families. She has diplomas in both asthma and COPD.

The UK has one of the highest rates of asthma of any country in the world, with around 5.2 million people receiving treatment for the condition.

While revised BTS/SIGN asthma guidelines 'emphasise that people with asthma should be offered education that should focus on individual needs and be reinforced by written action plans', this does not seem to be the case. A study conducted for Asthma UK in February 2004 found that only
3 per cent of people with asthma use a written action plan.

The issue of childhood asthma

In 2004 the Asthma UK Adviceline dealt with over 12,000 enquires. Around 19 per cent of these were from parents of children under the age of 16. The highest proportion was from parents of children aged between two and five.

Reports in the media about a child's death from asthma or concerns about treatment provoke an increase in calls from anxious parents. Calls vary, from one extreme of a child apparently receiving inappropriately high levels of inhaled steroids without add-on therapies being considered, to a child receiving no treatment for asthma despite being admitted to hospital for emergency treatment following an asthma attack three times in 12 months.

Although we are only hearing one side of the story, it is difficult to rationalise when a healthcare professional elects to ignore recommendations for best practice. Asthma UK's asthma panel results in 2002 showed that two-thirds of children were failing to meet the international targets for asthma care.

Many parents contact the Adviceline because they have difficulty in accepting that their child has asthma and that it cannot be cured. We are frequently a last resort as they have tried all other avenues and feel that healthcare professionals do not take their concerns seriously.

Parents with a history of asthma or allergic conditions often blame themselves for their child's condition. They are frightened because often their first experience of asthma is when their child has been admitted to hospital requiring emergency treatment.

Some parents report that they have been given conflicting advice from healthcare professionals. This means they can feel that they are in an impossible position. There have also been reports that parents have not been offered written information to help them manage their child's asthma.

The main reason for these enquiries is lack of knowledge about asthma. Parents may have difficulty understanding that asthma is a variable condition and at times it is well controlled and at other times it needs more attention. Often parents are unable to recognise when their child is having an asthma attack be it mild or severe. Many parents have concerns about giving their children steroid medications and this can lead to compliance issues.

Working in partnership with parents

Healthcare professionals need to work in partnership with parents to achieve the best outcomes for the children. They need to provide up-to-date information about the condition at point of diagnosis. Parents need to be given reassurances that medications are safe, particularly that inhaled steroids given at low doses cause no long-term side-effects.

During this period the child will need regular reviews to monitor their condition, check inhaler technique and evaluate response to treatment. This is an opportunity to reassure the parents and give them the chance to discuss any concerns. At this point the healthcare professional can begin to formalise a personalised action plan. This will contain information about adjusting medications according to symptoms, enabling parents to manage their child's asthma.

Children with asthma have a potentially life-long condition, which at times will need intervention. As healthcare professionals we need to protect their airways against future remodelling and irreversible obstruction.

This is achievable by taking on board recommendations for best care and incorporating them into practice to achieve the best outcomes.