Asthma is one of the most common long-term conditions affecting children, and an asthma attack can happen at any time — including in the classroom, playground, during PE or on a school trip.
For first aid instructors, teaching asthma management is about much more than demonstrating how to use an inhaler. School staff need to understand what an asthma attack can look like, what action to take, and when an inhaler is not enough.
Recognising an asthma attack
Children don’t always present with the classic symptoms we might expect. Staff may notice:
- Coughing, particularly persistent coughing
- Wheezing
- Shortness of breath
- Rapid or difficult breathing
- Chest tightness
- Difficulty speaking normally
- Increasing tiredness or distress
A key message for learners is don’t rely on wheezing being the only symptom to indicate an Asthma attack. Instructors should encourage school staff to look at the whole picture.
Paediatric and child assessment tools, such as the Breathing, Behaviour, Body Colour (BBB tool), introduced as part of the 2025 Resuscitation Guidelines, can help with early assessment in these situations.
The child’s own inhaler comes first
Children with asthma should normally have access to their prescribed reliever inhaler when they need it. Schools should have arrangements in place so that inhalers are readily accessible and not locked away where they cannot be reached quickly.
This is particularly important during:
- PE and sports
- School trips
- Outdoor activities
- Break and lunchtime
- After-school activities
A child’s inhaler being safely stored is only useful if staff can get to it quickly when it is needed!
When delivering training, encourage learners to consider the practical question:
“If this child had an asthma attack right now, where is their inhaler?”
Knowing the answer before an emergency occurs can save valuable time.
What about the school’s emergency inhaler?
Schools in England can choose to keep an emergency salbutamol inhaler and spacer for use when a child’s own prescribed reliever inhaler is unavailable, for example because it is lost, empty or broken. Written parental consent is required for its use under the relevant school arrangements. The circumstances in which it can be used should be covered by the school’s policy and the child’s healthcare arrangements.
This is an important distinction for instructors:
An emergency inhaler isn’t simply a spare inhaler that anyone with breathing difficulties can use.
Unlike the new regulations being introduced as part of Benedict’s Law, covering spare emergency adrenaline devices (Epipen or similar), a different legal situation exists for spare asthma inhalers.
Spare salbutamol inhalers can only be used on a child who has been prescribed a salbutamol inhaler which is either empty, lost or broken. Written consent for use of a spare device must be held by the school.
Schools that keep an emergency inhaler should have arrangements covering its storage, maintenance, expiry checks, staff training, consent and recording of use.
This is an excellent opportunity for instructors to remind learners that their school’s policy and the child’s individual healthcare arrangements are an important part of the emergency response.
Don’t forget the spacer
For children using a pressurised metered-dose inhaler, a spacer can make it easier to deliver the medication effectively.
Instructors should ensure learners understand that inhaler devices vary, and they should follow the instructions for the particular device being used.
Rather than simply demonstrating the technique, ask learners to think about the practical challenges they might encounter:
Can the child use the device confidently? Do they have access to a spacer? Does the school know where these are kept?
When an inhaler not enough?
Perhaps the most important message for school staff is knowing when to escalate.
If a child’s breathing is severely affected, symptoms are worsening, the reliever isn’t helping, or the child is becoming exhausted, staff should follow the school’s emergency procedure and seek urgent medical assistance.
Repeated use of an inhaler should never delay calling 999 when emergency medical help is required. Do not simply wait for the medication to work if the symptoms persist or the child deteriorates.
Further Guidance
The above guidance is taken from Department for Health document entitled ‘Guidance on the use of emergency salbutamol inhalers in schools’ March 2015. You can view the full document here.