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Dudley schools asthma policy

(Please print on schools headed paper)

Dear Parent/Guardian
I am pleased to advise you that this school takes its responsibility to pupils
with asthma very seriously, and would like to be regarded as an ‘asthma
friendly’ school. By working in close collaboration with local Specialist
Paediatric Consultants, the School Health Service, Children’s Services and
Asthma UK we have recently joined with many other schools and signed up to
a Dudley wide School Asthma Policy.
As part of the School Asthma Policy we need to compile a register of pupils
with asthma and also of pupils who may be experiencing ‘asthma type’
symptoms. In order to help us with this would you please complete the
enclosed questionnaire and return it to school as soon as possible.
The School Health Advisor may contact you again to request further detailed
asthma information, which will be recorded on the asthma record form. The
availability of this information is extremely important as it will enable school
staff to offer the safest and best possible care to pupils with asthma at all
Thank you for your co-operation in this important matter.
Yours sincerely

(Please print pages 2 & 3 for Questionnaire and copy back to back
Dudley Schools Asthma Policy
Asthma Questionnaire
Child’s Name__________________________________________________
Contact telephone/mobile no .
School and Class_______________________________________________
Date of Birth_____________________Doctor (GP)___________________
Hospital Consultant _____________________________

Question 1

Question 2

Question 3

Has your child been diagnosed with asthma? Question 4

If your child is known to have asthma has the school been informed? Question 5

Does your child take any medication? Please specify ________________________________
Question 6
Does your child need help to use their inhaler? Question 7

How often does your child experience symptoms i.e.
cough/wheeze (please tick one box only)

Question 8

Does your child ever miss PE/Games at school because of
How often? Please specify _______________________________________
Question 9

How many times in the last 12 months has your child :
(Please specify number of times in the boxes)

a) Been admitted to hospital because of asthma b) Seen a General Practitioner for an asthma attack/episode d) Visited the Hospital Out-Patient Clinic
Any other comments
(please answer in the box below)


Dear Parent/Guardian
Thank you for returning the completed asthma questionnaire, your
son’s/daughter’s name will now be placed on the School Asthma Register
which will be filed safely at school. The register will ensure that school is
aware of all pupils with asthma.
As part of the School Asthma Policy and accepted good practice, we are now
asking parents of all pupils with asthma to complete an Asthma Record Form,
which is enclosed with this letter. You may need to ask your doctor/practice
nurse to help you complete it; please return it to school as soon as possible.
Please ensure that your son/daughter has a reliever (blue) inhaler available in
school at all times. The inhaler should be clearly labelled with their name; you
will also need to keep a record of its expiry date so that a new one can be
ordered from your doctor. It is very important that you inform school if asthma
treatment is changed so that you can update the information on their form.
The completed form will enable school staff to have immediate access to
important information should your son/daughter need assistance with their
asthma or in the event of an emergency.
Thanking you again for your co-operation.
Yours sincerely
Asthma Nurse Specialist for Children and Young People
On Behalf of the Asthma Policy Co-ordinators

(Please print off pages 5 and 6 and copy back to back)
PUPIL’S NAME: D.O.B NAME OF SCHOOL: ADDRESS: TELEPHONE NO: (HOME) (WORK) ( MOBILE) GENERAL PRACTITIONER: SURGERY: HOSPITAL CONSULTANT: HOSPITAL: SCHOOL HEALTH ADVISOR: HEALTH CENTRE: What makes your son’s/daughter’s asthma worse (triggers)? Does your son/daughter tell you when they need to use their inhaler? Does your son/daughter need to use their inhaler before exercise? Please specify dose and when to be taken:

For cough, wheeze, breathlessness or tightness of the chest your child will take the blue
reliever inhaler as per your instruction below. When your son/daughter feels better they can
return to normal activities.


Continue to give (blue) reliever inhaler one puff every minute
Inform Parents/Guardian
Call an ambulance if symptoms do not improve after 5-10 minutes

Parents/Guardians consent for use of emergency inhaler YES / NO

School has a reliever (blue) inhaler and spacer device available to use in
the event of an emergency. This medication is called Salbutamol
(Ventolin) and has been issued by the Primary Care Trust under the
guidance of Dr Z Ibrahim – Consultant Community Paediatrician.
This inhaler will only be used if your son’s/daughter’s own medication is
not available and you cannot be contacted in the event of an asthma
Please sign below if you consent to the use of this device.
Signature …………………………………………………………………………….

First Name
School ……………………………………………………………………………….
School Health Advisor…………………………………………………………….

Child’s Name
Reason for Use
Staff Signature
(Please use these slips to inform parents that children have needed to use their inhalers at
school – not routinely pre exercise)

Asthma Medication Issue
This note is to advise you that : _____________________________________________________Year_____ (Name of Child) Needed to use _________________________________________________ (Name of medication and quantity) Signed______________________________________________________(member of staff) Date_______________________________________Time_______________ DUDLEY SCHOOLS ASTHMA POLICY
Asthma Medication Issue
This note is to advise you that: ______________________________________________________Year____ (Name of child) Needed to use ___________________________________________ (Name of medication and quantity) Signed ____________________________________________(member of staff) Date______________________________________Time________________ DUDLEY SCHOOLS ASTHMA POLICY
Asthma Medication Issue
This note is to advise you that : ______________________________________________________Year____ (Name of child) Needed to use ___________________________________________ (Name of medication and quantity) Signed ________________________________________(member of staff) Date_______________________________________Time_______________

Source: http://www.foxyards.dudley.sch.uk/pdfs/polocies/DUDLEY%20SCHOOLS%20ASTHMA%20POLICY.pdf

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