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Back-to-School Asthma Worse Among Deprived Children

Children in the most deprived groups have a nearly four-fold increased risk of being hospitalised with an asthma attack when they go back to school next month, almost double the likely increase among children from the least deprived areas, a charity warned. 

Every year there is an upsurge in asthma attacks as children return to school, but an analysis by Asthma + Lung UK showed "a huge 320% increase" among children and teenagers from the most deprived parts of England, whereas the increase among those from the least deprived parts of the country was almost half that number, at 170%.

The figures were based on "bespoke data supplied by NHS Digital" for the most recent NHS hospital admissions figures among 5- to 19-year-olds in England for September 2021 compared with August 2021. Overall there was a 308% increase in emergency asthma admissions in this age group, from 447 in August 2021 to 1822 in September 2021. 

Four-fold Discrepancy in Hospital Admissions by Deprivation Index

When the numbers were broken down according to the Index of Multiple Deprivation, admissions for the most deprived decile leapt from 87 in August 2021 to 368 in September 2021, an increase of 323%. In contrast, the increase for the least deprived decile was from 31 to 84 (171%). Thus by the September there were more than four times the number of childhood asthma admissions for the most deprived compared with the least deprived decile (368 versus 84) – which the charity described as a "huge disparity". 

It added: "Alarmingly, the figures also showed that 5- to 19-year-olds from the most deprived areas accounted for a fifth of all emergency childhood asthma admissions."

Emma Rubach, head of health advice at Asthma + Lung said: "We already know that when children go back to school after the summer holidays, we often see a spike in the number of asthma attacks, which leads to more hospital admissions."

Postulated reasons for the annual school-related surge include:

  • Exposure to more cold and other viruses 
  • Increased exposure to dust mites due to more time indoors
  • Seasonal allergies, including mould in autumn and pollen in spring and summer
  • Exposure to cleaning products used when schools are deep cleaned over the summer 
  • Heightened emotions like fear, stress, or excitement at the start of a new term
  • Increased physical activity and exercise at school for some children
  • Disruption of preventer inhaler routines
  • Transitioning from primary to secondary school, which may involve a different journey; a new, larger school, and more moving between classrooms
  • Exposure to new triggers, for example in new subjects such as chemistry

"Worrying" Disparities

However, Ms Rubach said, "this data also shows a huge disparity between the number of children and teenagers admitted to hospital after having an asthma attack from areas where there are higher levels of deprivation, compared with areas of lower deprivation". This was "very worrying", she said. 

Reasons could include that deprived children live in poorer quality housing, with more issues like damp and mould that can trigger asthma attacks, higher air pollution levels in more deprived areas, or even higher levels of stress, she said. The charity added that other reasons could include "not being able to afford the travel costs needed to attend medical appointments". 

The charity noted that the cost-of-living crisis has put a huge strain on low-income families already struggling to pay for heating and other essentials in winter, and "the health of their children could be suffering as a result".

It called on the Government as part of its upcoming Major Conditions Strategy urgently to put in place policies to improve respiratory care, and to provide "tailored financial support" for people on low incomes with lung conditions. 

Most Asthma Admissions and Deaths "Preventable"

According to NHS England, asthma is the most common long-term medical condition in children and young people in the UK, with around one in 11 affected and 1.1 million children on asthma treatment. Asthma is consistently among the top 10 causes of emergency hospital admission for children and young people, and the UK has one of the highest prevalence, emergency admission, and death rates for childhood asthma in Europe – most of the latter, according to the Royal College of Paediatrics and Child Health, being " largely preventable".

With children across most parts of England due to return to school in just over a week, Asthma + Lung urged parents to be on their guard and to look out for signs that their child's asthma may be worsening, such as wheezing, coughing, chest tightness, or breathlessness. Parents were advised to make an urgent appointment with their GP or asthma nurse if they had any concerns.

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