North London Partners in health and care

Supporting families of children living with asthma through the lockdown

Caroline Byrne
Enfield Paediatric Asthma Nurse

Covid 19 has affected all of us in so many ways. As an asthma nurse, I was initially worried about the effects of Covid 19 as its impact on the respiratory system. My role involved asthma consultations at a GP surgery three days a week but unfortunately, I have had a high ‘Did Not Attend’ (DNA) rate due to families not wanting to take their children out of school for appointments. Families found it hard to attend afterschool appointments due to work, after school activities and traffic depending where they were coming from.

When lockdown was put in place, I had a lot of phone calls from anxious parents worried about their child and how it will affect their asthma.

I ensured I spoke to families via phone who were on high dose steroids and referred to asthma UK and government guidelines for update information to support these families. Due to lockdown, I was able to speak to many families and spend quality time discussing their child’s asthma. As they were speaking from home, it was easier for families to check medication they had and speak to other members of the family to educate asthma and answer questions and worries.

Asthma A&E attendances reduced significantly. This was positive feedback. With the families who had previously DNA’d (did not attend) my clinics, I was able to contact them and complete my phone consultation over the phone. Families had time to talk and if they were not available at that time, it was easy to rearrange and I encouraged the parents to involve all family members for family education.

Home visits definitely were the way forward for me during lockdown. Families were happy for me to visit and I ensured the family I would be visiting with PPE protection to complete asthma education and home assessments.

An example of a successful home visit:

  • Patient 10years of age
  • Diagnoses with Asthma age 6
  • Four members of family have asthma
  • Numerous attendances to A&E and GP with asthma symptoms
  • Child and family members have house dust mite allergy and hayfever
  • Initial assessment: Carpet throughout the home, child’s bed very close to the ground, lots of pillows and teddy’s on bed. Mum reports child coughs most nights. Mum brought a box of all different inhalers that the family use. When I ask the child which one he uses, he picked an inhaler by colour and easiest to reach regardless if it was meant for him or another family member with asthma. He then takes one puff with NO spacer and incorrect inhaler technique
  • Asthma education given, support given to mum with organising medications for each family member and correct family member. House dust mite education given. Six weeks later home review, all changes made by mum, child has stopped coughing and all family members who have asthma have seen an improvement in their asthma

Home visits are the key to review their home environments and triggers. Medication can be reviewed and educating other family members that are present.

I have completed two asthma education teaching sessions via Microsoft Teams to GP’S and practices nurses. This was a great opportunity to teach a large number of health care professionals.

Previously, it had been difficult to find a suitable day to teach GP practices and time consuming. Now I have completed training to over 50 health care professionals with these two session.

I have been involved with supporting school nurses with asthma education to schools. We are introducing the asthma toolkit and to for schools to start implementing some of the templates in order to achieve the healthy London asthma standards.

Overall, I have found over lockdown, I have educated and supported more children and families with asthma and have built a good relationship with these families reassuring them during this difficult and unknown.