My 14-year-old son had a serious asthma attack post-exercise in school. Paramedics were called and he recovered after receiving nebulizer treatment. Now, he has been told he no longer will be allowed to have a seat in his rowing team, alternatively he is allowed to cox. He is devastated. I am trying to find out if any of you know of a similar situation, can schools just say no to intensive activity of asthmatic children? His GP has given a note saying he is fit to resume his activities.
He was diagnosed with asthma 10 years ago and had his first asthma attack in Nov 2020 following Covid infection. He is on Revlar preventer, Salbutamol, Dymista nasal spray for allergic rhinitis, Fexofenadine as antihistamine and montelukast at night. Thank you.
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UUrs
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I actually think this is an appalling decision from the school. Whilst it must have been worrying for the school staff to observe this I think they are showing no common sense.
From what you have written your son was ok after nebuliser treatment and didn’t need to go to hospital. I am not dismissing how serious it was to require nebulisers.
If gp has stated son is fit to row they have a MEDICAL professional stating opinion. Am assuming no one at the school is a doctor!
After the weekend I suggest you speak with an asthma nurse on this site. Armed with this information I would ask to have a meeting at the school to provide proper advice and opinion.
I know this will be putting an enormous strain on your son. But talk to him carefully about the situation. It’s important he stays as calm as possible otherwise stress could bring on an other attack. Also if unwell at school he must seek help. From his perspective he may feel a need to try to hide an attack which would damage his argument and potentially lead to an extremely serious asthma attack.
>>>From his perspective he may feel a need to try to hide an attack which would damage his argument and potentially lead to an extremely serious asthma attack.
That's an extreme reaction by the school and your son must be very disappointed at their decision, especially as they haven't even consulted with him, you or anyone involved in treating his asthma. Their aim should be to take reasonable adjustments in order for your son to continue, if he wishes to and assess the situation going forward. Knee jerk reactions are never helpful. Good job Steve Redgrave didn't attend the school as they may have said his diabetes was too much of a risk.
Not sure if this article helps, but British Rowing obviously see rowers who happen to have asthma as being able to take part in the sport with a safe and organised approach; plus.britishrowing.org/2022...
Your poor son, I think all is not lost with the right support.Well said Poobah, my first thought was Steve Redgrave my second my husband who rowed at Cambridge. I'm sure there's a British Olympic swimmer with asthma too (probably more).
My son was extremely sporty. At junior school after a sports teacher refused to allow him a puff of ventolin before the first cross country run of the season I made sure he had two spare ventolins at school, one in his sports bag and another in his classroom. I'd trained him to always have a puff before activities from 3 yrs to prevent an attack but he'd been forbidden to go to classroom, hence a 2nd surreptitious one in sports kit. The only time he'd had an attack at school. Cycling, rowing & swimming are excellent for lung stamina.
The helpline number is above, uk office hours. Also a WhatsApp number you can copy your post to. Good luck to your son.
Just remembered, a British Tour de France winner has asthma
>>> I'm sure there's a British Olympic swimmer with asthma too (probably more).
Peege, up to 50% of elite endurance athletes have asthma (depending on the type of sport -- more for those who train in the cold -- the cyclist fits the bill, those crazy mountain passes). Intense breathing at high ventilation rates dries out the airways and damages the epithelimum. In non-asthmatics, this damage can be repaired without causing inflammation and narrowing of airways. In asthmatics, it cannot, and it can be an aquired damage from high-intensity training. There are numerous well-cited scientific reviews on this. Here is one from 2012 I read yesterday (I can provide the PDF if you can't see it, message me privately)
Based on my experience, the school is unlikely to reverse their decision. The way it was explained to me (for my employer who prevented me from coming to work), it's their pivate property, and they can exclude anyone from coming. It's the top managment freaking out following the paramedic visit. I have gone through a union fight over a similar issue, with a lot of stress, with several formal committe hearings. Five people out of five on the committe of the top management during the hearing sided with the school. And yes, I did appeal, with the help of the teaching union.
1) Paramedics suggested that it may be best if we see a consultant in A&E and took us in the ambulance (without blue lights) and we sat in A&E for 4 hours and were discharged without any further intervention, even without prednisolone as his peak flow and spirometry readings were all normal.
2) We met asthma nurse two days later and again peak flow / spirometry was normal. GP issued the note saying he must remain active and continue all his activities.
3) Then came the email from the rowing team director saying no more seat for him on the boat, no more ergs and he can only do some coxing for rest of the summer. The incident happened on 13 May Monday, he was not allowed to go for national schools race on 24 May.
4) I met the director, tried my best to find a solution and he said they will reassess him in January next year and make a decision. I did not get the hint that he would never be allowed to row again. That message did not come across.
5) Next day, he was called into a room during lunch break and told it is highly unlikely he will ever hold the oar for the school or race in the school colours. Imagine the state of the 14-year old who gave his all on that erg machine two weeks ago to make it into the team to be told that! He held onto his despair until he saw me during the pick up and just cried his heart out. I can't think what was worse, seeing him crouched up wailing in pain on the library room floor unable to breathe or crying his heart out in the car hugging me like a baby.
6) I have spoke to British rowing, I have updated his respiratory team based in St Thomas Hospital London, have contacted few other rowing coaches and still wondering how best to address this. I am worried of further implications to his well being and what if he starts to hide his symptoms.
I am so disappointed that a first world country like ours where equal opportunities is fundamental to our rights, there is still so much stereotyping and discrimination.
Had he used salbutamol prior to exercising? If not,perhaps that's the key thing pecan do prior to pe,rowing,exercise and also always have it on him.school may reconsider with change of treatment x
Patk1, yes, you are absolutely right. He is supposed to use 2 puffs 10 minutes before the exercise. He remembers using only one puff. He is also supposed to always use the spacer. In this instance, there was no spacer. This has been updated in his asthma guidance. We have an upcoming appointment with his respiratory team. I will bring this up and make sure his technique is right.
Yes,teenagers! Yr perhaps going to have to remind him every day to use b4 exercise and to aLways have his inhaler in his pocket for emergencies.perhaps whn school see how more responsible he's treating asthma,theyll reconsider letting him join team
UUrs, if he is tall and has big lungs he may need even more puffs (of course, with the spacer). When I first got asthma 20 years ago, I used to think that it was not asthma, b.c 2 puffs were not doing anything to me. Took me a while to learn this.
Asthletes' lungs are often bigger than "normal' for their age, height, and weight (it's a self-selecting trait). I always was very good at running going back to middle school. It just felt effortless, and I never had to train to win local running races. Once I developed asthma, I learned that my lungs were 25% bigger than "normal" for my group, some genetic "defect". So I need more inhaler to saturate them.
Uurs, this must be very frustrating and devastating for your Son. However, I am not sure what you can do about the school's decision. They are legally covering their butts, and, in my mind and based on my own experience (below), nothing will make them change their decision. They will keep saying that "this is to protect your son's health". I can vividly visualize the top-management sh** br*** when they learned that paramedics got called. Not b.c. they were concerned for your son -- but b.c. they were afraid of a lawsuit and bad publicity.
I have had my worst asthma attack in my dusty/cold office (I used to teach at a university). My university has ignored for 7 years my complains about the heat and AC not working in the office. However, when I had to be taken out by an ambulance due to the athma attack, they immediately prohibited me from working during "unusual hours" (outside of 9-5). They claimed they "cared about my health" (they clearly did not -- as evidenced by 7 years of no action). When I stayed at work late anyway (my line of work required this), they held a disciplinary hearing and threatened with dismissal ("one more strike"). I have since left this work place.
Obviously, you also need to look at the management plan etc. I do not want to sound alarmist, but this can happen again, not necessarily after rowing. This is the top of the pollen/allergy season, it could have made his EIA (exercise-induced asthma) worse. In the EU and the USA, they offer allergen shots for this. In the UK, not so much (except a fancy private clinic in London). So, if standard treatmetns do not work, it might be biologics time.
My second-worst asthma attacks were following exercise in the summer.
Surely this exclusion is disability discrimination, since your son is being excluded from a school activity because of his health even though medical professionals have said he can carry out the activity safely. If rowing is so important to your son, it might be worth taking further medical and legal advice.
The statutory guidance for schools to support children with medical needs (assets.publishing.service.g... clearly states that ' it is not acceptable for a school to: prevent children from participating, or create unnecessary barriers to children participating in any aspect of school life. ...) of course school can still argue their case for exclusion. So, medical advise becomes important. I will try to get that done first before going back to school.
this is so disappointing from them - hope you get somewhere, seems so discriminatory and just stupid as exercise is the right thing to do with asthma where possible. There is a case in the news at the moment about the army refusing to accept someone who has family members with breast cancer, they have changed their mind and now accepted them as it would have been discriminatory. I am in my 40s and on the same drugs plus also diagnosed allergic rhinitis except I’ve found Fostair as my inhaler on MART regime has been a game changer for me, perhaps there’s other advice from asthma nurse/specialist and I’d definitely recommend speaking to an asthma and lung UK asthma nurse to explain everything to them as they may have other advice, every time I ring them I get another bit of information/tip. Does he use sterimar saline solution spray on his nose also? Asthma UK recommended that to use before Dymista and it has helped loads. I had a flare up earlier this month and they explained many people in same boat due to pollen - although my main trigger is house dust mites so we have no carpet which helps. They may be able to check his nasal spray and inhaler technique and perhaps talk about spacerss. If the school is going to stick to their guns - I hope not - but if they do I hope there is somewhere else he can continue this hobby. The whole thing with asthma is getting the right drugs and just carrying on with life in between flare ups and not letting it get in the way as much as possible, it is very easy to get very anxious and down about it - my recent flare up has really messed up my mental health, I really feel like the school need to take a step back and rethink their approach and perhaps when the dust has settled they will. Perhaps some reassurance for them from an asthma specialist or asthma nurse would help and involve them with his asthma management plan so they feel like they know what to do etc.
What you have described here is exactly same as what my son has, dust mite is the trouble maker.
We removed all the carpets long time ago. We vacuum his beds and pillows every night with Jimmy JV35. Until Feb this year, he sneezed and had cold every single day. After changing to Dymista, Fexofenadine Hydrocholride and Relvar, life seems to have changed overnight. His peak flow has gone up from 300 to 550. FeNo scores down from 140,000(beyond the scale) to 29,000. He has been doing similar type of exercises since early this year and has never complained. All was well till May 13, 2024 when he had this asthma attack.
The exercise period was between 2 and 2.55 PM. Warm up, stretch, taking turns for the 4-minute erg test, reporting the scores, he must have left the gym around 2.35 PM and the asthma attack happened in the library between 3 PM and 3.15 PM. I am also wondering why it did not happen in the gym during the exercise or immediately after the exercise. No one seems to have noticed anything different in the gym. He gave his all on that erg machine because he so desperately wanted to make it to the team. He didn't get the score he wanted and was very nervous about losing the seat after the test.
When I saw him at 3.30 PM (luckily I was very close to school and all I had to do was find parking and run) his pulse was 140+, his arms and legs were cramped, he couldn't move them, the nurses were giving him some oxygen, he was screaming that he is in pain. Paramedics came at 4.15 PM and gave him one 2.5mg Salbutamol and 500mcg Ipratropium. He recovered with that and walked unaided to the ambulance at 5.20 PM and was awake and spoke normally along the ride to the hospital, we reached hospital at 6 PM. His peak flow and spirometry tests were done around 8.30 PM and was discharged at 10 PM. After that he has not had a need for Salbutamol at all.
Never mind the school issue, but, I am still trying to get around the delayed onset of the asthma attack.
"He didn't get the score he wanted and was very nervous about losing the seat after the test."
Stress can be a huge trigger - if it is for him, then the asthma attack could have nothing (or very little) to do with exercising and everything to do with anxiety. So the attack might not be 'delayed' at all.
Alternatively, is there anything different in the library - e.g. new books, new furnishings - that might have triggered an attack?
>>>, he must have left the gym around 2.35 PM and the asthma attack happened in the library between 3 PM and 3.15 PM.
It is very common for symptoms of exercise-induced asthma (EIA) to develop after the exercise has stopped (within 30 min, but it depends on the individual). This is one of the hallmarks of EIA, and it is excplicitly mentioned in the 2012 review PDF I linked above. I have had my all bad asthma attacks after having climbed a very long hill (takes, say, 1 hr at 75% effort), then changing at the top to dry clothing and while walking calmy back down to recover from the workout. Takes 30 min for me to "pay the price" for the feel-good uphill workout.
The longer one spends exercising (and with the airways cooled), the worse the subsequent attack. During the exercise itself, the airway narrowing is prevented by hormones that widen the airway during the exercise (Lysistrata will know the mechanism).
Does he also carry an epipen for food allergies? I carry one, and I believe it has saved my life several times during bad asthma attacks in "remote" areas where ambulances could not get to quickly (or during covid -- when they had bigger priorities). When the attack is bad, I feel that I cannot even hold the spray in my lungs long enough for any effect. Plus, if allergens around are the culprit, taking a deep breath with the inhaler makes it worse for the first few mins, before the inhaler kicks in (takes 30 min for me). So I read in a paper that some US doctors use epinephrin for acute attacks. No breathing-in required and works much faster (5 min). Nurses here may not agree with this, as I am not sure if this is an approved usafe of epinephrin in the UK. Epinephrin also really helped when I worked in a secured building, and the ambulance could not get to me through the gate. So the injection helped me get up and get enough strength to walk to the exit. Not sure what I would have done otherwise.
Of course, after the use of an epipen or strong bronchodilators in the "field", you can never convince anyone in the AE that you had had a terrible asthma attack, as your peak flow will be through the roof (mine is 900 after an epipen and my baseline is 800). So, you will have to fight for prednisone by showing them your action plan, approved by the consultant.
If he is allergic to dust (as you seem to be saying), the library will make it worse. I won't enter a library anymore w/o a facemask. Libraries and book stores are bad news for me. Allergic asthma and EIA work together.
Yes, I didn't mean to imply that it couldn't be exercise-induced asthma, simply that there might be another explanation. Exercise is a trigger for me, but stress/anxiety is an even bigger one, plus it seems that OPs son also has a number of allergy triggers, so it might be worth considering whether exercise was the contributory factor here.
Mandevilla, I agree. Stress, allergies to aerosols and exercise all work together in this. Stress is a factor for me as well, although adrenalin helps :).
I think the main issue,if he wants to do vigorous sports,is 1.stressing daily if necessary,that he has to use inhaler beforehand,as lots of children these days do.otherwise it could be footy,cricket,rugby,or other competitive sport that contributes to an asthma attack
2. Remind him ea day to aLways have inhaler in his pocket
3. Ensure he knows the warning signs pre empting it going out of control
4. Teach him how to try relax,as losing it makes it 100 times worse.perhaps go thro calm controlled breathing ( even 5mins practise in evening). Once he's familiar with it,maybe go through it with cpl of his friends so they can help him in the event of needing to.
Once it's all in place,he will then have gd grounds to ask to be reconsidered for a place in September & school may then have confidence that he is taking the responsibility & care of himself that needs to.
Understandably,sounds like his anxiety was off the scale + coping strategies forgotten.
If u can do Yr best to let him see why things escalated,you'll be teaching him a gd lesson for the future.
We were in Evelina/St Thomas Hospital, London yesterday for further tests including an exercise test to check EiB. He performed well, no deviations or any symptom of asthma was detected. We received a call the evening before asking if we were available at 9 AM for tests to fill in a cancellation. Didn't even wink, we said yes. He was told not to take the preventer (Relvar) in the morning of the tests. He didn't need any Salbutamol before or after the tests. We walked all the way to Paddington station from St Thomas Hospital to catch a return train and he was still fine. It will take a while for them to compile all the test results and recommend next course of action.
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