When asthmatic Lisa Swainsbury had swimming lessons at her junior school, her mother used to hide her inhaler in her towel. For Mrs Swainsbury says her daughter was not allowed to carry her rescue medication with her during the school day. Instead it was kept in the secretary’s office.

Lisa’s mother says she complained to the school about this, particularly because the swimming pool was some 15 minutes walk away: “But they said if there was a problem, a teacher could always bring the inhaler up in the car . . . I tried to explain that an attack happens too quickly, any delay could be dangerous, but they didn’t seem to understand,” she says.

At one stage Lisa, who has had asthma since babyhood, was on three different drugs. Her GP required a peak flow meter reading each day - a check on lung function - and her mother used to go in to school at lunchtime to supervise her doing this because the staff said they couldn’t do it.

On days when Mrs Swainsbury was unsure about her daughter’s health, she would keep her at home rather than send her to school. In her last year at junior school, Lisa, who is now 12, lost about six weeks through illness: “I just felt they didn’t know enough about asthma, they didn’t know the symptoms. It caused me a lot of worry. On the one hand they complain if you don’t send the child into school, on the other, they give you no confidence,” says Mrs Swainsbury.

“It affected Lisa’s attitude, she didn’t want to go to school. She’s normally very happy-go-lucky, but she was embarrassed about having to ask for her inhaler, she was embarrassed about having asthma.”

Last year Lisa started at secondary school, where she is allowed to carry her inhaler and she is much happier.

At her old school, Christ Church school, Lewisham, the headteacher Jill Bonner says she doesn’t recognise Lisa’s experience. She says the school has been developing its asthma procedures for some time (although she’s not sure exactly when the policy changed) and it now allows children to carry inhalers if they wish.

While the National Asthma Campaign believes that teachers’ attitudes to asthma have generally improved over the past few years - as at Christ Church - it says standards remain patchy round the country. Although the NAC has produced a leaflet on good practice in conjunction with the National Union of Teachers and sent out more than 60,000 school asthma packs since 1991, unfortunately in some schools the information has lodged with one member of staff and failed to percolate through.

However, changes in government policy are pending. In the draft of the new Children’s Charter published in the summer, the government declared its intention to make easy access to an inhaler a right for every schoolchild. No longer will schools be able to lock inhalers away. Meanwhile the Department for Education and Employment is working on draft guidelines on medications in schools which are intended to promote good practice. Schools themselves should already have implemented the special needs code which requires them to identify children with a chronic medical condition, such as asthma, and draw up a programme for them with their parents and doctors.

No one teaching today can be blind to the evidence that there is a growing army of asthmatic children. The numbers shot up during the 1980s and now more than a million suffer from this most normal of childhood complaints. In almost any class there will be at least one sufferer, given the national estimates of five cases per 30 children, 80 in a school of 500.

What goes wrong with the asthmatic is that the airways in their lungs are almost continuously inflamed and are very sensitive to substances which irritate them. When a sufferer has an attack, the airways react to the irritant by narrowing and causing the child to cough, wheeze or gasp for breath. The triggers vary but typical factors in the school are exercise, viruses, cold air, cigarette smoke, fur from classroom pets, fumes from science experiments.

Asthma leads to days missed from school, broken nights, tiredness and consequently poor concentration. Research has shown that acute asthma can affect self-esteem and the ability to make friends.

The NAC wants every school to draw up an asthma policy - see right. What’s most important is to allow immediate access to medication. “It’s critical, ” says Joanna Taylor, education officer, “to the child’s confidence and wellbeing. Schools which restrict access are not acting in the child’s best interest and could be creating a potentially dangerous situation.”

Indeed, paediatricians agree most children would rather wheeze than put up their hand in class for some medicine.

With children spending so much time at school, Andrew Bush, senior lecturer in paediatric respiratory medicine at the National Heart and Lung Institute, believes teachers can make an important contribution to their health. Speaking at a conference for teachers on asthma at the Royal Brompton Hospital last month, he said: “We as health professionals have been very slow to involve teachers in the care of sick children in the same way as parents. It’s our impression that teachers have been rather left behind in the explosion of home care.

“The emphasis in modern paediatrics is keeping the child out of hospital, keeping him or her at home to the benefit of all. Parents with support from health professionals are now regularly doing treatments at home that would have been unheard of 20 years ago. We’re not asking teachers to become doctors or nurses but with the proper support and training, they ought to be able to do what a reasonably intelligent parent does.”

Bush, who is also a school governor and understands the stresses teachers face, nevertheless argues for them to take more responsibility.

A teacher may be well-placed to spot a child who’s condition has not been picked up. “If a child is sleepy and inattentive in class it maybe because he’s been watching the Texas Chainsaw Massacre, but it may also be because he’s got disturbed sleep at night due to asthma,” says Bush, Teachers may also be able to spot a child whose asthma is not well-controlled - the child may be using strategies to avoid sport like playing in goal or needing too much rescue medication.

In both instances the teacher could pass on that information to the parent or school nurse, says Bush.

“People have very low expectations of what treatment can achieve, but an asthmatic child should be normal with the right medication. If he wheezes when he plays football, the answer is not to stop the football but to get better treatment for his asthma.”

Whether teachers enthusiastically seize Mr Bush’s challenge or not, (and some may resent their ever-expanding job description), the NAC believes many teachers do want to learn more. It quotes a survey earlier this year, which found that 80 per cent of teachers wanted clearer guidance on medication. Certainly Kingston University reports great interest among it’s students in a new 10-hour course for primary BEd students on asthma and other common conditions which it has run for the first time this term.

At Ashley Junior School, a grant maintained school, in the New Forest, head teacher Colin Williams started a series of initiatives when he discovered an increasing number of inhalers piling up in the school office.

“It seemed to be uncontrollable.” he says.“We needed to become aware of who needed an inhaler, what sort of inhaler and why. How severely affected were the children? What were their perceptions?” Six months ago the children all filled in an asthma questionnaire and Williams discovered that, out of 280 pupils, there were 34 sufferers with an equal number of girls and boys. The vast majority of these had mild asthma and were affected less than once a month - most attacks happened when the children were playing outside or when in bed. Three of the children had had hospital treatment.

The survey led the school to draw up a register of asthmatics. A GP was brought in to familiarise the teachers with the different devices and explain the different treatments. Parents and children were consulted and given the option of carrying their medication or keeping it in the school office. The school also obtained a spare inhaler and spacer (see box) for emergencies.

Although the school has a written policy, Mr Williams feels it is the day-to-day practice which really matters. All the teachers are aware of the need for prompt action if a child shows symptoms - and so far they haven’t had to deal with an emergency.

“We’re not asking the staff to do anything special, just be aware of the children’s needs,” says Williams, “It’s no more of a chore than anything else. “The questionnaire revealed how blase the children were about asthma - one small child said she always got an attack on the roundabout in the park, another said he kept his inhaler on the microwave at home. These kids regard asthma as the most normal of conditions.”

The National Asthma Campaign runs a telephone help line staffed by asthma nurses who can give specific information or advice: 0345 01 02 03 It also produces asthma management packs for schools. Write to them at Providence House, Providence Place, London N1 ONT Telephone: 0171 226 2260