It may seem odd that it is the children with the least puff who are playing the wind instruments at the Parish Church CE junior school in Oldham. When you learn that these children also suffer from asthma, it almost seems cruel to ask them to draw a breath and hold it to play a note for as long as they can. But, as part of the Bronchial Boogie project, these children are learning breath control to help combat their asthma.
"I suffered from asthma as a child in the 1950s," says the scheme's creator, Wendy Andrew, special projects co-ordinator for Oldham music service. "We didn't have inhalers in those days, so we learnt breathing exercises to help us control the attacks. I later went on to music college as a singer and learnt better breath control, which has helped me to keep the asthma in check."
In the UK, in an average year 1,500 people die from asthma, including 25 children. Six times as many children suffer from the condition now than did 25 years ago. But there is widespread ignorance about how and when to use the medication available.
There is particular concern in Oldham, one of the most deprived local authorities in England, where the death rate from respiratory disease is 36 per cent higher than the UK average. Bronchial Boogie targets areas with above average hospital admission rates for asthmatic children. Some of them live in overcrowded, damp houses, are frequently absent from school and suffer from low self-esteem. They struggle in PE and have difficulty keeping up socially and academically.
Bronchial Boogie is a partnership between Oldham music service, the local primary care trust and other health service professionals, backed by a grant from the Children's Fund. "The scheme is a mix of educating children and their parents about their medication and their asthma, and of their learning to play an instrument that helps develop breath control," says Ms Andrew. "The children also have time to play games that contribute to their level of fitness and self-esteem." Tuition and instrument loan are free to the schools, and the children can take their instruments home for practice.
At Parish Church school, the regular Thursday after-school Bronchial Boogie session is taking place in adjoining classrooms. Clarinet teacher Tony Sullivan, from Oldham music service, is taking a novice group of three Year 3 children who are gallantly battling with the tricky reeds.
(The four participating schools also have the choice of cornet and flute.) "This group has only been playing for a few weeks, but already I can see an improvement in their breath control," says Mr Sullivan. "I am impressed with the way they are determined to keep trying even though they are not necessarily musically orientated."
At first, the pupils find the physical effort involved tiring; holding a flute makes their arms ache. At the end of lessons they are often exhausted. After half an hour, a more experienced group enters; they performed in a concert at the end of last term and each received a certificate. "As well as the pleasure from the music, their sense of achievement is helping boost their confidence and giving them a feeling they are important in their schools," says Wendy Andrew.
The pupils who have finished their music are now playing games. These vary from school to school and may include dance, a mini obstacle course or blowing Maltesers with a straw. A school health adviser from the primary care trust checks their peak flow measurements to establish lung capacity, fills in their diaries to keep a record of their progress and talks to them about any problems.
When they join Bronchial Boogie, children and parents learn how their medication works and when to take it. "It can be quite complicated to work out that you take the brown as a preventer and the blue as a reliever, but sometimes you have to take the blue in order for the brown to be effective," says Ms Andrew. "The nurses found that sometimes the child does not have the best device for them, or does not really know how to use an inhaler." Families are also helped to work out what may trigger attacks, such as certain foods and drinks, dust or animals.
The information gathered from questionnaires and diaries over the last year is encouraging. "We have noticed a big improvement in attendance," says Jean Bennett, headteacher at the Parish Church school. "There has also been a drop in the need for the children to use their reliever sprays." For the 30 children in the pilot project, there has been an impressive improvement in respiratory health, with sleepless nights down from 90 per cent to 47 per cent, and 70 per cent showing an improvement in peak flow rate; the proportion reporting daytime symptoms has fallen from 60 per cent to 10 per cent. Absences are down from 35 per cent to 5 per cent, and 85 per cent of parents say that the combination of education, monitoring and playing wind instruments has helped combat their children's asthma.
Bronchial Boogie is now into its second year and taking on more schools, including a secondary. "Sometimes I struggle to get my breath, but playing the clarinet is helping me breathe much better," says Parish Church pupil Leyton Wands, glowing with the satisfaction of a tune well played, and the puff required to play it.
What is asthma?
Asthma is caused by inflammation of the airways that carry air into and out of the lungs. (It is in the lungs where blood takes up oxygen and gives off carbon dioxide.) The airways of asthmatics are very sensitive and when they come into contact with something that irritates them (a trigger), the muscles around the airways tighten and they become narrow and start to produce sticky mucus or phlegm. This results in the common symptoms of asthma: coughing, wheezing, shortness of breath and a tight feeling in the chest. Wheezing does not always occur and, in fact, coughing is the most common symptom. Typical triggers of asthma are colds or flu, allergies (such as pollen, animals and dust mites) and irritants such as cold air, tobacco smoke, chemical fumes and exercise.
Who gets asthma?
Eight million people in the UK have been diagnosed with asthma and 1.4 million children are currently receiving treatment. This represents one in eight children, and while many will grow out of their symptoms, these may persist into adulthood. Some people develop asthma in later life. We do not understand what causes the condition, but it can be inherited. It can also be attributed to factors of modern lifestyles, including housing, diet, environmental pollution or irritants at school or in the workplace.
How is asthma treated?
Asthma is treated with anti-inflammatory drugs. Typically these are steroids that act like cortisol, a hormone produced naturally by our bodies. Steroids are normally delivered through inhalers (usually brown, red or orange) and should be taken every day irrespective of any symptoms.
The symptoms of asthma, but not its cause, can be treated with bronchodilators. These drugs, also delivered by inhalers (usually blue), relax the muscles surrounding the narrowed airways and make breathing easier.
What to do in an asthma attack An asthma attack often occurs after the gradual worsening of symptoms over several days. When this happens it is important to take the usual dose of bronchodilators (relievers) straight away, to sit down (not lie down), rest hands on knees, relax and breathe as slowly as possible. Wait five to 10 minutes, and if the symptoms do not disappear, call for medical help.
Continue taking the reliever until help arrives.