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Monitoring epidemiological trends in back to school asthma among preschool and school-aged children using real-time syndromic surveillance in England, 2012–2016
  1. Nick Bundle1,2,
  2. Neville Q Verlander3,
  3. Roger Morbey4,
  4. Obaghe Edeghere4,
  5. Sooria Balasegaram2,
  6. Simon de Lusignan5,6,
  7. Gillian Smith4,
  8. Alex J Elliot4
  1. 1 United Kingdom Field Epidemiology Training Programme, Public Health England, London, UK
  2. 2 Field Epidemiology South East and London, Field Service, National Infection Service, Public Health England, London, UK
  3. 3 Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
  4. 4 Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, West Midlands, UK
  5. 5 Research & Surveillance Centre, Royal College of General Practitioners, London, UK
  6. 6 Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
  1. Correspondence to Dr Alex J Elliot, Real-time Syndromic Surveillance Team, Public Health England, Birmingham, West Midlands B3 2PW, UK; Alex.Elliot{at}


Background Back to school (BTS) asthma has been previously reported in children; however, its epidemiology and associated healthcare burden are unclear. We aimed to describe the timing and magnitude of BTS asthma using surveillance data from different health services in England.

Methods Asthma morbidity data from emergency department attendances and general practitioner (GP) consultations between April 2012 and December 2016 were used from national syndromic surveillance systems in England. Age-specific and sex-specific rates and time series of asthma peaks relative to school term dates were described. The timing of a BTS excess period and adjusted rates of asthma relative to a baseline period were estimated using cumulative sum control chart plots and negative binomial regression.

Results BTS asthma among children aged below 15 years was most pronounced at the start of the school year in September. This effect was not present among those aged 15 years and above. After controlling for sex and study year, the adjusted daily rate of childhood GP in-hours asthma consultations was 2.5–3 times higher in the BTS excess period, with a significantly higher effect among children aged 0–4 years. A distinct age-specific pattern of sex differences in asthma presentations was present, with a higher burden among males in children and among females aged over 15 years.

Conclusion We found evidence of a BTS asthma peak in children using surveillance data across a range of healthcare systems, supporting the need for further preventative work to reduce the impact of BTS asthma in children.

  • asthma
  • asthma exacerbation
  • school
  • general practitioner
  • emergency department
  • surveillance
  • children

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  • Contributors GS, OE and AJE conceived the study. NB, OE, GS and AJE developed the study protocol and NB undertook all data analysis and prepared the first draft of the manuscript. NQV and RM provided statistical support. All authors reviewed and approved the final version of the manuscript for submission.

  • Funding This work was undertaken as part of the national surveillance function of PHE and received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No data are available.