RETURNING to school after the summer holidays should be an exciting time for children as they embark on new lessons and are reunited with friends.

But the stark warning today from a charity which campaigns to improve the health of asthma sufferers is that the sudden change in routine, as well as the exposure to new cold and flu bugs at the start of term, poses a very real danger to some pupils.

Although it is not exactly clear why there is a spike in children being admitted to hospital as a result of asthma attacks in August and September, the leading theory is that their lungs may have become more inflamed over the summer as children fell out of the habit of using their brown inhaler.

As most parents discover, school classrooms are also a breeding ground for cold and flu bugs. For children with asthma, however, these sorts of respiratory bugs can be a serious trigger.

"If you notice that your child needs to use the blue reliever inhaler more than three times in a week, that's a sign that their asthma is not under control, " said Collett Harris, of Asthma UK.

READ MORE: Back-to-school warning over potentially deadly asthma attacks

She also advised parents to be on the look out for classic symptoms such as wheezing, becoming short of breath during activities and nighttime coughing fits.

She added: "You hear about parents having sleepless nights looking after their kids because they're coughing, that dry asthma cough - that is a sign that you need to speak to your GP, that your asthma is getting worse."

Natalie Homer is among the parents who admits that the family had let their inhaler routine slip during the holidays. Her son Isaac was hospitalised in 2017 after picking up a cold which triggered a major asthma attack.

She said: “We weren’t consistent with giving Isaac his preventer inhaler. This came back to bite us when Isaac was rushed to hospital fighting for his life. I had no idea that coughing at night and a tummy ache could be a sign that a major asthma attack was brewing."

In recent years, asthma deaths in Scotland have been among the highest so far this century. There have been more than 500 deaths among adults and children with asthma in the past five years alone, and tragically more than 300 of them are considered to have been preventable.

Basic care such as yearly review with a GP or asthma nurse, a written action plan explaining how sufferers can stay well and an inhaler technique check have been absent for a number of patients who later died.

READ MORE: Study says air pollution is behind one in three childhood asthma cases

In June, the father of 12-year-old Tony Fagg, from Darvel in Ayrshire, spoke out about the sudden death of their son six years ago after charity leaders warned that the "same mistakes are being made again and again" because recommendations had been "ignored".

The Loudoun Academy schoolboy had been out skateboarding the night before his death and attended school as normal that day. However, he suffered a sudden asthma attack at his mother's house in Galston and was pronounced dead on arrival at hospital a short time later.

His father, Anthony, said: “Tony wasn’t given basic care such as an inhaler check to ensure his medicine reached his lungs properly or an asthma action plan that told us what medicines he was taking and how to stay well. It’s appalling that people are still dying from asthma.”

The Scottish Government says it is developing a Respiratory Care Action Plan for Scotland, which will set out key priorities in the prevention, diagnosis and treatment of respiratory conditions, including asthma.

It comes as recent research claimed that as many as one in three new cases of childhood asthma could be caused by air pollution - higher than previous estimates.

READ MORE: Scotland has highest rate of avoidable childhood deaths in UK

The study, led by the Barcelona Institute for Global Health (ISGlobal), looked at asthma in more than 63 million children across 18 European countries, including the UK, in 2016.

Co-author Professor Mark Nieuwenhuijsen, said simply switching to electric cars would not be enough to deliver truly clean urban air.

He said: “A lot of the air pollution we have comes from cars, residential cooking and heating, industry and ports, so what you need to get rid of is the fossil fuels that produce all this pollution.

“And, besides that, what you also might want to look at is a reduction of cars in cities because, even if you get electric cars, if they run on renewable energy you still have particulate matter coming from the brakes, tyres and the wear and tear of the car.

“So you are also looking towards a reduction of cars and a move towards public transportation, cycling or walking.”