HEALTH : A breath of fresh air for children with asthma

Janice Richardson has taken over as head of what is possibly Britain's most exclusive and unusual school. Its fees for boarders are £21,000 a year, more than the most expensive mainstream private school.

There are only 43 pupils, who are outnumbered by a staff that includes 11 nurses. Yet the children who go to Pilgrims School do not, on the whole, have affluent parents; what they have in common is disabling illness. They all suffer from severe asthma or eczema; most have both.

Yesterday, Brian Mawhinney, Secretary of State for Transport, announced measures to reducepollution from vehicle exhausts, which are increasingly linked with asthma. At least Pilgrims, near Seaford on the Sussex coast, enjoys fresh air; there is no other school like it in Britain. It takes children aged nine to 16 years, many of whom have missed months, or years of conventional schooling because of their illnesses. Some have come close to dying of heart failure because of acute respiratory problems.

Demand for places is growing. The latest figures show that while asthma cases are increasing generally, it is children who are suffering most. Of the 3 million asthma sufferers in the UK, a third are under 18 years old. Around one in seven children now suffers from asthma, double the rate recorded in the 1970s.

While most young asthmatics learn to manage with the help of drugs and a few days off school a year, Jean Richardson's charges need 24-hour care and monitoring. Before they are accepted for Pilgrims, their condition has to be severe enough to persuade their local authority to pay the fees for a place. Mrs Richardson, who became the head teacher in January, says: "These children are the most severe sufferers. Our aim is to give every child the confidence to take control of their lives, to realise their full potential and enjoy life."

From the outside, Pilgrims, run by ICAN, the charity for children with special educational needs, looks unexceptional. The first clue to its special role are the thin, almost spartan carpets and an absence of plush soft furnishings throughout the building.

"Thick-pile carpets may look cosy, but think of the dust mites that can live there,'' says Jean Meadows, senior matron. The team of nurses she heads provide round-the-clock cover, including night dormitory patrols to monitor the children's breathing.

When children arrive at Pilgrims, their background is often one of missed classes, a lack of confidence and a history of bullying. "Children can be very unkind: our children have been called lungs, wheezers and whistlers," says Ms Meadows. Most are on high-dose medication and some have a history of asthmatic episodes so severe that they have spent much of their lives on hospital ventilators.

What the school teaches them is how to manage their illness themselves. "One of the main things we try to give them is confidence in handling their condition, a process of learning, understanding and controlling," says Mrs Richardson.

Self-management and awareness is critical for asthmatics and can mean the difference between life and death. Of the 2,000 deaths each year from asthma, 80 per cent are preventable.

Teaching the children how to use their inhalers and other medication is a key task. Those with severe eczema are taught how to use ointments to make their condition less distressing.

Vivienne Steels, deputy head at the school, says that being somewhere they will receive immediate help if needed gives the children confidence. "At Pilgrims, if you feel wheezy, mum doesn't have to be called to come and fetch you from school. Help is here, including our doctor, who has three sessions a week at the school, as well as being on call."

The school's chief aim is to enable the children to lead as normal a life as possible: many who arrive have rarely taken part in football or other sports because of either their own or others' fear of an asthma attack.

"Children are encouraged to develop to their full potential," says Mrs Steels. "Some take part in games and other things they have never had the confidence to do before. We follow the Nat-ional Curriculum and are very proud of their achievements."

Many find leaving home difficult. The school operates a buddy system whereby newcomers are allocated a special friend. "They do not come from a background where boarding education is the norm and many come long distances," says Mrs Richardson.

Once children can manage their illness, they return home; the average stay is about two-and-a-half years. Others stay longer, taking their GCSEs and going on to sixth-form studies.

Andrew Stimson, 14, came to Pilgrims two years ago. "I was classed as a very severe case of asthma. In the six months before I came here I had not been to school. I use an inhaler at least twice a day and I have severe eczema which meant I could not walk properly," he recalls.

Coming to Pilgrims has, he says, changed his life. "It was daunting at first, being away from my parents, but I am much better now and have started playing games. At an ordinary school, it feels like you are on your own. Here, everyone is a friend and everyone understands."