Asthma and Back to School: A Dangerous Combination

By Ann-Marie Brooks, M.D., Pediatric Pulmonologist

We have a problem in Georgia: Children are dying of asthma, but where is the outcry?

Why don’t we hear PSAs that warn parents, children, teachers and coaches that fall is one of the most dangerous times for children with asthma?

From coast to coast, September is the No. 1 month for asthma attacks in kids. And it’s not a coincidence that the timing overlaps with kids heading back to school.

One may argue the numbers are small, maybe 5 to 10 deaths per year—but does that matter when each one is preventable? Would it matter more if you knew that approximately one in eight children in Georgia has asthma and death could occur in any one of them, regardless of the underlying severity?

What if I told you about the young child who thought his asthma was under control so he didn’t keep his appointments with the asthma specialist? How he one day had difficulty at school, didn’t respond to his inhaler, collapsed and died on his way to the hospital—would that be enough to start the discussion?

Or how about the pre-teen who started coughing after dinner, went upstairs and used her inhaler multiple times without telling her parents? Then suddenly cried out that she couldn’t breathe and took her last breath in her mother’s car on the way to the hospital?

After 20 years of practice, I—unfortunately—have many stories that would break your heart (and have broken mine). Just think: That could be your child with asthma or your child who watched his classmate collapse and never return to school.

During the summer months, asthmatics often enjoy a welcome reprieve from symptoms. With low allergen counts and fewer respiratory illnesses floating around, many kids go the entire summer without “needing” an inhaler. They run, swim and spend hours outside without difficulty.


Lung function testing can detect swelling and inflammation in the lungs before symptoms appear.

Inevitably, that temporary reprieve leads to a cringe-worthy conversation: “He’s done so great; I really think he’s outgrown his asthma. He doesn’t need his medications any more, does he?”

At that point, I remind families that we have this discussion every summer. About two weeks into school, a cough appears and gradually worsens until managing it at home is no longer an option.

Emergency room visits for asthma begin to climb in August and peak in September and October. There are many potential reasons for this: peak ragweed (and other weed allergens) counts, anxiety associated with going back to school, changes to routine and increased viral exposures.

While many of those triggers can’t be controlled; there are some very important steps every parent can do to protect their children during this challenging time.

  • See your physician and create an updated asthma action plan. The plan should outline how to recognize your child’s triggers, how to avoid triggers and how to manage symptoms as soon as they occur. Ideally, this should be done before school starts, but late is better than never! If available, obtain lung function testing. Swelling and inflammation of the airways may show up on these tests before you or your child notice symptoms. Make sure you leave with multiple copies of the action plan – one for each caretaker, including teachers and coaches.
  • Get refills for all medications. If your child also has food allergies, be sure to obtain a food action plan and an up-to-date epipen.

    Without a spacer device, less than 10 percent of the medication will actually get to the lungs.

  • Be sure to have a spacer device for both home and school; no matter how coordinated your child thinks he is, less than 10 percent of medicine actually gets to the lungs without a spacer. Most insurance companies will approve a rescue medication for both home and school if your provider indicates as such on the prescription.
  • Focus on taking (or restarting) you child’s daily controller medication. Remember this is the medication that is necessary to prevent an asthma exacerbation. The earlier you start, the more effective it will be during those times of stress.
  • Make an appointment with your child’s teacher/coach to review triggers, signs of distress and how your child typically responds to medication. Develop a plan to keep the classroom free from potential triggers. Georgia law allows all children to carry an albuterol inhaler with parent and physician permission. Together with the teacher, determine where the inhaler will be stored.
Dr. Brooks

Dr. Brooks leads a team that specializes in pediatric allergy and immunology, asthma, pulmonology and respiratory therapy.

The goal for every child with asthma should be to use the least amount of medicine to achieve the highest level of functioning.

A child with asthma should have a good night’s sleep, free of coughing or frequent awakenings, and should be able to participate safely in activity.

Remember: Asthma can be controlled, not cured. For most, it’s a lifetime condition.

So, I beg you, please do not assume your child has outgrown asthma unless a medical professional has confirmed as such!