By Dr. Seth Craig
Going back to school in the fall presents some special challenges for the child with asthma. There are the added challenges of preventing and treating asthma away from home. This necessitates having an Asthma Action Plan at the school as well as appropriate medications to treat asthma flares. The Asthma Action Plan lists the medications the child may need and when to use them, and may also list the triggers of the child’s asthma.
Asthma has been referred to as an epidemic and affects one in thirteen children in the United States; asthma is now the leading cause of school absences for all chronic illnesses. There are several suspected causes for this increase in asthma prevalence including air pollution, poor dietary quality, obesity, and the “Hygiene Hypotheses” which states we are too clean by killing off beneficial bacteria in our environment with cleansers and in our bodies with antibiotics.
School air quality has the same influences as those seen in other commercial buildings. The ventilation systems need to have adequate filtration to remove airborne particulate matter and must bring in enough fresh air from outdoors to dilute chemicals from building materials and from cleaning and maintenance materials. The amount of fresh air needed is also determined by the number of people in the building. Special air irritants may occur in the art, science, and shop/vocational arts rooms. As in the home, dust and mold may be a concern with carpets and in areas where there are water leaks.
Physical education is often the class which calls attention to the child’s asthma. If the asthma is not adequately controlled, the child will have difficulty running and will not be able to keep up with the other children of his or her age. This can be humiliating and frustrating for the child. It is important to ask the Phys Ed teacher how the child is doing in class. If the child is unable to keep up with the other children the parent should discuss this with the child’s doctor. A child needs to have some degree of physical fitness even if the child does not have a great interest in athletics. It should also be said that some children with asthma become discouraged with sports if they have difficulty running and this prevents them from participating in sports which can be fun social activities. These are good reasons to seek good asthma control.
When should the child with asthma stay home from school? A general consensus would recommend that the child stay home with an acute infection, especially if the temperature is over 100 degrees, if the child has difficulty breathing, is tired from being up most of the night, or otherwise unable to participate in the school activities of the day, or if the child has frequent cough or wheezing which does not respond to medication. The child who is very sick or who has frequent school absences due to asthma needs medical attention. It is important for the child to see his doctor or go tho the Emergency Department immediately if he is not responding well to his medication or is lethargic or struggling to breathe.
With asthma we have the opportunity to prevent many asthma “attacks” and to allow the vast majority of children with asthma to attend school regularly and to participate in athletics and other activities which require physical exertion such as marching band, singing, cheerleading, and others. Asthma control often requires regular preventive medications and the use of a quick-relief inhaler shortly before exercise. It is important for the child with asthma and other chronic respiratory problems to be evaluated by an allergist so that the triggers of the symptoms can be identified and that a program of treatment can be initiated. An additional resource of information on school and asthma can be found at The Allergy and Asthma Network/Mothers of Asthmatics at www.aanma.org.
Seth Craig, M.D.
Allergy & Asthma Center of Fredericksburg, Ltd.
1300 Thornton Street, Suite 200
Fredericksburg, VA 22401