Planning and communication: Keys to helping children with asthma in school

As of the 2024 school year, asthma was one of the leading causes of school absenteeism and is a leading chronic illness among children and adolescents in the United States, according to the CDC. As children prepare for another year of learning, it is estimated that in a classroom of 30 children, 3 are likely to have asthma, with increased numbers among low-income populations.¹

Back-to-school wellness visits and check-ups are the time to remind parents of children with asthma about in-school scenarios to help their children deal with asthma. From treatment plans to planning medication times in the classroom to physical activity exertion during recess, parents must have the resources and an understanding of the condition to help their child maintain reasonable control of their asthma in the school setting.² Primary health care providers can have a meaningful role in helping parents with their child’s asthma needs while they navigate the start of a new school year.

Challenges of dealing with asthma in school

Going from summer break at home back to the school setting can be difficult for children with asthma, due to environmental and scheduling changes. On top of natural changes to these aspects of the child’s life, when the bell rings again in the fall, inconsistent communication and an under-recognition of symptoms could contribute to increased asthma flares and symptoms.

“Children at school face several challenges in making sure that their asthma stays under good control, as compared to being at home, where family and children can minimize their exposures and triggers that may flare up their asthma,” said Richard J. Wong, DO, pediatric pulmonologist, Phoenix Children’s, in an interview with Contemporary Pediatrics. “Additionally, while at school, some children may not have ready access to rescue therapies when they are symptomatic, either due to school policy, a lack of an asthma action plan, or stigma, such as bullying.”

Wong noted a study published in Archives of Pediatrics and Adolescent Medicine in 2005, whose data showed that the start of the school year in September was associated with a 46% increase in pediatric asthma emergency department visits, particularly among grade school students.³

The timing of medication in both the school and at-home settings can be a challenge for parents as well.

“Another challenge is the daily schedule, which may or may not account for whether they need to take their medications at a certain time,” Tyra Bryant-Stephens, MD, added. Bryant-Stephens is a board-certified pediatrician, medical director of the Community Asthma Prevention Program, and chief health equity officer of the Center for Health Equity at Children’s Hospital of Philadelphia.

“A common challenge we see is that getting ready for a busy school day can make it difficult for families to remember to give the morning dose of medication, even though they give the evening dose at home,” said Bryant-Stephens.

Challenges can also vary by age. Wong stated that young children who cannot articulate their symptoms must rely on teachers and school nurses to recognize these symptoms and intervene. He noted that middle school–age children can begin to have some freedom regarding taking some control of their medication management, though stigma could play a factor with adherence, leading to undertreatment of symptoms.

“[With] adolescents, parents are trying to encourage full independence of their asthma management,” said Wong. “Adolescents often underreport symptoms and feel like their controller therapies may not be necessary. They may think, “Why do I need to take this if I am feeling great every day?” This can lead to an overreliance on short-acting beta agonists because [those] relieve their symptoms most quickly. As a result, they miss doses and can easily have asthma flares.”

Provider communication can help parents and children with asthma

Parents must fully understand how asthma affects their child’s well-being, and that’s where the pediatrician’s role comes into play at the child’s next well visit. According to Bryant-Stephens, most schools require a medical form stating that children can receive medication at school, which the pediatrician may need to sign. Pediatricians should explain to parents that adapting the home environment to the school environment as much as possible can help with medication adherence and consistency.

“An asthma action plan or written asthma care plan is important for the school to have, as well as for home,” she stated. “It is really important that when children come for their well visit, they get everything they need for school. It is also important to ensure they have an inhaler for home and one for school. This requires understanding their insurance and talking to parents about how to best obtain these medications. In addition to their medication, they also need another spacer or holding chamber and another mask for younger children, making sure they have everything they need for school as well as home.”

Additionally, Bryant-Stephens noted 5 key aspects to review with parents at a well visit before the school year begins, which include the following:

• Discussing the child’s asthma triggers
• Reviewing what they need from the provider
• Ensuring the school checklist is complete
• Using control medication
• Making sure refills are readily available

Having access to the school nurse as an extension of the multidisciplinary team can streamline communication and medication adherence for the child during school hours. However, the availability of such nurses can vary widely across schools.

“School nurses are often isolated; they are the only ones in the school with health care knowledge,” added Bryant-Stephens. “We need to consider them part of the health care team, so children get the care they need during the day. Whatever we can do to foster communication and help parents see nurses as allies—not adversaries—is important. School nurses are not calling parents just to send children home because they are sick. They are allies in keeping children in school. The better the communication and collaboration, the better the student’s school experience will be.”

Practical guidance for the child

As the child with asthma navigates the long-term, inflammatory disease and all its challenges,⁴ some practical reminders could help quell symptoms and flare-ups. Simple reminders include pacing during physical activity and tracking medications daily.

“I often tell children to pace before and after exercise. We talk about slow warm-up and slow cool-down. An abrupt start or finish can trigger symptoms. Children can understand the idea of slowly working up to vigorous activity for 5 minutes and then slowly winding down instead of stopping abruptly,” said Bryant-Stephens.

Additionally, reminders related to the school environment that may not be front of mind for the child could make a difference, especially as the return to school and allergies can go together, potentially increasing the chances of asthma flare-ups.

“I often tell parents that if they take a vacation from allergy medications in July, they should restart them at the end of August so the child is less likely to have allergic symptoms that can trigger asthma. We cannot avoid colds—they will happen—but we can control other triggers,” said Bryant-Stephens.

“It is important to make sure enough refills are always present for families and to encourage the use of spacers with pressurized metered-dose inhalers, having enough for both home and school,” added Wong. “This ensures optimal medication delivery to help treat the child effectively if they are symptomatic.”

References

1. Managing asthma in schools. CDC. August 13, 2024. Accessed July 10, 2025. https://www.cdc.gov/school-health-conditions/chronic/asthma.html
2. Back to school with healthy lungs. American Lung Association. Updated November 20, 2024. Accessed July 10, 2025. https://www.lung.org/lung-health-diseases/wellness/back-to-school
3. Silverman RA, Ito K, Stevenson L, Hastings HM. The relationship of fall school opening and emergency department asthma visits in a large metropolitan area. Arch Pediatr Adolesc Med. 2005;159(9):818-823. doi:10.1001/archpedi.159.9.818
4. Managing asthma in the school environment. Environmental Protection Agency. Updated March 21, 2025. Accessed July 10, 2025. https://www.epa.gov/iaq-schools/managing-asthma-school-environment