Managing Asthma in School: A Guide for Schools

  1. Home
  2. |
  3. Allergies and Asthma at School...
  4. |
  5. Managing Asthma: A Guide for...

Table Contents

Asthma is a leading cause of chronic disease-related school absenteeism. Students experience fewer missed days from school when parents and school administrators work together to address risk factors for students with asthma at school. Understanding “what is asthma,” coupled with a healthy school environment, can improve asthma management in school.

Photo of smiling little school kids in school corridor

Do schools need an asthma policy?

School personnel and school nurses need to develop policies and plans so they are prepared to deal with asthma at school. This includes:

  • asthma training for school personnel
  • asthma education in schools
  • effective asthma management programs

An asthma management plan to reduce asthma triggers should also be addressed to improve a student’s health. Allergy & Asthma Network offers tools to keep children safe at school and for professionals to access resources.

Asthma management and school health services

It is vital to identify your students with asthma as soon as possible in order to meet their individual health needs. Schools should be aware of environmental health issues. They should develop prevention strategies to create asthma-friendly schools.

COVID-19 Recommendations for Back to School

Photo of school nurse with a stethoscope checking a teen student's heart rate.

How do schools deal with asthma?

Schools should have sound school health policies and protocols in place for managing asthma in the school setting. Asthma programs should address how to care for students who are known to have asthma as well as those students who experience their first symptoms at school. The policies should include (but aren’t limited to):

  • students covered by the policy
  • school programs and environments covered
  • medication administration, documentation and storage
  • identifying staff members authorized to administer the medication
  • a planned response in case of an emergency
  • education, training and notification, including asthma information for teachers
  • a school district communication plan

A district or school protocol should describe the appropriate procedures or guidance to follow for the care of students with asthma. It’s especially important to have protocols in place that outline emergency care, medication use and stock albuterol.

Asthma and school: a simple protocol

Children with asthma benefit from a protocol to manage asthma and to guide care.

  • Set up a medication system for maintenance and emergency medications.
  • Meet with parents (as needed) to build a trusting relationship and obtain:
  • Communicate with faculty, school nurses, and staff to alert them to student health needs.
  • Provide asthma education to staff as needed.
  • Review symptoms of asthma with all staff and post signs of symptoms in classrooms.
Download Back to School Checklist for School Nurses ➡

Asthma Signs & Symptoms – A Guide for Schools

Thumbnail graphic of Asthma Symptoms for School Staff Print and display above phone in each classroom.

School Staff should know the following about asthma and allergies:

➤ Signs and symptoms

➤ Common risk factors, triggers and/or allergens

➤ How to prevent asthma flares / allergy exposures

➤ Never send a child to the School Health Office alone

➤ What are the signs and symptoms of an emergency

➤ How to respond to an asthma or allergy emergency

➤ Needed medication

➤ How to administer medication

➤ How to access emergency medical services as needed (911)

Photo of children running down the hallway of a school

Asthma management program during the school year

  • Touch base with students with asthma to discuss management of their health condition at school.
    • Assess their ability for self-care and self-medication.
  • Obtain medications, medication orders and Asthma Action Plan if not previously completed.
  • Track expiration dates for medications.
  • Write an Individualized Healthcare Plan.
  • Develop written Emergency Care Plan as needed with family and student input.

What should the school or school nurse do at the end of the school year?

When a parent or guardian picks up medication stored at school:

  • Return unused medication.
  • Provide medication forms.
  • Request personal Asthma Action Plan to be completed for the next school year.
  • Remind the parent to make an appointment with the doctor to get a health update and forms completed. Doctor’s offices can get VERY BUSY close to the start of school.
  • Discuss progress made in self-management at home and school.

Asthma training and education for schools

School employees should know the following about asthma and asthma care:

  • asthma signs and symptoms
  • common risk factors and asthma triggers
  • how to prevent asthma flares
  • never send a child to the School Health Office alone
  • what are the signs and symptoms of an emergency
  • how to respond to an asthma emergency
  • needed medication, such as a quick-relief inhaler
  • how to administer the medication
  • how to access emergency medical services as needed (911)
  • how to manage activities, environmental triggers, and use daily air quality information

The school nurse, teachers and athletic coaches should have a copy of the child’s Asthma Action Plan.

School nurses and teachers can help children with asthma feel comfortable talking about their condition. Try to maintain confidentiality if preferred. Educate other students about asthma so they will be more understanding and know when to get help from an adult.

Consider using multiple teaching approaches to educate staff. Teaching methods may include:

  • group educational session at a faculty meeting
  • small group approaches during a team meeting
  • individual sessions for teachers who are responsible for students with severe asthma.

Reinforce the teaching through faculty newsletters, reading materials in the faculty room and individual notes or emails.

What Asthma Action Plan should be used at school?

Allergy & Asthma Network recommends the School Asthma Management Program (SAMPRO) Asthma Action Plans and resources.  The SAMPRO resources were developed with multiple stakeholders under the direction of the American Academy of Asthma, Allergy & Immunology (AAAAI) and the National Association of School Nurses (NASN).  The Asthma Action Plan is available in English and Spanish. You can add the school district’s logo if desired. 

You can find the SAMPRO resources here ➡

Photo of teacher standing in a classroom with students at their desks.

Questions & Answers on Asthma at School (Q&A)

The following is a list of questions we often get from schools, parents, and school nurses.

How do schools help kids with asthma?

Schools provide services that allow students with asthma to fully participate in their educational program. Schools follow guidance from a student’s healthcare provider. Care is provided to manage asthma symptoms, respond to asthma episodes, and help the student participate in physical activities.

How does asthma affect a child in school?

Students bring their asthma to school. The school must be aware of the student’s asthma triggers to help prevent asthma flares. When their asthma is well controlled, students can participate in the classroom as well as in sports and physical activities.

What is an asthma-friendly school?

An asthma-friendly school addresses a student’s physical, social and environmental needs. It aims to provide a healthy school environment. The “Asthma-Friendly Schools” program from the American Lung Association offers a toolkit to assist schools with guidance.

What can a school nurse do for asthma?

School nurses assess breathing and respiratory symptoms to determine the health condition of a student with asthma. The nurse plans for student care by:

  • writing an individualized healthcare plan and/or emergency care plan
  • providing education to help students to learn to self-manage their asthma condition.

How can teachers help students with asthma?

Teachers should learn what a student’s asthma triggers are and work to reduce known triggers in the classroom environment. The teacher can develop a trusting relationship and help the student feel comfortable in sharing when they are experiencing asthma symptoms. The teacher can treat the student’s health condition confidentially and encourage full participation in the school’s educational program.

What are effective ways for school staff members to help students with asthma?

School staff members can be aware of the need to reduce asthma triggers in the school environment. They can create an environment that doesn’t single out the student with asthma while ensuring that they have full access to routine and emergency medication as needed.

What are the first aid steps for asthma?

Students who experience an asthma attack at school should never be left alone. The school nurse should be contacted as soon as possible to conduct a health assessment. An albuterol inhaler is the first-line treatment for quick relief of asthma. In compliance with school district protocols, it should be given as soon as possible. If symptoms worsen, 911 should be called to respond to a breathing emergency.

What are some management strategies for asthma?

Each student’s asthma is unique to them and will require unique interventions. However, there are some strategies that are fairly universal. Students often benefit from schools doing the following:

  • Identify asthma triggers and reduce triggers in the school environment.
  • Develop a system that includes routine and emergency medications.
  • Develop written care plans as needed.
  • Provide education for students, families and school staff.
  • Make school a safe and supportive place for children with asthma.

How can teachers reduce the risks of asthma in the classroom?

Teachers can help create a classroom environment that reduces or eliminates a student’s asthma triggers. Identify possible triggers, such as:

  • Mold from excess moisture in the building
  • Cockroaches, mice and other pests
  • Dander from animals in the classroom
  • Dander brought in on clothing from pets at home
  • Secondhand smoke
  • Chemicals from cleaning products
  • Chalk dust
  • Perfume, cologne and/or plug-in air fresheners

In addition, outdoor allergens and irritants such as pollen or school bus exhaust can enter classrooms through open doors or windows.

Teachers can work with the school’s custodial staff to remove mold, get rid of pests, and use cleaning products that are not harmful to people with asthma. Don’t keep a classroom pet, don’t wear perfume or cologne and don’t use plug-in air fresheners.

Teachers should also be aware of asthma symptoms and be ready and willing to seek care for their students with asthma when needed. They can support students with asthma by encouraging a school community and classroom that is free from bullying.

Why is asthma education important?

Awareness and education go hand in hand in creating safe and supportive environments for students with asthma. When asthma is in control and education is in place, students can fully participate in their educational program without limits to their physical activity.

What are the most common triggers for asthma attacks in school?

The U.S. Environmental Protection Agency (EPA) identifies the most common asthma triggers at school as:

  • cockroaches and other pests
  • mold resulting from excess moisture in the building
  • dander from animals in the classroom
  • dander brought in on clothing from animals at home

What can schools do to reduce the incidence of asthma attacks?

Schools can assess their indoor air quality as a part of their program to reduce triggers for asthma in school. Knowing a student’s triggers and removing as many as possible from the school environment can improve a student’s breathing and possibly reduce the need for medication.

Does school bus exhaust trigger asthma?

School bus exhaust releases small particles into the air that can settle deep into a student’s lungs. The particles can contain toxic air pollutants that can irritate the airway and cause or worsen asthma symptoms.

How does asthma affect school attendance?

According to the U.S. Centers for Disease Control and Prevention (CDC), asthma is the number one cause of children missing school. Sometimes it’s difficult for parents to decide when to keep their child with asthma home from school. Allergy & Asthma Network developed a resource “When to Keep Your Child with Asthma or Allergies Home from School” that may be helpful.

What is an asthma care plan?

There are several kinds of care plans used for asthma at school:

  • Asthma Action Plan – outlines asthma care based on symptoms.
  • Individualized Healthcare Plan – for students that require more complex care at school. It’s written by the school nurse to direct nursing care.
  • Emergency Care Plan – for students whose asthma is likely to result in a medical emergency. It’s written in non-medical language to help guide parents, students and school staff.

Who can fill out an Asthma Action Plan?

The student’s healthcare provider should complete the Asthma Action Plan. It is based on the provider’s assessment and medical orders.

What should be included in an Asthma Action Plan?

Asthma Action Plans usually provide the child and family with steps to follow depending on their current symptoms:

  • Green Zone – daily care when symptoms are under control
  • Yellow Zone – actions to take when student is beginning to experience an asthma attack
  • Red Zone – steps to follow when asthma becomes an emergency

How can coaches and gym teachers help student-athletes manage asthma?

Parents, gym teachers and athletic coaches should meet at the beginning of the school year to discuss a child’s asthma. They can also meet prior to the start of a sports season. Gym teachers and coaches should get a copy of the Asthma Action Plan and keep it with them, such as on a clipboard during practices or games.

Coaches and gym teachers should make sure the child always has a quick-relief albuterol inhaler at gym class, practice and/or games. The child, the coach and gym teachers should know where the quick-relief inhaler is at all times. If the school has stock albuterol, they should speak with the school nurse about access to the medication. They should know how to administer the medication in an emergency.

Coaches should also be supportive and encouraging. Some children with asthma, especially those in middle school or high school, tend to hide their symptoms because they don’t want to appear different. Let them know other children have asthma and that coaches and teachers are there to help.

What are evidence-based resources to use as a part of school-based asthma management policies?

Allergy & Asthma Network has valuable, evidence-based resources for schools and school nurses.

The U.S. Centers for Disease Control and Prevention (CDC) offers resources for school personnel on planning and maintaining as asthma management program. CDC’s National Asthma Control Program (NACP) has also developed EXHALE, a set of six strategies that contribute to better asthma control.

Each EXHALE strategy can reduce asthma-related hospitalizations, emergency department visits, and healthcare costs. Using the EXHALE strategies together in a community can have the greatest impact.

The U.S. Environmental Protection Agency offers resources to help schools identify and reduce potential asthma triggers at school.

CDC Asthma Resources for Schools

EXHALE Resources from Allergy Asthma Network

Posters for Schools

Managing Asthma in the School Environment from the EPA

School Health Resources ➡

School Nurse Chronic Health Assessment Tool – SN CHAT

A tool developed for school nurses by a school nurse, SN CHAT offers tools and resources to help school nurses manage chronic health conditions in the school setting.

School nurses can use SN CHAT®:

  • Guide conversations in person or via phone with a student’s parent, guardian, or caregivers
  • Learn about the health needs of an individual student
  • Decide if you should create a school plan for a student, which may include an Emergency Action Plan (EAP) and/or an Individualized Healthcare Plan (IHP)

Asthma resources are available for schools and school health professionals

Understanding Asthma (in English and Spanish)

Reviewed by:
Andrea Jensen, AE-C, CHES, is a certified asthma educator and certified health education specialist. She is an environmental health educator with the Utah County Department of Health. Andrea is the mother of three children with asthma and has asthma herself. She authors the “My Life As an Asthma Mom” blog.