Adult taking young child with backpack into school

If the past predicts the future, then September is sure to be a challenging month for children with asthma. Research shows what parents have known all along: asthma attacks requiring a hospital or ER visit start to spike in early-to-mid September and decline in mid-October.

Approximately 25% of all children’s asthma hospitalizations occur in September. Doctors even identified the third week of September as the peak week for asthma attacks, hospitalizations and ER visits.

Schoolchildren spend anywhere from 800 to 1,100 hours in school every year. A healthy school environment is a key factor in asthma and allergy management in schools.

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Why Does the September Asthma Peak Happen?

  • Return to school means exposure to multiple allergens (indoor mold, animal dander) and respiratory irritants (air pollutants from idling school buses)
  • High levels of ragweed and mold allergens in outside air
  • Greater exposure to cold germs and viruses, including the flu
  • Irregular medication use from summer months – when children don’t follow their asthma medication schedule in summer, they are more at risk for asthma flares in September when they’re exposed to more allergens and triggers
  • Anxiety and stress associated with the new school year

What are common asthma symptoms?

  • Coughing: Coughing from asthma is often worse at night or early morning (called nocturnal asthma)
  • Wheezing: A whistling sound when breathing out.
  • Chest tightness or chest pain: An intense heaviness on the chest.
  • Shortness of breath: You’re unable to catch your breath. Sometimes you may not be able to speak, especially during an asthma flare.

What are some common triggers of asthma in September?

September is, in many ways, a month of transitions. It is the end of summer and the start of fall. The heat and humidity may cool off, but ragweed is in abundance.

September is also when millions of children head off to school. And it’s when flu and cold viruses tend to emerge. Many children are exposed to more risk factors that can trigger allergies and lead to an asthma attack.

Common asthma triggers:

  • Indoor allergens – Children start to spend more time indoors, either in school or in the home doing homework. They may be exposed to allergens, such as mold, pet dander, dust mites and cockroaches, that can cause an allergic reaction.
  • Outdoor allergens – Ragweed is a potent allergen that emerges in early August and sticks around until first frost.
  • Irritants – Diesel exhaust from school buses can linger in the air outside the school. It can also enter classrooms through open winders.
  • Tobacco smoke – Cigarettes are frequent asthma triggers, whether inhaled by smoking or via secondhand smoke.
  • Exercise-induced asthma – Physical activity can trigger symptoms in September, especially when exercising outdoors during pollen season.
  • Viral respiratory infections – Cases of colds, flu and sinus infections rise in September. The COVID-19 virus and its variants are considered highly contagious. People with moderate to severe asthma are high risk for more severe complications if they are diagnosed with COVID-19.
  • Stress – New grades, new classrooms, new teachers and increased homework could cause increased anxiety and make asthma worse.
  • Cold air – In some parts of the United States, cold air arrives in September. Some children may experience a rise in symptoms due to cold air or sudden changes in temperature.
  • Strong smells – Teachers and classmates may wear scented products such as perfume, cologne or hair products. Some teachers may use air fresheners (including the plug-in kind) in their classrooms. Cleaning products used in school can also contain chemicals and odors. These can all trigger asthma attacks.

What are ways to keep a child healthy during the September Asthma Peak?

Preparation is the key to keeping your child healthy. Review your child’s Asthma Action Plan. This is an individualized plan of prevention and treatment that lays out what to do if symptoms arise. Many schools require it be kept on file.

  1. Schedule an asthma checkup with your child’s doctor before the school year begins.
  2. Make sure all asthma medications are refilled prior to start of school year.
  3. Take long-acting asthma medicines as prescribed by your child’s doctor.
  4. Keep or carry medications at school, particularly a quick-relief inhaler to treat asthma when symptoms suddenly worsen.
  5. Keep a peak flow meter, a device that signals brewing lung problems.
  6. Encourage frequent handwashing to reduce risk of catching a cold or a virus.
  7. Identify and avoid asthma triggers, especially if your child has allergic asthma. If pollen is a problem, talk with teachers about staying inside from outdoor activities.
  8. Get the flu and COVID-19 vaccine to prevent infections and/or severe symptoms.
  9. Follow the Asthma Action Plan and provide one to the school nurse.
  10. Maintain good asthma control throughout the entire year, even if symptoms are well controlled during summer.
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What are some ways to get a child involved in self-managing asthma to avoid flares?

Involve children in the conversation about asthma management. Help them understand when, why and how to take medications and other ways to keep asthma under control. Review their inhaler technique periodically – ask your doctor about using a valved holding chamber, a handheld device that attaches to the inhaler and directs the medicine to the airways.

Is there anything else to do to help a child avoid catching colds, flu and other viruses?

Here are some tips to boost the immune system:

Healthy lifestyle choices and basic hygiene can go a long way toward boosting your child’s immune system and preventing the spread of germs at school year-round.

Make sure all family members get the flu And COVID-19 shot before school starts.

It’s recommended for everyone ages 6 months and older and those diagnosed with chronic disease, including asthma. Also it’s recommended you get the COVID-19 vaccine.

Reduce daily stress.

Stress can impact our ability to fight illness. Establishing daily routines and expectations can make the day less stressful. Yoga, meditation and listening to music can help. Having a close friend can help buffer effects of stress.

Exercise every day.

Regular, moderate exercise – 30 minutes five times a week for adults and 60 minutes every day for children – is associated with improved lung health. It’s also linked to a greater sense of well-being and promotes cardiovascular fitness.

Eat a healthy diet.

A balanced diet high in fruits, vegetables and whole grains and low in saturated fats contributes to good health and supports a healthy immune system.

Get enough sleep.

People who don’t sleep enough have less ability to fend off colds, flu and other illnesses. Sleep needs vary individually and by age, but on average adults need 7-9 hours of sleep a night and school-age children need 9-11 hours of sleep.

Establish good personal hygiene.

Wash hands regularly and cover your cough/sneezes with your elbow. These simple actions keep germs from spreading and protect you and those around you.

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