Breathe Easy During the September Asthma Peak

Did you know that asthma attacks and asthma-related ER visits and hospitalizations rise every September? It’s called the September Asthma Peak.

What is the September Asthma Peak?

Are you or a loved one among the 28 million Americans diagnosed with asthma? If yes, then you should know that September is a peak time for asthma attacks.

This is the month when ER and hospital visits for asthma attacks increase to their highest level of the year, especially among children.

• Asthma cases start to rise in early September.
• The September Asthma Peak Week is the third week of the month. This is the week when asthma-related doctor visits and ER and hospital admissions are at their highest level.
• Asthma-related cases and asthma attacks start to decline in the fourth week of September. They return to normal levels in early October.

Why does the September Asthma Peak happen? September is often a time when adults and children are exposed to more allergy and asthma triggers than they were during the summer.

In some areas of the United States, the September surge in cases can begin in late August. In other areas, the surge may occur in October.

Remember: while the spike in asthma flare-ups is highest the third week of September, asthma flares can happen anytime. The best way to stay healthy is to be prepared. Follow your Asthma Action Plan, take medications as prescribed, and know your asthma triggers before symptoms begin. 

Why is Asthma Worse in September?

Many people notice their asthma gets worse in September. Doctors call this the September Asthma Peak. Asthma attacks tend to increase during this time of year. School-age children are affected the most, but adults can also have more asthma symptoms.

There is no single reason why asthma gets worse in September. The rise in asthma cases in September is often caused by a perfect storm of triggers and circumstances.

Children return to school in late summer, where they spend more time in close contact with classmates. Many adults also return to regular work and family routines after the summer. As people spend more time together indoors, respiratory viruses such as the common cold, the flu, COVID-19, and RSV spread more easily. Children often bring viruses home, where they spread to other family members, from siblings to grandparents.

These infections inflame the airways and trigger asthma symptoms. Studies cite respiratory viruses as a primary trigger for asthma attacks in September.

Also in September, fall allergy season begins in many parts of the country. Ragweed pollen is often at its highest level in September. Mold can grow on damp leaves and in wet places after rain. If inhaled, these allergens can inflame the airways and make it harder to breathe.

Spending more time indoors after summer can increase exposure to indoor asthma triggers. Indoor allergens include dust mites, mold, pet dander, and strong odors from cleaning products or air fresheners.

Air pollutants can also play a role. Diesel exhaust from idling school buses, trucks and heavy traffic can irritate the lungs. In some areas, wildfire smoke or thunderstorms can make air quality worse.

Another reason for the September Asthma Peak is that some people stop taking their daily controller medicine during the summer because they feel well. When they return to school or work and are exposed to more triggers, their airways may already be inflamed, making an asthma attack more likely. 

Who is Affected by the September Asthma Peak?

The September Asthma Peak can affect people of all ages. Some groups are at higher risk, however. 

School-age children have the largest increase in asthma attacks during September. When they return to school after summer break, they are exposed to more cold viruses, allergens and other asthma triggers. These may include diesel exhaust from idling school buses and scented air fresheners used in classrooms.

Adults with asthma can also experience worsening symptoms, particularly parents and caregivers of school-age children. Children often bring home respiratory viruses from school, increasing the risk of asthma flare-ups for the entire family.

People with allergic asthma are at risk in the fall. Ragweed pollen, indoor and outdoor mold, and other indoor allergens like dust mites can increase the risk for flare-ups.

People with asthma that is not well controlled are at higher risk. This includes those who stop taking their daily controller medication during the summer because they may be feeling better. Continuing your asthma treatment as directed – even if your symptoms improve during the summer – can help prevent asthma attacks during the September peak.

How Common Is the September Asthma Peak?

Asthma epidemics in September have been reported in many countries. It’s estimated that between 20-25% of all childhood asthma attacks that require emergency medical care occur during September.

In the United States, the highest number of September asthma cases are usually in the Northeast and Midwest. Respiratory viruses such as colds and the flu also start to emerge. Ragweed pollen is potent at the time of year – it’s found everywhere in the United States.

In the South, lingering heat and humidity in September can trigger asthma symptoms. Severe thunderstorms are common at this time of year in the South. Hurricane season continues into November.

And in the West, people with asthma may be impacted wildfire smoke. It can blow hundreds of miles and impact air quality.

The September Asthma Peak phenomenon first made headlines in the early 2000s. September asthma flare-ups were at their highest in 2005. Since then, cases have dropped slightly and stabilized. September remains the leading month for asthma attacks that require hospitalization.

What Can Trigger Asthma During September?

September is a month of transitions. It’s the end of summer and the start of fall. Heat and humidity may decline in the Northeast and Midwest, but ragweed pollen is in full bloom.

September is also the time when people start to spend more time indoors. The U.S. Environmental Protection Agency (EPA) estimates that people spend 90% of their time indoors. That means children and adults are sharing and spreading germs in enclosed spaces during cold and flu season. They are exposed to more indoor allergens.

Here are common asthma triggers in September:

• Respiratory viruses. The common cold, the flu, COVID-19 and RSV are all highly contagious. They can spread easily in indoor spaces. Any respiratory infection can be more severe for people with asthma and lead to an asthma attack. These viruses can result in ER visits and hospitalizations.
• Outdoor allergens. Ragweed pollen is a strong allergen that blooms in early August and sticks around until first frost. Raking or picking up damp leaves in the fall can expose you to mold.
• Indoor allergens. Common indoor triggers include mold, dust mites, pet dander, cockroaches and mice. Any of these can cause allergies to flare up and trigger asthma symptoms. Mold might occur around a leaky faucet. Dust mites are in bedding, carpeting and stuffed animals.
• Exercise. Many schoolchildren begin fall sports or PE classes in September. For adults, the weather is still warm enough to engage in physical activity. Exercise, especially outdoors during ragweed season or when air quality is poor, can trigger asthma.
• Weather changes. As summer turns to fall, the cooler mornings, cold air, and sudden weather changes can trigger asthma symptoms in some people. These weather shifts may also increase airway sensitivity.
• Air pollution. Poor air quality can trigger asthma. Diesel exhaust from idling school buses, trucks, and heavy traffic can linger in the air and irritate airways. Ozone pollution may still be high during warm September days. Fumes can enter classrooms and offices through open windows and vents.
• Wildfire smoke. Wildfires can happen anywhere, but they are most common on the West Coast and in the Southwest. Smoke from wildfires can travel hundreds or even thousands of miles. In recent years, wildfire smoke from Canada has drifted to the Midwest and East Coast. Even if a wildfire is far away, the smoke can cause hazy conditions, worsen air quality and trigger asthma.
• Thunderstorms. Some parts of the country may still have severe thunderstorms in September. (Hurricane season lasts into November.) Although it’s rare, severe thunderstorms can trigger asthma attacks in some people. Heavy rain and strong winds can break airborne pollen into tiny pieces and stir up mold spores, making them easier to breathe deep into the lungs. This can lead to sudden asthma symptoms during or shortly after a storm.
• Strong smells. Strong smells such as perfume, cologne or hair products can cause irritate asthma. Art class or classes that involve woodworking may cause symptoms from strong odors or dust. Some offices and school classrooms sometimes use air fresheners or scented candles that can trigger asthma. Cleaning products can also have chemicals and strong odors.

• Stress. Returning to school, balancing work and family responsibilities, or adjusting to new routines can increase stress. Emotional stress is a common asthma trigger for many people.
• Tobacco smoke and vaping. Exposure to cigarette smoke or e-cigarette aerosol can happen at any time of the year, but it’s worth including as a potential September asthma trigger. Even thirdhand smoke – residue left on clothing, furniture and other surfaces – can affect people with asthma.

Nighttime symptoms are often an important warning sign for asthma. If you wake up at night with coughing, wheezing or shortness of breath, your asthma may not be well controlled.

Talk with an asthma specialist about ways to avoid your triggers. This way you can improve your asthma control before symptoms can become severe.

How to Stay Healthy During the September Asthma Peak?

Preparation is the key to staying healthy during the September Asthma Peak. If you or your child has asthma, here is what you should plan for leading up to and during the month of September:

Schedule an asthma checkup for all family members before September. Discuss your current asthma control at this checkup. Uncontrolled asthma will increase your risk of flare-ups heading into the fall.

Review your Asthma Action Plan. This is a type of treatment plan you develop with your doctor. It details what you should do if you develop sudden asthma symptoms. If necessary, adapt your Asthma Action Plan if your exposure to asthma triggers is higher in September. Also, make sure the school nurse has a copy of your child’s Asthma Action Plan.

Make sure all asthma medications are refilled leading up to September – including before children return to school. Double check the expiration date on your quick-relief inhaler.

Take daily controller inhalers as prescribed, including during the summer months. Studies show the lowest refill rate for asthma medications is in July. At doctor appointments, show how you use your inhaler to confirm you are using it correctly. 

Keep or carry medications at school and work, especially a quick-relief inhaler to treat sudden asthma symptoms.

Identify and avoid asthma triggers, especially if you or your child has allergic asthma. If ragweed season is a problem, exercise indoors. For schoolchildren, talk with teachers about offering the option of staying inside during recess or gym class.

Check indoor air at home, school and work for asthma triggers. Keep windows closed and keep pets away. (At home, keep pets out of the bedroom. At school, ask if the teacher can keep pets out of the classroom.) Wash bedcovers and pillowcases to eliminate dust mites. Talk with the custodial staff at work and school to find out if cleaning chemicals could be causing symptoms.

Check asthma control. Do you or your child use a quick-relief inhaler twice a week in September — or any time of the year? Or have nighttime symptoms? These are signs that asthma may not be well-controlled. Take a quick quiz using the Rules of 2® to determine your level of asthma control at ControlYourAsthma.org. If signs point to poorly controlled asthma, see a healthcare professional right away.

Use a peak flow meter. This is a device that can signal brewing lung problems and alert you to a coming asthma attack.

Get the flu and COVID-19 vaccines early to prevent infections and/or severe symptoms. Flu vaccines are usually available at pharmacies by late August.

Encourage handwashing to reduce the risk of catching a cold or a virus. Many schools and workplaces are providing hand sanitizers.

It’s important to have good asthma control at all times of the year. If you have asthma that is not well controlled despite taking a daily controller medicine, talk with an asthma specialist. You may have moderate to severe asthma. New precision medications called biologics are available for moderate to severe asthma. These medications target the source of symptoms rather than treat the symptoms themselves. 

How Can Parents and Schools Help Children During the September Asthma Peak?

The September Asthma Peak occurs soon after school starts. Parents can start working together with their child’s healthcare provider and the school in the summer months. This can ensure there’s a plan in place for asthma symptoms.

Good communication with school staff and a clear Asthma Action Plan can help keep children healthy all year long.

What Parents Can Do

Parents can lower their child’s risk of an asthma attack by planning ahead.

• Schedule an asthma checkup before school starts in August or September. Talk with the healthcare provider about your child’s level of asthma control.
• Follow the Asthma Action Plan. Share it with the school nurse, teachers, coaches, and other staff. Make sure your child follows the plan
• Take asthma medications as prescribed. Make sure your child stays on schedule with daily asthma controller inhalers, if prescribed.
• Pack quick-relief asthma medicine for school. Give your child a quick-relief albuterol inhaler to carry at school. (Send a spacer if needed.) Check to make sure it is not expired and has enough medicine left. Find out if the school has stock albuterol inhalers on hand for emergencies.

• Check on classroom exposures. Some classes, such as science labs, art, woodworking, or shop classes, may expose students to dust, fumes, chemicals, or strong odors that can trigger asthma symptoms. If your child is starting middle school or high school, review their class schedule before school begins. Before the school year begins, visit classrooms and identify potential asthma triggers. Then work with teachers and the school nurse to reduce your child’s exposure.
• Watch for early warning signs. Coughing, wheezing, shortness of breath, waking up at night, or using a quick-relief inhaler often can signal asthma is getting worse.
• Get vaccines to help prevent illness. The flu vaccine is recommended for all people 6 months of age and older with asthma. Annual vaccines, including COVID-19, are typically available from pharmacies in September.
• Encourage healthy habits. Good handwashing can help prevent children from bacteria and germs. Keep children home if they get sick.

Does your child with asthma also have severe food allergies? Partner with your child’s school to reduce food allergy risk, share an updated emergency care plan, and ensure epinephrine is readily available.

What Schools Can Do

Schools can help children with asthma stay safe.

• Keep a copy of the Asthma Action Plan. Make sure staff, including teachers, coaches and bus drivers, know what to do if a child has asthma symptoms.
• Allow quick access to asthma medicine. Children should be able to get their quick-relief inhaler quickly in an asthma emergency. Follow state and local school policies on stock albuterol inhalers and training.
• Reduce asthma triggers. Keep classrooms clean and dry to prevent mold, including during the summer months. Choose fragrance-free cleaning products when possible.
• Improve air quality. Reduce diesel exhaust by limiting school bus idling near school buildings. Keep heating and air systems working properly.
• Have a plan for poor air quality days. Work with physical education teachers to move class indoors when air pollution, wildfire smoke, or high pollen levels make it unsafe for students with asthma to exercise outside.
• Minimize exposure to strong odors. Ask teachers to not use scented air fresheners or other fragranced products in the classroom.

• Make exercise safe. Children with asthma should be able to join sports and physical education. They may need to use their quick-relief inhaler before exercise if their healthcare provider recommends it.
• Prevent bullying. Research shows children with asthma are more likely to be bullied at school. Create a positive school climate by developing clear anti-bullying policies and encourage respect between all.

Can Students with Asthma Self-Carry Quick-Relief Inhalers at School?

Yes, children with asthma have the right to self-carry and use prescribed quick-relief albuterol inhalers (also called rescue inhalers) under federal and state laws. It is critical that children with asthma have quick access to their quick-relief inhaler to treat symptoms. A delay in treatment can lead to worse symptoms. It can also lead to a life-threatening asthma attack.

How do you know if your child is ready to self-carry at school? Your child must know how to properly use the inhaler. Your child must be able to identify asthma symptoms. Talk with your child’s doctor, the school nurse and teachers to assess readiness.

If your child is not ready to self-carry, work with the school to have a plan for emergency treatment. Find out if your child’s school has stock albuterol inhalers and where the supplies are kept.

At the start of the school year, make sure your child’s teachers understand the self-carry laws. Your child should not be punished for carrying or using their asthma inhaler.

How Does the September Asthma Peak Affect Adults?

Most September asthma research focuses on the impact on children. But many adults are affected as well.

One reason is that respiratory viruses spread quickly in the fall. Children often catch a cold or the flu at school and bring it home with them. Or adults may get a virus in the workplace. At home, viruses then spread to other family members, from siblings to grandparents.

For people with asthma, respiratory viruses are one of the leading causes of asthma attacks in September. Viral infections can inflame the airways, making breathing more difficult and increasing the risk of severe symptoms.

Older adults and people with other health conditions may be more vulnerable to serious illness. This makes it even more important to keep asthma under good control.

Adults can lower their risk by taking their asthma medicines as prescribed and following their Asthma Action Plan. Stay up to date on vaccines, practice good hand hygiene, and seek medical care if asthma symptoms begin to worsen.

How to Manage Asthma During the September Asthma Peak?

Don’t let the September asthma peak catch you by surprise. You can lower your risk by planning ahead.

Take your asthma medicines as prescribed, follow your Asthma Action Plan, and always carry your quick-relief inhaler. Prevent asthma attacks by avoiding respiratory viruses, fall allergens, smoke, strong odors and poor air quality when you can.

Get enough sleep, manage stress, and stay up to date on recommended vaccines. If your asthma symptoms get worse or you need your quick-relief inhaler more often, contact your healthcare provider for a checkup.

Some other important tips:

• Take your asthma medicine the right way. If your healthcare provider prescribes a daily controller inhaler, use it every day as directed – even if you feel well. Controller medicines help reduce swelling and inflammation in your airways. This makes it less likely that asthma triggers, such as viruses, ragweed pollen, or mold, will cause an asthma attack during the fall. If your asthma is still not well controlled, talk with your healthcare provider. They may recommend changing your medicine or adding a different treatment.
• Use your inhaler correctly. Using your inhaler with the correct technique helps more medicine reach your lungs. Ask your healthcare provider or pharmacist to watch your inhaler technique and make sure you are using it correctly. If you use a metered-dose inhaler, ask whether a valved holding chamber or spacer could help. A spacer attaches to your inhaler and helps deliver more medicine into your lungs. It can be especially helpful for children and older adults.
• Know your asthma triggers. Learn what causes your asthma symptoms and try to avoid those triggers when you can. Common fall triggers include respiratory viruses, ragweed pollen, mold, dust mites, smoke, and strong odors. Keep a diary of your symptoms and what you were doing before they started.

It’s also important to make sure you have a strong immune system to fend off respiratory viruses that begin to increase in September.

What are some tips to boost your immune system?

Healthy lifestyle choices and basic hygiene can help boost your immune system or your child’s immune system. This can help prevent the spread of germs at home, school and work year-round. It’s also an important part of reducing the risk of an asthma attack.

Get vaccines for all family members.

The flu vaccine is recommended for everyone ages 6 months and older. It’s especially important for people with asthma and older adults. The COVID-19 vaccine is also recommended for people with asthma. Getting the vaccines provide important protection and reduce the risk of severe illness.

Most children get the pneumonia vaccine as part of their routine childhood shots. The pneumonia vaccine is also recommended for:

• children ages 5-17 with asthma;
• adults ages 18-49 with asthma or COPD; and
• all adults 50 years of age or older.

Reduce daily stress.

Stress can impact our ability to fight illness. Develop daily routines to make your day less stressful. Practicing yoga or meditation and listening to music can help. Talk with a close friend to help relieve stress.

Exercise every day.

Regular, moderate exercise can keep your lungs healthy. This can include 30 minutes of exercise five times a week for adults, and 60 minutes of exercise every day for children. Daily physical activity also helps heart health and leads to a greater sense of well-being.

Eat a healthy diet.

Eat a balanced diet high in fruits, vegetables and whole grains and low in saturated fats. This can contribute to good health and support a healthy immune system. It’s also important to stay hydrated, especially if it’s warm outside. Keep a bottle of water close by during the day.

Get enough sleep.

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

Establish good personal hygiene.

Wash hands often and cover your cough and sneezes with your elbow. These simple actions can help keep germs from spreading. They can protect you and those around you. 

How Can College Students Manage the September Asthma Peak?

College students can experience asthma symptoms when they return to campus after summer break.

Living in dorms, attending crowded classes and participating in campus activities can increase exposure to respiratory viruses. Fall allergies, air quality issues, stress and changes to a daily routine can make asthma harder to control.

Some practical tips for college students with asthma:

• Develop a routine for taking asthma medication. When you arrive on campus, make a plan to take your daily asthma controller at the same time every day. For example, keep your inhaler by your toothbrush and when you brush your teeth each morning, take your daily dose. Keep your quick-relief inhaler in your backpack.
• Keep your living space clean. Whether you live in a dorm, apartment, or shared house, dust regularly, wash your bedding often, and report water leaks or mold right away. Ask roommates not to smoke, vape, or use heavily scented products indoors.
• Help prevent illness. College campuses bring together people from many places, making it easier for viruses to spread. Avoid close contact with people who are sick. Find out if your campus health center offers flu and COVID-19 vaccines or get them at your local pharmacy.

• Check air quality before spending time outside. Many college students walk or bike across campus, exercise outside, or attend outdoor campus activities. On days with high pollen counts, ozone, wildfire smoke, or poor air quality, limit going outside when possible.
• Know when to get help. If you’re using your quick-relief inhaler more often to treat asthma, or you have nighttime symptoms regularly, these could be signs your asthma is not well-controlled. Make an appointment at your campus health center or your healthcare provider.