Managing Asthma at School
A safe, healthy school environment is important for students with asthma. It supports their respiratory health and well-being, helps them stay focused, and increases their opportunities for success in the classroom.
Asthma is one of the leading causes of missed school days. Since students spend most of the year in school, it’s important that asthma is managed just as carefully at school as it is at home.
When parents and school staff work together, students with asthma are more likely to stay in school and stay healthy. Working together as partners to manage triggers and medications can help keep students with asthma safe.
What are the basic facts about asthma at school?
It’s important for parents and school staff to understand asthma so they can provide effective care and support. According to the U.S. Centers for Disease Control and Prevention (CDC):
- 1 in 12 school-age children are diagnosed with asthma – about 6% of children in the United States have been diagnosed with asthma.
- 26+ million Americans are diagnosed with asthma.
- 13.8 million school days are missed each year due to asthma – it’s the #1 reason students miss school.
- 3 in 5 people limit their physical activity (they should not have to limit activity if asthma is under control).
- Studies show schoolchildren with asthma struggle more in class when their symptoms are not well controlled.
Asthma treatment is always improving. New medicines are available to help control symptoms. A healthcare provider can help choose the best treatment plan for a child with asthma.
Allergy & Asthma Network resources that can help you better understand asthma medications and tools include:
- Asthma Medications and Treatments
- Respiratory Treatments Poster
- Video Series: How to Use an Asthma Inhaler
- BiologicMeds.org(for moderate to severe asthma treatment)
What are the roles of parents and school staff in managing asthma?
Parents play a key role in helping their child manage asthma at school. They should tell school staff about their child’s asthma, provide the school with any needed medications, and turn in all necessary forms. Parents should also let school nurses and/or teachers if their child self-carries their asthma inhaler at school. (This is permissible by law.)
Teachers, school nurses, and other staff can develop effective asthma management programs. This can help them know what to do if a child has an asthma attack or emergency. Clear protocols and plans should be written and set in place so they are easy to follow.
Good communication between parents, teachers and the school nurse helps everyone stay on the same page. Children play a role too. They should learn to talk about their asthma in a way that is appropriate for their age. As children get older, they will need to develop self-management skills as teens and learn when to ask for help.
How can parents prepare their child with asthma for school?
Here are a few things to keep in mind when speaking with your child’s doctor and school staff about preparing your child for school.
Meet with your child’s doctor
Plan ahead and make an appointment with your child’s doctor before the back-to-school rush. It can be harder to get an appointment as it gets closer to the first day of school. During the appointment, talk about your child’s asthma, general health status, and any other concerns you may have.
Be sure to update:
- Medication permission forms
- Prescriptions for medication taken at school
- School forms and care plans, such as an Asthma Action Plan
- Sports physical forms when needed
Meet with your child’s school nurse or school health official
Schedule a meeting before the first day of school with the school nurse and/or school staff. Get teachers involved, if possible, as they are often more hands-on with schoolchildren.
At this meeting, you can provide:
- Updates about your child’s health
- Details on any asthma issues from the summer months
- Information on asthma triggers
- Accommodations needed for your child
- Medication permission from parent and healthcare provider
- Asthma medications, such as a quick-relief albuterol inhaler
- An updated Asthma Action Plan
- Additional prescribed medications
- Written permission to discuss your child’s health with your child’s healthcare team.
Be sure to find out the school nurse’s schedule. Some schools do not have a full-time school nurse. If there is no full-time school nurse, find out which staff member is responsible for giving your child medication.
What are some common asthma triggers at school?
Asthma triggers are found both inside and outdoors. These include allergens, irritants and respiratory viruses such as colds and the flu. (Respiratory viruses passed on from others in school are common asthma triggers.)
Asthma triggers in the classroom may include:
- Mold from excess moisture or leaks in the building
- Cockroaches, mice and pests
- Dander from animals in the classroom
- Dander brought in on clothing from pets at home or on stuffed animals
- Strong smells from cleaning products or air fresheners
Schoolchildren can be exposed to outdoor asthma triggers when outside for gym class or recess, or through open doors or windows. These include common allergens and irritants:
- Pollen (grass, tree or ragweed)
- Smoke from cigarettes
- School bus exhaust – it releases small particles into the air that can settle deep into student’s lungs. The particles can contain toxic air pollutants that can irritate the airway and cause or worsen asthma symptoms.
What asthma symptoms should my child bring to the attention of the teacher?
Every child’s asthma symptoms are unique. It’s important for school staff and classroom teachers to be able to identify asthma symptoms, including the signs of an asthma attack. Symptoms may include:
- Wheezing – a scratchy or whistling sound from lungs when breathing
- Shortness of breath or rapid breathing – possibly associated with activity
- Chest tightness or pain
- Fatigue – student may stop playing or avoid activity
- Coughing – may be continual or happen often
What Asthma Action Plan should be used at school?
Allergy & Asthma Network recommends the School Asthma Management Program (SAMPRO) Asthma Action Plan. 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 multiple languages, including English and Spanish. Read more about Asthma Action Plans.
What types of care plans are there at school for students with asthma?
There are four main types of asthma care plans at school:
- Individualized Healthcare Plan (IHP): A written plan by the school nurse to direct nursing care. This document should be updated often. It explains treatments, education and emergency response.
- Emergency Action or Care Plan (EAP or ECP): A plan written in easy-to-understand language for school staff that explains what to do during a medical emergency.
- Section 504 Plan: A legally binding plan that gives students with health problems extra support and classroom support to help them learn. Students with asthma are eligible for 504 Plans.
- Individualized Education Program (IEP): A written statement of special education needs. It is only used in asthma if an educational disability exists. This is also a legally binding program for students.
How should parents maintain communication with school staff throughout the school year?
Check in with school staff with any concerns about your child’s asthma that may come up during the school year.
Concerns may include:
- Questions about asthma medication
- Use of inhaler at home or school
- Asthma triggers
- Asthma flares at certain times of the year
- School staff readiness to treat an asthma flare
- Asthma treatment (if needed) during field trips
- Issues during recess and physical education class
How can parents handle a change in their child’s condition during the school year?
If your child has an asthma attack, inform the school right away. You should also let the school know if there are any changes in your child’s asthma symptoms or treatment plan.
Keep an eye on the expiration dates of asthma medications your child keeps or carries at school. Be sure to get new prescription filled before the medication you have expires.
A good idea is to put a reminder to refill prescription on your calendar for 3-4 weeks before the medicine runs out. That way, you have time to visit the doctor, get a new prescription, and bring the medication to school.
How do I know when to keep my child home from school?
Is your child not feeling well before school? It can be hard to know when children should go to school and when they should stay home. A chronic health condition like asthma can make that decision even harder. That’s where your child’s Asthma Action Plan comes in. It provides clear guidance on which symptoms to watch for and what steps to take during the school day.
Communication is key. Keep teachers and the school nurse informed if your child is starting to show signs of an asthma flare or is recovering with the help of medication. Working together ensures your child gets support to stay healthy and safe at school.
Missing school can sometimes make kids feel anxious. Keep in mind that anxiety symptoms can look like asthma symptoms. If you think your child is not feeling well due to anxiety, call your healthcare provider to get help for your child.
This chart can help you decide if your child is okay to go to school.
For All Students
| When to Go to School | When to Stay Home |
|---|---|
| No fever for 24 hours | Fever of 100.4° or higher |
| Has energy to participate in school activities | Feels too sick to participate in school activities |
| Occasional cough | Moderate to severe cough |
| Feels good | Shortness of breath |
| No vomiting or diarrhea for 24 hours | Stomach pain |
| Sore throat | |
| Vomiting | |
| Diarrhea | |
| Neck pain | |
| Rash | |
| Bloodshot eyes | |
| Feels extra tired | |
| Needs fever or pain medication to feel good |
For Students with Asthma
| When to Go to School | When to Stay Home |
|---|---|
| Slight wheeze | Sleepness night due to asthma symptoms |
| In Green Zone on Asthma Action Plan | Significant wheezing, coughing, shortness of breath |
| Experiencing asthma flare that is not well controlled with quick relief medication |
Important: Call 911 or go to the hospital or emergency department if you think your child is having an asthma emergency.
If your child is missing a lot of school due to asthma, or has emergency department visits, talk with your healthcare provider, preferably an asthma specialist. You may need to adjust your child’s Asthma Action Plan and medication. It may also help to look at the home or school environment for allergens or irritants that make it harder for your child to breathe. Work with the school to find ways to manage asthma symptoms and reduce asthma triggers.
What should school staff know about asthma?
Every school staff member can help make sure children with asthma are safe at school. Classroom teachers and school health officials should know asthma symptoms, including the signs of an asthma attack. Asthma symptomsmay include:
- Wheezing – a scratchy or whistling sound from lungs when breathing
- Shortness of breath or rapid breathing – possibly associated with physical activity
- Chest tightness or pain
- Coughing – may be continual or happen often
- Fatigue – student may stop playing or avoid activity
Other things school staff should know include:
- Common risk factors, triggers, and allergens that trigger asthma
- Medication types, such as a quick-relief inhaler
- How to administer medication if needed
- Ways to manage activities, environmental triggers, and poor air quality to prevent asthma flares
- Safety protocols, like never sending a child with asthma to the school nurse alone
- Signs and symptoms of an asthma emergency
- Steps to respond to an asthma emergency
- How to access emergency medical services as needed (911)
Teachers and the school nurse can help children with asthma feel safe and supported. If a child wants to keep their asthma private, that should be respected. It is also helpful to teach classmates about the condition. Asthma education can help classmates better understand what the condition is and know when to tell an adult if help is needed.
There are different ways to provide asthma education to school staff, such as:
- Talking about asthma during staff meetings
- Having small group discussions in team meetings
- Meeting one-on-one with teachers who have students with severe asthma
School nurses can remind staff about asthma by:
- Sharing information in staff newsletters
- Posting reading materials in the teacher’s lounge
- Sending emails or notes to staff
How to set up an asthma protocol for school
At the start of the school year, the school nurse should:
- Create a system for keeping and giving daily and emergency asthma medicine.
- Meet with parents (as needed) to build trust.
- Gather a doctor’s note with medicine instructions and asthma medications such as quick-relief inhalers
- Asthma Action Plan
- Tell teachers and staff about student health needs.
- Teach about asthma, including what to do during an asthma attack.
- Go over asthma symptoms with staff and post signs in classrooms and common areas.
These protocols should be checked and updated during the school year to make sure children with asthma get the right care.
Asthma Signs & Symptoms – A Guide for Schools
Print and display above phone in each classroom.
What steps should be taken if a child has an asthma attack at school?
A quick-relief albuterol inhaler is the first-line treatment for an asthma attack. It should be given as soon as possible (in compliance with school district protocols). Assist the child with administering the inhaler, if needed.
Help the child to sit upright. Do not allow the child to lie down. A sitting position is generally more comfortable during an asthma attack.
Stay calm. Students who experience an asthma attack at school should never be left alone. The school nurse should be contacted as soon as possible. Follow steps on the child’s Asthma Action Plan.
Monitor the child’s breathing after the medication. If symptoms worsen, call 911 for emergency medical services. Breathing difficulty and bluish lips or fingernails (which means the child is not getting enough oxygen) are signs the child needs emergency medical help.
How should schools take care of students with asthma?
Schools should have clear policies and protocols to help students with asthma. These should help both students already diagnosed with asthma and those who might have their first symptoms at school. Good asthma policies should include:
- Which students are covered by the policy
- What school programs and environments are included
- How medications are stored, used, and tracked
- Who is allowed to give medicine
- What to do in an emergency
- Training and education for staff
- A school district communication plan
- Prevention strategies to create asthma-friendly schools
Schools should also have clear rules for emergency care, medication use, and stock albuterol.
How to reduce the risk of asthma flares at school?
Parents should tell their child’s teachers and the school nurse about asthma triggers. This could be outside (pollen, mold, school bus exhaust) that may be in the classroom.
Schools can work to reduce exposures:
- Teachers, school nurse and custodial staff can work together to identify and remove mold before the school year starts.
- Keep windows and doors closed to keep pollen and school bus exhaust out of the classroom. Establish a “No Idling” policy for school buses outside the facility.
- Limit outdoor activity on days that have an unhealthy air quality index level, including high levels of pollen. Check the air quality index online at AirNow.gov.
- Keep furry animals out of the classroom. (This includes stuffed animals, which may contain dust mites). Consider goldfish for a classroom pet.
- If cleaning products with harmful chemicals are causing breathing problems, talk with the custodial staff about using nontoxic products.
- Do not allow smoking cigarettes on school grounds.
How can teachers and school nurses manage asthma during the school year?
School nurses do more than just follow a checklist at the start of the year. They help students manage asthma for the entire school year. Here are some things to think about:
- Talk with students about how they take care of their asthma.
- Check if students are ready to self-manage asthma.
- Get needed medicines and forms from parents and doctors, such as an Asthma Action Plan.
- Keep track of medicine expiration dates.
- Write an Individualized Healthcare Plan, Emergency Care Plan or 504 Plan.
- Work with families to keep asthma care up to date.
Teachers 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 is the September Asthma Peak?
September can be a tough month for children with asthma. Asthma attacks in children often increase in early to mid-September, especially during the third week of the month. About 1 in 4 asthma hospital visits occur in September.
Why is this? Research shows children are exposed to more potential triggers when school starts, particularly from respiratory viruses and ragweed pollen.
What can parents and school health services do?
- Schedule an asthma checkup for all family members before September.
- Review your Asthma Action Planwith doctors and school staff.
- Make sure all asthma medications are refilled leading up to the month of September – including a quick-relief inhaler.
- Take controller inhalers as prescribed, even if asthma appears well controlled during the summer months.
- Keep or carry the quick-relief inhaler at school.
- Identify and avoid asthma triggers at school, especially if you or your child has allergic asthma.
- Get vaccines early to prevent infections and/or severe symptoms.
- Encourage frequent handwashing to reduce the risk of catching a cold or a virus.
Read: 10 Ways to Stay Healthy During the September Asthma Peak Week
Download a FREE Copy of How to Avoid the September Asthma Peak
Can children with asthma play sports in school?
Yes! Schoolchildren with asthma can play fully in sports as long as their asthma is under control. Exercise is good for:
- improved respiration and breathing
- better heart health
- Improved mental health and confidence
- Sleep and energy
- Building strong muscles and bones
- Weight control
- Skin health
Students with asthma should follow these tips for exercise or sports
- Talk to your doctor first.
- Start slow and build up your endurance.
- Avoid cold, dry air.
- Listen to your body during exercise.
- Stay hydrated. Stop to drink water regularly.
- Use a quick-relief albuterol inhaler before exercise if prescribed by a doctor.
How to help student athletes with asthma?
Parents should meet with coaches and gym teachers at the start of the year or sports season. Share your child’s Asthma Action Plan.
- Make sure coaches know the symptoms of an asthma attack. Ask coaches to keep the Asthma Action Plan with them, such as on their clipboard during practices or games.
- Make sure your child always has a quick-relief albuterol inhaler at PE, practice and games.
- Confirm the child, gym teacher and coach knows where the quick-relief inhaler is at all times and has quick and easy access to the medication in an emergency.
- Confirm the gym teacher and coach knows how to administer the medication in an emergency.
- Stay in touch with the coach throughout the sports season. Alert the coach to any changes to your child’s asthma and/or treatment plan.
- 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 end-of-school-year tips for managing asthma?
As each school year comes to a close, it’s a good idea to talk with the school or school nurse. Find out how the school year went in terms of your child’s health and what asthma issues occurred that can be improved next school year.
For parents:
- Talk with your child about what went well at school and what can be better.
- Pick up any leftover medicine from school.
- Ask for any healthcare or medication forms needed for next school year.
- Make a doctor’s appointment early to avoid back-to-school rush.
For school staff:
- Return all medicine to parents.
- Give parents forms for next year.
- Ask for an updated Asthma Action Plan.
- Remind families to visit their doctor over the summer the parent to make an appointment.
- Talk about how well the child managed asthma at home and school.
What evidence-based resources are available for managing asthma at school?
Many trusted resources and tools are available for schools to help students with asthma. Here are a few of them.
Allergy & Asthma Network has plenty of helpful tools and information for schools and school nurses.
- Find asthma posters and tools in our online store
- Resources for Healthcare Professionals
- Virtual Asthma Coaching Program
The U.S. Centers for Disease Control and Prevention (CDC) shares asthma resources to help schools start and maintain a strong asthma management program.
CDC’s National Asthma Control Program (NACP) developed EXHALE, a set of six strategies that can help to better manage asthma. When schools and communities use all six EXHALE steps together, they can help reduce asthma attacks, emergency room visits and medical costs.
The U.S. Environmental Protection Agency (EPA) offers resources to help schools identify and reduce potential asthma triggers at school.
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)
Resources from the National Association of School Nurses (NASN)
Reviewed by:
Eileen Censullo, RRT, is a respiratory therapist. She currently serves as Director of Network Relations for the American Heart Association. She was on the executive board of the Pennsylvania Society for Respiratory Care from 1995 to 2015. She has also served as Respiratory Care Manager at Taylor Hospital in Ridley Park, Pennsylvania.
