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Managing Asthma in the School Environment

Asthma Management: A Priority for Schools

  • An average of one out of every 10 school-age children has asthma
  • Asthma is a leading cause of school absenteeism.
  • Each year, 10.5 million school days are missed due to asthma.
  • Asthma can be controlled through medical treatment and management of environmental triggers.
  • Asthma is a serious, sometimes life-threatening respiratory disease that affects 24.6 million Americans, including 7.1 million children. Although there is no cure for asthma, it can be controlled through medical treatment and management of environmental triggers1.

On this page:


Take Action to Manage Asthma in the School Environment

  1. Develop an IAQ management program in your school or district that includes asthma management strategies. Use the "Framework for Effective School IAQ Management" to improve the school environment, safeguard children's health and reduce exposure to environmental asthma triggers.
  1. Develop an asthma management plan, outlining policies on the use of inhalers and other medication, as well as emergency procedures for asthma attacks. Obtain Asthma Action Plans from students’ parents or doctors outlining students’ triggers, medications and emergency contact information. Ensure that your school nurse tracks this information, as well as key student health indicators, such as the number of asthma attacks, headaches, coughs, fevers and itchy eyes.
  1. Use the IAQ Tools for Schools Action Kit to identify, solve and prevent IAQ problems that may exacerbate asthma symptoms. Conduct a walkthrough of your school buildings using the IAQ Tools for Schools Action Kit checklists to determine whether asthma triggers exist. If triggers are found, develop and implement a remediation plan. For more information on conducting a school walkthrough, access resources from the Virtual School Walkthrough webinar, with IAQ expert speakers David Blake at the Northwest Clean Air Agency and Richard Prill at Washington State University.
  1. Offer education on environmental asthma triggers and management strategies for teachers, custodians and other school staff. Encourage teachers to incorporate information on the symptoms and dangers of asthma and the importance of quality indoor environments into appropriate lesson plans, such as in science, math, language arts or health classes.
  1. Check out EPA’s resources to learn how to make a difference for students with asthma:
 

Visit EPA's Asthma webpage for information on common asthma triggers and how to manage them; asthma education programs available in your community; and no-cost resources that schools can use to educate students and staff about asthma.

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Asthma and Absenteeism

Asthma is the leading cause of school absenteeism due to a chronic condition, accounting for nearly 13 million missed school days per year.

Asthma has reached epidemic proportions in the United States, affecting millions of people of all ages and races. An average of one out of every 10 school-age children now has asthma, and the percentage of children with asthma is rising more rapidly in preschool-age children than in any other age group.

Asthma is a leading cause of school absenteeism due to a chronic condition, accounting for nearly 13 million missed school days per year. Asthma also accounts for many nights of interrupted sleep, limits activity and disrupts family and caregiver routines.

Asthma symptoms that are not severe enough to require a visit to an emergency room or to a physician can still be serious enough to prevent a child with asthma from living a fully active life.

Asthma is a long-term, inflammatory disease that causes the airways of the lungs to tighten and constrict, leading to wheezing, breathlessness, chest tightness and coughing. The inflammation also causes the airways of the lungs to become especially sensitive to a variety of asthma triggers. The particular trigger or triggers and the severity of symptoms can differ for each person with asthma.

Because Americans spend up to 90 percent of their time indoors, exposure to indoor allergens and irritants may play a significant role in triggering asthma episodes. Some of the most common asthma triggers found in schools, as well as techniques to mitigate them, are addressed on this page's section:

 

Each day, one in five Americans occupies a school building. The majority of these occupants are children. Environmental asthma triggers commonly found in school buildings include:

  • respiratory viruses
  • 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.

Secondhand smoke and dust mites are other known environmental asthma triggers found in schools. Children with asthma may be affected by other pollutants from sources found inside schools, such as:

  • unvented stoves or heaters
  • common products including:
    • chemicals
    • cleaning agents
    • perfumes
    • pesticides
    • sprays.

In addition, outdoor environmental asthma triggers, like ozone and particle pollution, or bus exhaust, can affect children with asthma while at school.

Students with uncontrolled asthma often miss more school and have poorer academic performance than healthy students. With the help of strong school asthma management programs, students with asthma can have equally good school attendance. When asthma is well controlled, students are ready to learn.

Effectively managing a child's asthma is best accomplished through a comprehensive plan that addresses both the medical management of the disease and the avoidance of environmental triggers. Because children spend most of their time in schools, day care facilities or at home, it is important to reduce their exposure to environmental asthma triggers as much as possible in each of these environments. This publication focuses on steps that schools can take to help children breathe easier.

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Develop an Asthma Management Plan in Your School or District

As you develop your district's or school's Asthma Management Plan, consider incorporating the following activities for quality asthma management:

An IAQ management program that does not address asthma will not be able to address environmental health risks comprehensively, because IAQ and asthma are inextricably linked. By managing IAQ, you are already taking an important first step to managing asthma in your school or district. However, IAQ is only one component of effective asthma management.

To address asthma on all fronts, it is important to have an asthma management plan. If you are using theIAQ Tools for Schools Program and "Framework for Effective School IAQ Management," you most likely have the sustainable programmatic infrastructure in place to address this critical need in a more measurable, targeted and intentional way.

The components of CDC's "Strategies for Addressing Asthma within a Coordinated School Health Program," described below, form the foundation for an effective asthma management plan.

  1. Establish management and support systems for asthma-friendly schools.
  2. Provide appropriate school health and mental health services for students with asthma.
  3. Provide asthma education and awareness programs for students and school staff.
  4. Provide a safe and healthy school environment to reduce asthma triggers.
  5. Provide safe, enjoyable physical education and activity opportunities for students with asthma.
  6. Coordinate school, family and community efforts to better manage asthma symptoms and reduce school absences among students with asthma.

For more information, download the following guidance documents:

It is important to identify all students with asthma through monitoring morbidity associated with asthma, for example, frequent episodes at school, health room visits, limited physical activity, needing to leave school early or absenteeism. This can help to assess which programs or monitoring activities your school or district should implement. Focus resources on students whose asthma is not well controlled in order to promote improved school attendance and performance.

In order to identify what works and how you can improve the design and delivery of your school asthma management plan, it is essential to monitor program effectiveness. CDC and EPA offer resources on evaluation guidance specifically for asthma programs. To view a Webinar entitled "Evaluating School-based Asthma Programs," visit:

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Controlling Common Asthma Triggers Found in Schools

Many factors found in the indoor and outdoor environment can cause, trigger, or exacerbate asthma symptoms. Some common environmental asthma triggers found in schools are listed below, along with suggestions for managing each common trigger:

Asthma Triggers Found in Schools Asthma Management Tips for Schools

Environmental Tobacco Smoke - Environmental tobacco smoke is a mixture of smoke from the burning end of a cigarette, pipe, or cigar and the smoke exhaled by the smoker.

Eliminate Exposure to Environmental Tobacco Smoke

Enforce no-smoking policies in schools.

Pests - Cockroach body parts, secretions, and droppings, as well as the urine, droppings, and saliva of other pests (such as rodents) are often found in areas where food and water are present.

Control Pest Problems

Use Integrated Pest Management (IPM) to prevent cockroach and other pest problems (e.g., store food in tightly sealed containers and place dumpsters away from the building).

Mold - Mold can grow indoors when mold spores land on wet or damp surfaces. In schools, mold is most commonly found in bathrooms, kitchens, basements, around roof seams and plumbing, and in portable classrooms and trailers. Mold can grow anywhere that moisture is present.

Clean Up Mold and Moisture

Fix leaks and moisture problems and thoroughly dry wet areas within 24-48 hours to prevent mold growth. Clean hard, moldy surfaces with water and detergent, then dry thoroughly.

Dust mites - Dust mites are too small to be seen but can be found in almost every home, school, and building. Dust mites can be found in school carpeting, upholstered furniture, stuffed animals or toys, and pillows.

Reduce Dust Mite Exposure

Make sure schools are dusted and vacuumed thoroughly and regularly, and keep classrooms free of clutter. If stuffed toys are present, ensure they are washable and wash them regularly in hot water.

Animal dander - Pets' skin flakes, urine, and saliva are often found in classrooms and science labs. Any warm-blooded animal, including cats and dogs, may trigger asthma.

Control Animal Allergens

Remove classroom animals from the school, if possible. If not, locate animals away from sensitive students and ventilation systems.

Other Sources of Indoor Air Pollutants:

Usually the most effective way to improve IAQ is to eliminate individual sources of pollution or to reduce their emissions. Common sources of indoor pollution include secondhand smoke, school bus diesel exhaust coming into the school building, the off-gassing of furnishings and flooring, and chemicals from cleaning products. The following pollutant sources are especially important to control:

  • School Bus Exhaust. Passing no-idling policies near the school building can reduce the indoor air pollution from school bus exhaust.
  • Cleaning Products. Choosing the least-toxic cleaning methods and selecting appropriate products are important components of pollutant control. Fumes from cleaning products can linger long after they have been applied, which can exacerbate asthma symptoms and expose students and staff to potentially harmful substances.
  • Chemical Management. The School Chemical Cleanout Campaign gives K-12 schools information and tools to responsibly manage chemicals. A successful chemical management program meets the unique needs of each school and ensures that all schools are free from hazards associated with mismanaged chemicals.

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Additional Resources

U.S. Environmental Protection Agency 

Asthma Community Network

  • The Asthma Community Network Exit serves as a year-round resource for mentoring and collaboration. It's designed to provide the tools, information and partners to support asthma management programs to communities and schools.

Statistics are from National Health Statistics Reports, "Asthma Prevalence, Health Care Use, and Mortality: United States, 2005-2009" (PDF) (15 pp, 229K, About PDF). Lara J. Akinbami, M.D., Office of Analysis and Epidemiology, National Center for Health Statistics; Jeanne E. Moorman, M.S., National Center for Environmental Health; and Xiang Liu, M.Sc., Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. Dept. of Health and Human Services, Number 32, January 12, 2011.