Avoiding the "September Epidemic"

Most people associate the cold-and-flu season with the cold, dark days of late fall and winter. But as soon as children get back to their classrooms after the school summer break and start swapping germs, the incidence of respiratory infections rises sharply. Colds due to rhinovirus peak in September, with other viral infections also increasing. While this poses a problem for all children, those with asthma are particularly at risk of more severe illness.

Viral infections cause more than 80 percent of asthma “attacks” (or exacerbations) in children and more than half of all asthma attacks in adults. Asthma attacks requiring hospitalization are so frequent in September that the "September epidemic of asthma exacerbations" is a recognized phenomenon. A quarter of all children hospitalized for an asthma attack are admitted in September. Below are several tips to help parents of children with asthma prepare for the new school year.

• Asthma Action Plan. Ask your doctor for a written Asthma Action Plan for the school. This plan should include what medicine to use to treat asthma symptoms and changes in peak flow zones, what medication to use as a pretreatment before exercise, emergency telephone numbers and a list of things that make your child's asthma worse.

• Meet with school staff. Plan a meeting with school staff before or in the beginning of the school year. It is helpful to have the school nurse, health aide, teacher and physical education teacher at the meeting. Your child also can be involved in the meeting. Take the written Asthma Action Plan to the meeting. Review the Asthma Action Plan, use of the peak flow meter, medicines and things that make your child's asthma worse.

• Special school supplies. Keep a peak flow meter, spacer and rescue medicine at school for your child. Make sure the rescue medicine has not passed its expiration date. Takes these items home at the end of each school year.

• Gym class. Make sure your child has a pretreatment for gym class or other physical activities, especially outdoors in cold weather.

• Field trips. Asthma should not keep your child from participating in an off-site field trip. Be prepared to take medicines along to use for flare-ups.

• Medication side effects. Studies have shown that asthma medicines typically don't cause concentration problems. However, if a child who receives high doses of medicine during an episode may experience side effects, such as restlessness and trouble concentrating.

• Keep in touch. Continue talking with your child and school staff about managing asthma at school on a regular basis, even if everything is fine at school. Talk with the school staff if your child misses school and assignments.

• When to stay home. Talk with your child's doctor about when it is okay to stay home from school because of asthma or illness. Mild asthma symptoms can usually be handled at school but there are a number of factors (what triggered the asthma, the stability of peak flows, fever, how much medicine your child is taking, etc.) to consider when deciding whether to keep your child at home.

This information has been approved by Ronina Covar, MD (April 2014).