From the common cold to mold, the respiratory viruses and allergens regularly swirling around the classrooms can send kids' asthma into a frenzy come fall. The No. 1 reason why students chronically miss school, asthma is also the culprit behind the annual early-autumn spike in hospitalizations and doctors' visits for the nearly 5 million children and teens in the United States with the chronic lung disease.

So, the newly updated asthma guidelines from the National Institute of Health's National Asthma Education and Prevention Program (NAEPP) couldn't come at a better time. Though they're geared toward helping doctors help their patients, the recommendations do contain a key take-home message for anyone with asthma: Proactively stay on top of the condition to keep it under control — not just when problems arise, but every day.

When students' asthma isn't in check, it can affect everything from how well they do in class to how much they're able to participate in sports. That's why it's so crucial to consistently manage kids' asthma to prevent symptoms or keep them from getting worse.

People with asthma have airways that are overly sensitive to certain things (called triggers) that normally don't bother others. So, kids with asthma may have a tough time once school is in full swing and they're regularly coming into contact with common in-school triggers such as:

• viral infections (like colds or the flu)
• dust mites
• chalk dust
• animal dander (from the class pet)
• mold
• exercise, cold air, and pollen (which can become a real problem during phys-ed classes)

Kids may react to these triggers over time, with gradual exposure, or suddenly and without warning. The result is usually an asthma flare-up (or attack) — when the lungs' already-inflamed airways become more swollen and clogged with sticky mucus, and the muscles around the airways tighten, leaving little room for air to flow through. But when asthma is well controlled, flare-ups happen less often and may not be as serious.

What This Means to You

You can tell when asthma isn't under control, says the American Academy of Allergy, Asthma & Immunology (AAAAI), if a child:

• has asthma symptoms that are waking the family at night
• has a hard time playing sports, exercising, or participating in physical activities like dance
• chronically misses school (and you keep missing work)

To manage asthma day-to-day and help prevent major flare-ups before they happen, it's also wise to:

• Work with your doctor to create — and help kids follow — a written asthma action (or management) plan.
• Talk to the school nurse, coaches, and teachers (especially phys-ed teachers) about your child's asthma, possible in-school triggers, and warning signs of an asthma attack. Give the school a copy of your asthma action plan.
• Make sure your child carries all controller medications (to keep the asthma in check) and rescue medications (to relieve symptoms and help treat attacks). And always have on hand all meds and a peak flow meter (an inexpensive, portable device that helps monitor asthma).
• Encourage and help your child to steer clear of possible triggers.
• Drive home the message that regular and thorough hand washing can help keep a lot of infectious bugs at bay.
• Recognize the early warning signs that a flare-up might be coming (though you can't always prevent an attack):
  • rapid or irregular breathing
  • coughing
  • throat clearing
  • unusual fatigue
  • trouble sitting or standing still
  • restless sleep

Make sure to track how your child is doing day to day by keeping a weekly asthma diary that records symptoms, medications, and readings from the peak flow meter. This will help your doctor make any necessary changes to the treatment plan.

Reviewed by: Steven Dowshen, MD
Date reviewed: September 2007