Back to school: Tips for keeping asthma under control

Asthma is one of the leading causes of missed school days. As children head back to school, it's critical to understand asthma in school-aged children and the steps to take for monitoring and preventing asthma flare-ups.

Asthma facts

Asthma flare-ups in children often occur when a child faces exposure to certain triggers. Triggers vary between children but include viral infections, stress, exercise, mold, smoke, dust, and other particles in the air. With exposure to the trigger, the body reacts with swelling and muscle tightening around the airways and increasing mucus production. As the airways narrow, wheezing occurs (which sounds like a high-pitched whistle) and breathing becomes difficult.

• Among children with current asthma, 50.3 percent have uncontrolled asthma.
• Asthma is one of the leading causes of missed school days for children.
• Asthma is the top chronic disease among children.
• Asthma affects about 6.1 million children under the age of 18.
• In 2016, asthma episodes affected 3.5 million children.
• Asthma is the third-most-common cause of hospitalizations in children under 15.

Uncontrolled asthma with frequent severe asthma attacks comes with a high cost to families because of increased risks of emergency department visits, hospitalizations, and missed work and school days. Between 2008 and 2013, the annual cost of asthma was $81.9 billion, including medical bills and missed work and school days. However, controlled asthma has virtually no impact on everyday life.

How does asthma affect school-aged children?

Children with uncontrolled asthma are less likely to do well in school. Research shows that educational attainment is worse among children hospitalized with asthma when compared to their peers, and school absences play a role. Across the United States alone, childhood asthma makes up about 14 million school absences yearly. An asthma diagnosis for children in low-income families nearly doubles the risk of failing a grade.

Fortunately, early interventions and plans for managing asthma symptoms can improve educational performance in children with asthma.

What can be done?

The National Asthma Education and Prevention Program (NAEPP) offers guidelines to diagnose and manage asthma and prevent asthma attacks.

• Early diagnosis is vital.
  An earlier diagnosis means early management and fewer asthma exacerbations. After a medical history and examination showing periods of respiratory symptoms, children ages five and older should get a spirometry test. Spirometry in children with asthma will show partially reversible airflow obstruction.
• Determine the severity of asthma.
  Since the signs and symptoms vary in a child with asthma, initial and routine monitoring is critical. An initial peak flow test and spirometry help to determine the severity. When asthma becomes stable, the level of medications to maintain treatment goals measures the severity of asthma.
• Routine visits and spirometry monitor asthma severity.
  As mentioned, symptoms frequently vary in a child with asthma, so routine visits with a healthcare provider are crucial. Depending on the severity level, patients should be assessed every one to six months.
• Determine and control asthma triggers.
  Determining the child's asthma triggers plays a critical part in controlling asthma. The NAEPP recommends that patients with persistent asthma be tested for indoor allergens. Once allergens are determined, their avoidance is recommended to avoid asthma attacks. In other cases, medications help to relieve these symptoms.
• Treat comorbid health conditions.
  When a child's asthma symptoms worsen and don't respond to medication adjustments, the healthcare provider should look for other health conditions that could exacerbate asthma. Whether it's sinusitis, reflux, or respiratory infections, treating these conditions may alleviate asthma symptoms.
• Prescription medications
  The medications in a child's asthma management plan depend on the severity of asthma symptoms. Anti-inflammatory drugs like nebulized corticosteroids manage symptoms by treating the underlying inflammation. All children with asthma should receive a short-acting bronchodilator to treat acute symptoms.
• Physicians and parents work together.
  Physicians should work with parents to develop the child's asthma control plan. Writing out the plan helps to clarify expectations, allows children and parents to remember the treatment plans, and lets parents share it with the child's school teacher. The asthma control plan should be reviewed and adjusted at every follow-up visit.

Keeping asthma under control

Poorly controlled asthma can cause hospitalizations and missed school days. Fortunately, children can remain healthy and avoid the hospital with the right tools, including an asthma control plan and routine spirometry.

_{Clinical statements come from these sources:}

_{https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/learn-about-asthma/asthma-children-facts-sheet}

_{https://www.cdc.gov/nchs/hus/topics/asthma.htm}

_{https://www.cdc.gov/asthma/asthma_stats/uncontrolled-asthma-children.htm}

_{https://www.aafa.org/asthma-facts/}

_{https://onlinelibrary.wiley.com/doi/10.1111/cea.14022}

_{https://www.aafp.org/pubs/afp/issues/2003/0701/p169.html}