Asthma and the September Epidemic
In this entry, I would like to discuss some things to think about as families go back to school in terms of asthma. One is the increase in asthma exacerbations during this period, and the other some thoughts about asthma control as kids go back to school.
Asthma gets worse in September
For several years, doctors and patients have observed that asthma control, including asthma exacerbations, increase in September. Some doctors and scientists have even called the increase in hospitalizations for asthma the “September Epidemic.”
The reason for this remained obscure until recent studies that looked into the major causes of worsening asthma control and if they changed in September. It turns out that the increase in asthma worsening and kids going back to school are not merely coincidences. A detailed study of asthma attacks looking at many individuals (using 12 years of hospitalization data from the Canadian health ministry) showed that there is a sharp spike in asthma hospitalization in children about 2 weeks after Labor Day, the usual time of school return after summer vacation.
Even more interesting was the fact that asthma exacerbations were also increased in adults, not just children. Of note, this increase occurred about a week later than in children.
So, what is the connection?
It is well known that respiratory viral infections, especially a common cold virus called rhinovirus, are significant causes of asthma exacerbations. A parallel study to the one above demonstrated that nearly two thirds of children seeking emergency care for asthma had common cold virus in their noses. This suggests that the September Epidemic is largely caused by cold viruses. In addition, the delay in asthma exacerbations in adults suggests that children, upon returning to school, are sharing colds and cold viruses that they bring to school after summer vacation, causing a rise in colds and a rise in asthma exacerbations. These colds are then brought home and affect parents with asthma.
An interesting aside – the study mentioned above examined a control group of asthmatics during the same time in September but whose asthma was not in a flare. The researchers found that the children without exacerbations were more likely to be taking anti-inflammatory controller medications that the children whose asthma had flared. This makes another point about long-term asthma control that is especially important going back to school: All asthmatics should be taking their regularly scheduled controller medicine whether their asthma is controlled or not.
I have discussed strategies to minimize spread of cold viruses between individuals in these two posts:
Have a look at these entries for details.
Other considerations about asthma during school return
The return to school is a time when many kids go back to participating in organized sports. For kids with asthma, it is an important time to be prepared. Many children have asthma that is brought on by exercise, and September and October are peak seasons for ragweed pollen in many areas of the United States. As school-age children (and college students) get back to the routine of regular exercise, it is especially important that they are taking their controller medications regularly, if directed by their asthma care provider. Asthmatics that have symptoms brought on by exercise can often minimize symptoms with exercise with premedication, say taking two puffs of albuterol 15 to 30 minutes before strenuous exercise.
Younger children may need to have their parents work with the school nurse so that asthma medications are readily available in case quick relief is needed. Ask your asthma care provider to provide an extra prescription for quick-relief medication to be kept with the school nurse or health office, so that it is available if a child runs out or forgets to keep it handy. For children who have severe allergies to foods or bees, an EpiPen should be kept with the school nurse in case of a reaction.
Schools all have different policies about keeping medications and different systems to care for kids when they are sick in school. You should check with your child’s school to become familiar with what they have in place and how you can work with them to keep your child’s asthma under the best control in school as you do at home.
Frederic Little is an Assistant Professor in the Department of Medicine at Boston University. He attends on the Allergy Consultation Service as well as the Medical Intensive Care Unit and Pulmonary Consultation Service at Boston Medical Center. He wrote for HealthCentral as a health professional for Asthma and Allergy.