Another school year has started! For many families, the first couple weeks of September can be an exciting time but for others it can bring a sense of foreboding, especially if a child has asthma.

For the parents of these children, September might also mean preparing teachers and other staff members for their child’s likely impending and sometimes life-threatening asthma attack. Parents worry because school boards don’t have a consistent policy to protect children who have asthma and need to have rapid access to devices like puffers. Sometimes emergency medications are kept locked up in the principal’s office. Where’s that key? 

Every September, in many Western countries, including the United States, the United Kingdom, and Canada, there is an epidemic of more physician consultations, emergency department visits, and hospital admissions for childhood asthma. In fact, September is when 20% to 25% of all childhood severe asthma exacerbations requiring hospitalization occur. 

Why in September?  

One reason is that most of children who have asthma attacks in September are infected  with the Human Rhinovirus (HRV), a virus which happens to be the most common cause of colds.  Multiple studies have shown that HRV illnesses peak in the fall, and becoming infected with the virus triggers attacks in asthmatics and makes them more severe, especially in school age children. Kids returning to school contribute to the transmission of respiratory virus infections because of increased contact on school buses or in classrooms. 

Children who have allergies are more susceptible to these viruses, and the reaction in their lungs is worse. Allergies appear to be playing a role in the September asthma epidemic. For example, there is significant exposure to cat allergens at school, which is spread via clothing on kids from homes with cats to the air in classrooms.

Stress can play a role too. Going back to school can be highly stressful and can worsen asthma symptoms in children. 

It is likely that many factors act together to bring about the September asthma epidemic. 

Pollution inside the school worsens the problem 

What about the quality of air in schools? Indoor air can be compromised by allergens, contamination of pollutants from both outdoor and indoor sources, and inadequate ventilation. We know that poor indoor air quality in schools is common and can negatively influence attendance and the performance of students. There is a growing body of scientific studies that demonstrate associations between exposures to common indoor air chemical contaminants and asthma, especially in kids. 

Some contamination occurs from the outdoor air. Pollution in the school is higher when a school is close to a major roadway. School buses and cars often idle in the school parking lot. Exposures to auto exhaust aggravates asthma in children.   

Indoor air contamination in the schools is also due to chemical products introduced into the indoor environment. Sources include off-gasing from building materials and floor coverings, cleaning products, and the fragrances that children bring into the school from their homes – fabric softeners, fragrances in personal care products, and air fresheners. All these products are present for the whole school year, but what compounds the effect in September is the chemical contamination due to all the cleaning and renovations that occurred during the summer months to get the schools ready for the new academic year.

Icing on the cake

Repairs over the summer include cleaning, painting, sanding and refinishing gym floors, cleaning carpets, repairing leaking roofs and windows, and cleaning light fixtures, glass, furniture and walls. How well ventilated is the school during the hot summer if the windows are kept closed to save costs of air conditioning? 

Sometimes school boards build new structures and place the children in the classrooms before the materials have finished off-gassing. Or even worse, before they are finished construction.

The significance of all these chemical exposures is amplified in a study published in January of this year. HRV can create changes in nerve cells in the lungs, making them more sensitive to chemical exposures. Sensitization by the chemicals indoors and HRV can bring on the inflammatory changes seen in asthma. The combination of these exposures, which is greatest in September, has the effect of inducing severe asthma attacks in susceptible children. 

Protecting our kids 

How can we reduce the transmission of viruses? We must continue to  teach children to cover their mouths with a sleeve when they sneeze and cough, to prevent the spread of the droplets containing viral particles from settling on surfaces, remaining infectious for hours or days.  These particles can get re-suspended into the air for long periods.

How do we reduce the chemical contamination when we need to keep our schools in good repair? 

School boards can reduce the chemical contamination by:

• not allowing vehicles outside to idle
• using low emitting paints and glues
• prohibiting the use of deodorizers
• using non-scented cleaning products
• teaching the children and their parents about indoor chemical contamination from scented products
• building new schools farther from major roadways 

Increase ventilation especially prior to and during September. More fresh air willreduce the risk of exposure to viruses. Increasing ventilation also reduces the chemical contamination. Better air filtration can reduce viral and chemical pollutant exposures. 

Almost 10% of children have asthma and the numbers are increasing. Some of these kids get severe asthma attacks, just by returning to school. 

Returning to school in September means that many children are walking into a building with poor air quality, with HRV, and more chemical pollutants that can be the final trigger to induce a severe asthma attack. We know that inadequate ventilation and poor air quality in schools leads to adverse health effects, negative effects on learning, and reduced attendance. Bring up these issues with your Parent Teacher Association, the principal, the school board, and Ministry or Department of Education.  They all need to get educated! 

We should be creating healthier conditions in the schools for all our children to thrive in, physically and academically.