Understanding Asthma Exacerbations in Kids During the Fall

Have you noticed that your child seems more prone to having asthma exacerbations, or flare-ups, when they return to school in the fall? If so, you're not alone. There can be several reasons for this increase in "back-to-school" asthma flares:

  • Exposure to viruses, such as the common cold and flu
  • Rising levels of ragweed and other weed pollens
  • Increases in the levels of mold spores
  • Indoor allergens in the classroom
  • Changes in air quality

Prevention of asthma exacerbations is essential. These flare-ups are the top reason for missed school days each year, and cost $50 billion in health care costs each year. Plus, who wants to see their children struggling to breathe instead of playing and studying happily?

Let's look a bit closer at each of the factors listed above.

Daily Viral Prevalence

That's a fancy term for the fact that once kids go back to school in the fall (or after any school break), they are more likely to come into contact with respiratory viruses.  This can include common cold viruses, as well as the flu and other respiratory infections.

A study presented to the Proceedings of the National Academy of Sciences a couple of years ago attempted to shed new light on the fact that asthma flares among school age kids show a consistent pattern that mirrors the school calendar.

Although data exists for asthma hospitalization rates, influenza transmission and air quality issues, there is a lack of data about common cold transmission. Researchers felt this is significant, since it is widely-accepted that colds are the main culprit when it comes to fall asthma exacerbations.

So, they created a computer model that examined possible drivers of asthma exacerbations:

  • Results were compared to real-world health data
  • Data was gathered from 66,000 asthma hospitalizations
  • Study was limited to 8 cities in Texas over a 7-year period

These were their results:

  • Daily viral prevalence was the strongest predictor in kids of asthma hospitalizations for flare-ups
  • Children infect each other much more frequently than they are infected by adults
  • Such transmissions were reduced by 45% during school breaks

This study was limited and the authors emphasized that more study in larger populations in different areas of the country are needed. However, it seems likely that viral infections are a factor in the increase in asthma flares during the fall.

Rising Levels of Ragweed Pollen

Late summer and early fall (until the first frost) is the prime season for ragweed and other weed pollens. And this coincides precisely with the start of each school year.  About 10 to 20 percent of us in the U.S. are sensitive to ragweed pollen. But if you are allergic to other types of pollen, then you are very likely to also be allergic to ragweed pollen (75% of us are).

Ragweed tends to grow in rural areas, but the spores are easily spread over hundreds of miles by the wind and sometimes by insects. These are members of the ragweed family:

  • Sage
  • Burweed marsh elder
  • Rabbit brush
  • Mugworts
  • Groundsel bush
  • Eupatorium

Even when kids are in school, they may be spending time outdoors at recess or on field trips. So chances are, they're coming into contact with ragweed pollen. And ragweed allergy can trigger asthma attacks as well as allergy symptoms.

Increases in the Levels of Mold Spores

Mold spores are another trigger for allergies and asthma attacks. Unfortunately, molds are everywhere, both indoors and out. But in the fall, outdoor mold spore levels rise, as leaves begin coming down from trees. And molds don't die from the first killing frost as pollens do.

Indoor molds may also be found in damp areas, such as under a sink or around an aquarium or de-humidifier. So, be on the lookout for places like that in the school room.

Indoor Allergens in the Classroom

In addition, there may be indoor allergens found in the new classroom at the start of the school year. These might be things that weren't present in last year's room or in the home environment.

They might include:

  • Dust mites, found in dark, dusty corners or in carpet
  • Insect allergens from critters who set up shop in unused classrooms over the summer
  • Pet dander (either carried in by classmates or from a classroom pet, such as a guinea pig)

All of these things can trigger allergy and asthma symptoms in sensitive children.

Latex allergy is another thing to be aware of. In the classroom, latex might be found in balloons, rubber bands, rubber balls, rubber gloves or bandages. Symptoms may come from direct contact with one of these things or even from breathing latex fibers that are in the air.

Changes in Air Quality

You would think this might be less of a concern once kids return to school. After all, they're less likely to be exposed to car exhaust and long periods in outdoor polluted air once school's back in session. Although, if they walk to school or spend much time around school buses, this may not be as true.

However, it's indoor air quality I'm thinking about. Normally, you'd expect the indoor air in schools to be clean. But in sensitive kids, certain cleaning solutions or air fresheners might trigger symptoms. New carpeting can emit toxic fumes too. Pesticides can be another source of fumes.

If your older child is involved in wood shop, they may be sensitive to sawdust or other fumes emitted by electric tools. Kids in auto shop may be exposed to car exhaust or paint products.

And other students or staff may wear perfumes, cosmetics or hair sprays that can trigger symptoms in a sensitive child.

So, What Can a Parent Do?

Many of these fall asthma triggers are going to be hard to completely avoid for your child. Awareness is the first step. Also, be sure you have an updated Asthma Action Plan and that your child follows whatever medication treatment plan has been set up. A rescue, or quick-relief, inhaler should always be available to them when at school.

Teach your child the importance of hand washing to stop the spread of viruses. And make sure they understand not to share food or utensils with other children, especially if the other child has a cold. And be sure your child gets his or her annual flu shot!

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Asthma.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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