Managing Asthma in the School Environment

On this page:

• Asthma Management: A Priority for Schools
• Take Action to Manage Asthma in the School Environment
• Develop an Asthma Management Plan in Your School or District
• Controlling Common Asthma Triggers Found in Schools
  • Other Sources of Indoor Air Pollutants
• Additional Resources

Asthma Management: A Priority for Schools

Asthma is a long-term, inflammatory disease that causes the airways of the lungs to tighten and constrict, leading to wheezing, breathlessness, chest tightness and coughing. The inflammation also causes the airways of the lungs to become especially sensitive to a variety of asthma triggers. The particular trigger or triggers and the severity of symptoms can differ for each person with asthma.

During 2013, children with asthma aged 5-17 missed 13.8 million days of school per year. Because Americans spend up to 90 percent of their time indoors, exposure to indoor allergens and irritants may play a significant role in triggering asthma episodes. Some of the most common asthma triggers found in schools, as well as techniques to mitigate them, are addressed on this page's section, Control Asthma Triggers.

Each day, one in five Americans occupies a school building. The majority of these occupants are children. Environmental asthma triggers commonly found in school buildings include:

• Cockroaches and other pests
• Mold resulting from excess moisture in the building
• Dander from animals in the classroom
• Dander brought in on clothing from animals at home.

Secondhand smoke and dust mites are other known environmental asthma triggers found in schools. Children with asthma may be affected by other pollutants from sources found inside schools, such as:

• Unvented stoves or heaters
• Common products including:
  • Chemicals
  • Cleaning agents
  • Perfumes
  • Pesticides
  • Sprays.

In addition, outdoor environmental asthma triggers, like ozone and particle pollution, or bus exhaust, can affect children with asthma while at school.

Students with uncontrolled asthma often miss more school and have poorer academic performance than healthy students. With the help of strong school asthma management programs, students with asthma can have equally good school attendance. When asthma is well controlled, students are ready to learn.

Effectively managing a child's asthma is best accomplished through a comprehensive plan that addresses both the medical management of the disease and the avoidance of environmental triggers. Because children spend most of their time in schools, day care facilities or at home, it is important to reduce their exposure to environmental asthma triggers as much as possible in each of these environments. This publication focuses on steps that schools can take to help children breathe easier.

Take Action to Manage Asthma in the School Environment

1. Develop an IAQ management program in your school or district that includes asthma management strategies. Use the Framework for Effective School IAQ Management to improve the school environment, safeguard children's health and reduce exposure to environmental asthma triggers.

1. Develop an asthma management plan, outlining policies on the use of inhalers and other medication, as well as emergency procedures for asthma attacks. Obtain Asthma Action Plans from students’ parents or doctors outlining students’ triggers, medications and emergency contact information. Ensure that your school nurse tracks this information, as well as key student health indicators, such as the number of asthma attacks, headaches, coughs, fevers and itchy eyes.

1. Use the IAQ Tools for Schools Action Kit to identify, solve and prevent IAQ problems that may exacerbate asthma symptoms. Conduct a walkthrough of your school buildings using the IAQ Tools for Schools Action Kit checklists to determine whether asthma triggers exist. If triggers are found, develop and implement a remediation plan. For more information on conducting a school walkthrough, access resources from the Virtual School Walkthrough webinar, with IAQ expert speakers David Blake at the Northwest Clean Air Agency and Richard Prill at Washington State University.

4. Offer education on environmental asthma triggers and management strategies for teachers, custodians and other school staff. Encourage teachers to incorporate information on the symptoms and dangers of asthma and the importance of quality indoor environments into appropriate lesson plans, such as in science, math, language arts or health classes.

5. Check out EPA’s resources to learn how to make a difference for students with asthma:

• Managing Asthma in the School Environment (PDF)
• Help Your Child Gain Control Over Asthma
• Dusty the Asthma Goldfish and His Asthma Triggers Funbook

Develop an Asthma Management Plan in Your School or District

An IAQ management program that does not address asthma will not be able to address environmental health risks comprehensively, because IAQ and asthma are inextricably linked. By managing IAQ, you are already taking an important first step to managing asthma in your school or district. However, IAQ is only one component of effective asthma management.

To address asthma on all fronts, it is important to have an asthma management plan. If you are using the IAQ Tools for Schools Program and Framework for Effective School IAQ Management, you most likely have the sustainable programmatic infrastructure in place to address this critical need in a more measurable, targeted and intentional way.

The components of CDC's "Strategies for Addressing Asthma within a Coordinated School Health Program," described below, form the foundation for an effective asthma management plan.

1. Establish management and support systems for asthma-friendly schools.
2. Provide appropriate school health and mental health services for students with asthma.
3. Provide asthma education and awareness programs for students and school staff.
4. Provide a safe and healthy school environment to reduce asthma triggers.
5. Provide safe, enjoyable physical education and activity opportunities for students with asthma.
6. Coordinate school, family and community efforts to better manage asthma symptoms and reduce school absences among students with asthma.

For more information, download the following guidance documents:

• "CDC's Strategies for Addressing Asthma within a Coordinated School Health Program"
• "Managing Asthma: A Guide for School"

It is important to identify all students with asthma through monitoring morbidity associated with asthma, for example, frequent episodes at school, health room visits, limited physical activity, needing to leave school early or absenteeism. This can help to assess which programs or monitoring activities your school or district should implement. Focus resources on students whose asthma is not well controlled in order to promote improved school attendance and performance.

In order to identify what works and how you can improve the design and delivery of your school asthma management plan, it is essential to monitor program effectiveness. CDC and EPA offer resources on evaluation guidance specifically for asthma programs. To view a Webinar entitled "Evaluating School-based Asthma Programs," visit:

• Asthma Community Network Webinars

Controlling Common Asthma Triggers Found in Schools

Many factors found in the indoor and outdoor environment can cause, trigger, or exacerbate asthma symptoms. Some common environmental asthma triggers found in schools are listed below, along with suggestions for managing each common trigger:

Other Sources of Indoor Air Pollutants:

Usually the most effective way to improve IAQ is to eliminate individual sources of pollution or to reduce their emissions. Common sources of indoor pollution include secondhand smoke, school bus diesel exhaust coming into the school building, the off-gassing of furnishings and flooring, and chemicals from cleaning products. The following pollutant sources are especially important to control:

• School Bus Exhaust. Passing no-idling policies near the school building can reduce the indoor air pollution from school bus exhaust.
  • Learn more about the Clean School Bus USA program.
• Cleaning Products. Choosing the least-toxic cleaning methods and selecting appropriate products are important components of pollutant control. Fumes from cleaning products can linger long after they have been applied, which can exacerbate asthma symptoms and expose students and staff to potentially harmful substances.
  • Learn more about environmentally preferable purchasing.
• Chemical Management. The School Chemical Cleanout Campaign gives K-12 schools information and tools to responsibly manage chemicals. A successful chemical management program meets the unique needs of each school and ensures that all schools are free from hazards associated with mismanaged chemicals.
  • Learn more about the Schools Chemical Management.

Additional Resources

U.S. Environmental Protection Agency 

• EPA's Asthma Website

Asthma Community Network

• The Asthma Community Network serves as a year-round resource for mentoring and collaboration. It's designed to provide the tools, information and partners to support asthma management programs to communities and schools.