Schools - National Asthma Public Policy Agenda

By encouraging policymakers to create safe school environments you can help those suffering from asthma and other lung diseases.

Air pollution in schools affects how children learn and is harmful to their developing lungs. Poor indoor air quality also causes health problems for faculty and staff. Asthma is one of the most common causes of school absences due to a chronic disease. Some of the issues that arise for schools educating children with asthma include potential asthma emergencies, absenteeism, decreased student productivity, increased health office visits, and maintaining access to lifesaving medications. In many cases, schools are not prepared to manage these issues, resulting in a school environment that may actually worsen an individual's asthma and inhibit students' learning. When children with asthma go to school, their health and safety become a shared responsibility between the school, parents, and healthcare provider.

The American Lung Association believes that coordination between schools and the healthcare system is critical to improve asthma health outcomes. Provision of adequate health services may require creative solutions, such as partnerships and establishing links between schools and communities. By encouraging policymakers to create safe school environments you can help those suffering from asthma and other lung diseases.

Here are four policy recommendations set forth in the National Asthma Public Policy Agenda. (Although these policy recommendations focus on schools, children with asthma in all institutional settings, including childcare and residential programs, should receive similar protections.)

Supporting Strategies:

  • Establish laws to authorize stocking of asthma medication in schools.
  • Provide funding to support school nurses in every school.
  • Expand Medicaid programs to allow school districts to bill Medicaid for all Medicaid eligible services delivered to Medicaid enrolled students. 
  • State Boards of Education should create and disseminate standards or recommendations for healthcare services and alternative methods for providing care in schools in the absence of school nurses. 
  • State Departments of Health and State Departments of Education should coordinate activities to support asthma policies and practices in schools.
  • States should use funding from and implement procedures recommended by ESSA to improve school buildings.

Supporting Strategies:

  • Implement recommended strategies such as those outlined in CDC’s EXHALE Guide for Schools on coordination of care and educate all students with asthma and their caregivers on asthma self-management.
  • Ensure that all students with asthma who are not well controlled are provided case management by a school nurse or another designated school personnel.
  • Educate all educational personnel (especially health services, physical educators, coaches, and athletic trainers) about asthma, including how to identify and respond to students at risk for a respiratory emergency.
  • Establish and implement emergency protocols for students in respiratory distress.
  • Designated school health staff should identify and track all students with a healthcare provider diagnosis of asthma and assess and refer students who may be at risk for asthma or have asthma that is not well-controlled based on a nurse assessment for clinical diagnosis and treatment.
  • Obtain and ensure the use of an asthma action plan for all students with asthma in all settings.
  • Ensure students with asthma have immediate access to quick-relief medications by establishing protocols to define students’ assessment of readiness for self-carry and stock medication in school.
  • Schools should identify alternative options for care when school nurses are not present, such as School-based Health Centers (SBHCs), community health workers or telehealth.

Supporting Strategies:

  • Communities should educate and train personnel from after-school programs, youth serving organizations and licensed childcare systems about effective asthma friendly policies and practices to improve childhood asthma.
  • After-school programs, youth serving organizations and licensed childcare systems should implement emergency protocols for students in respiratory distress.

Supporting Strategies:

  • Develop, implement and sustain an indoor air quality program as detailed in U.S. Environmental Protection Agency’s Indoor Air Quality Tools for Schools.
  • Educational systems should strive to have ventilation systems that meet the minimum guidelines of American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE).
  • Educational systems should follow work practices to reduce exposure to cleaning agents and disinfectants that cause or aggravate asthma as recommended by EPA’s “Safer Choice” program.
  • Require schools, grounds, facilities, vehicles and sponsored events to be 100% tobacco-free, including e-cigarettes.
  • Schools should minimize students’ exposure to outdoor air pollutants on days with unhealthy levels of air pollution, including using ventilation/filtration and other strategies to reduce exposures while inside school buildings.
  • Schools should adopt zero-emission technology for school buses, and policies to prevent school bus and personal car idling on school grounds.
  • Schools should develop and implement a disaster response plan that addresses exposure to indoor and outdoor pollutants (e.g., mold, wildfires), access to asthma medication and cleaning up schools.

Page last updated: May 23, 2022

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