Creating Lung Friendly Environments for Youth

Strategies for addressing asthma, tobacco, clean air and more in schools and community organizations.

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School Health and Safety Policies and Environment

Prohibit use of tobacco by students, staff and visitors

Schools and districts should prohibit the use of tobacco by students, staff, and visitors 24 hours a day, 7 days a week in all school buildings, on all school grounds, at all school sponsored events off school grounds, and in all school vehicles. References to “tobacco” include all commercial tobacco products, which are any products containing, made of, or derived from tobacco or nicotine that are intended for human consumption. These include combustible and smokeless tobacco as well as electronic smoking devices.

The American Lung Association is committed to helping schools address the youth vaping epidemic with tools to protect and support schools and students. Visit our resources for ways to educate school staff and parents, implement school policies, and support students with cessation programs. The American Lung Association also offers education opportunities for staff, parents, and caregivers on the dangers of tobacco use.

Improve Access to Asthma Medication in Schools

Schools and districts should have written policies that permit students to carry and self-administer quick-relief (i.e. reliever) medication for chronic health conditions (e.g., asthma). School staff should receive professional development on chronic health conditions basics and emergency response at least every two years. When children with asthma attend school, their safety and management of asthma becomes a shared responsibility between the family, their asthma care provider, and the school staff. All 50 states and the District of Columbia have passed a law allowing students to carry and use inhalers at school, yet some kids are still being denied access to these lifesaving medications during the school day. Whether your state has passed a stock asthma medication law or not, there is still space to create and implement policies that can save the lives of children with asthma.

Improve staff ability to respond to asthma emergencies.

Unfortunately, it doesn’t take long for an asthma episode to become an asthma emergency. That is why being prepared for and knowing how to handle an asthma emergency is crucial for school staff members. All staff, not just school nurses, should be educated about asthma - a chronic health condition - and should know how to handle an emergency if it should arise. The American Lung Association offers a training for Responding to Asthma Emergencies in Schools as well as ongoing education opportunities.

Health Education

Build your knowledge and skills in lung health and preventing lung disease

Your lungs are an essential part of the respiratory system that work together to help you breathe. Learn how your lungs work and how to keep your lungs and yourself healthy.

Deliver evidence-based health education curriculum in tobacco and asthma-self management education

Are you looking to enhance your professional skills while serving your community with training and certification from the American Lung Association? Become a facilitator or educator, attend an educational webinar or in-person class, take part in continuing education, or join us in advocating for patients and lung health.

Physical Education and Physical Activity Programs

Promote physical activity among students with asthma

People living with lung disease can and should get regular exercise for many reasons. The lungs and heart get stronger with exercise, individuals are better able to perform the tasks of daily living and feel better in mind and body. However, if an individual is already dealing with shortness of breath, it can be intimidating to think about increasing physical activity. It is important for children with asthma to work with their healthcare team to address physical activity and asthma. Physical education teachers and coaches play an important role in helping children with asthma find exercises that work.

Learn how to respond to respiratory distress during physical activity


The presence of asthma symptoms during exercise does not preclude or prohibit a student from exercising. For all kids, participating in after-school sports, physical education, and recess is important. Teachers, coaches, and other members of the school staff should be familiar with asthma symptoms and what to do in case a student experiences an asthma attack. School staff should encourage children with asthma to monitor symptoms, to self-carry and self-administer quick-relief medication, including pre-medicating, if appropriate. Staff should be ready for students who do not self-carry.

The American Lung Association offers a variety of helpful resources on asthma triggers, how to handle a breathing emergency, and how to help students manage their symptoms so they can participate in activities to the fullest.  


Protect students from outdoor air pollution

Air pollutants can cause dangerous health effects. Exposure to air pollution can trigger asthma episodes, cause respiratory distress, and can negatively impact lung development for growing children. Learn about the causes, the impacts, and ways to take action. Schools and communities should monitor areas where children exercise or play for air pollution, allergens, or irritants. 

Nutrition Environment and Services

Build your understanding of how nutrition and weight can impact asthma

Food provides the body with nutrients like carbohydrates, fats, and proteins. Eating a diet with fewer carbohydrates and more fat may help you breathe easier. When the body metabolizes carbohydrates, it produces more carbon dioxide for the amount of oxygen used. When the body metabolizes fat, it produces less.  ​​​

Learn more about the connection between allergies, anaphylaxis, and asthma

Asthma can be triggered by an allergic reaction to foods food preservatives (e.g., sulfites) or medicines (e.g., aspirin, non-steroidal anti-inflammatory drugs). Common foods that may cause an allergic reaction include eggs, peanuts, tree nuts and shellfish. Individuals should work with a healthcare provider to identify the foods or food additives that they are allergic to, avoid them, and use an epinephrine autoinjector (EpiPen®) to treat anaphylaxis. 

Allergy shots or immunotherapy can reduce the risk for anaphylaxis and help prevent asthma symptoms. Remember that identifying and minimizing exposure to known allergens can do a lot to improve quality of life. Controlling allergic conditions such as rhinitis can improve and sometimes prevent asthma symptoms. 


School Health Services

Support healthcare services provided by school nurses and personnel.

Schools should have at least one full-time registered school nurse all day, every day at each school. School nurses are often the first and sometimes only provider of health services within a school or network of schools. They often work between multiple groups – students, parents/caregivers, doctors, teachers – to keep children safe and healthy during the school day. Equipping school nurses with quality training and resources is essential to the health of students. 

Understand the healthcare services that can be provided for students in school

All students should have access to quality healthcare. In some cases, it may be necessary for a school to support students’ families and caregivers in accessing quality healthcare services. In a school setting, healthcare services may include immunization offerings, hearing and vision checks, and check-ups or physicals. Schools can work with community providers to offer these services that benefit students and may otherwise be inaccessible to families. Referrals to outside providers can also be offered in cases of limited capacity or specialty needs.  

Improve care coordination for students with chronic health conditions

Partnerships between students, parents/caregivers, doctors, school nurses, and school staff are important for healthy students. All entities should be aware of an individual student’s diagnoses, health concerns and a written plan should be on file. In the event of a health emergency, a written and reviewed plan ensures that the student’s health can be attended to immediately. Documents may include an Asthma Action Plan for students with asthma, medication administration approval forms, medical condition forms, immunization records, and allergy list. The American Lung Association offers educational opportunities that address Asthma Action Plans as well as sample plans.  

School Counseling, Psychological, and Social Services

Develop mental health services for students who have asthma and/or use tobacco products

Mental health can be correlated to the frequency of asthma flare-ups. Research shows that anxiety and depression can result in increased asthma symptoms, require more time and money for additional healthcare services, and can result in more frequent breathing emergencies. Unfortunately, being diagnosed with and managing a chronic lung disease, like asthma or COPD, increases the likelihood that a patient will experience anxiety, depression or panic attacks. Those dealing with anxiety and depression can often feel physically and emotionally drained, which may prevent patients from properly managing their asthma.

Reduce breathing problems by learning to manage stress

Learning to manage stress and relax is not easy with today's busy lifestyle. Emotional stress is a common trigger for asthma. Stress also impacts our regular routines, so individuals may forget to take a controller medication or leave a quick-relief (rescue) inhaler at home. Both situations put individuals at risk of being unable to control an asthma flare-up. It is a vicious circle that cannot be ignored, so learning to manage stress is important. 

Implement ways to support individuals with asthma as a caregiver or community member

Getting help when needed is important for managing asthma. Family, friends, co-workers, and healthcare teams can support individuals in many ways. Explore these resources to get connected with additional support. Connect to support resources including experts, community groups and treatment assistance.  

Social and Emotional Climate

Build collaboration between school, caregivers, and students to support overall health

It is important to keep communication open between schools, families, youth, and their doctor. This allows for better support to make good, healthy decisions.  

Youth or young adults with asthma often face multiple stigmas and stereotypes, which can lead to feelings of embarrassment and loss of disease control. Individuals may be nervous about using their inhaler or having an asthma episode in public and can experience feelings of distress and discomfort in new environments.  

Adults can play a significant role in protecting youth from the dangers of vaping and nicotine dependence. Keeping youth from starting is critical and they need our help. Youth tobacco use can be prevented by families, schools, communities, and policymakers joining together. 

Learn the reasons why kids may use tobacco products and how to help them be tobacco-free

The overwhelming majority of adult tobacco users began using tobacco before age 18, and many were addicted before they even finished high school. So, why do kids pick up that cigarette in the first place? Parents, social pressure, advertising, stigma—are just some of the different reasons a young person might try tobacco. 

Foster and promote self-advocacy and self-assurance among students

Learning to use asthma medicine independently, talking to healthcare providers, quitting smoking, and saying “No” to tobacco products are just some of the situations youth will encounter during adolescence. Preparing them with positive communication and self-advocacy skills through education, awareness, and caregiver-child conversations can help youth learn to manage their lung health effectively:  

Physical Environment

Assess indoor air quality and improve clean air at school

We all want children and teachers to be safe at school. But there are some dangers—such as air pollution or exposure to pesticides—that are not always obvious. Air pollution in schools can affect how children learn and harm their growing lungs. It can also cause health problems for faculty and staff. You can help protect your family and your community by learning more about keeping the air in schools clean and healthy. 

Protect students against dangerous outdoor air quality

Air pollutants can cause dangerous health effects. Exposure to air pollution can trigger asthma episodes, cause respiratory distress, and can negatively impact lung development for growing children. Learn about the causes, the impacts, and ways to take action. 

SMART Surfaces

Steps schools can take to counter the impact of climate change and improve air quality, both outdoors and indoors. 

Employee Wellness and Health Promotion

Create a safer and healthier workplace for all employees

Americans spend more than half of their time at work, and many are either at risk for or dealing with lung disease of some kind. Lung disease—which includes chronic conditions like asthma and COPD, and respiratory illnesses like the flu and pneumonia—is one of the most common and costly of all health problems. And tobacco use is the leading cause of lung cancer and other major health issues. By making small changes in the workplace environment and providing resources to employees to change behaviors and improve health, we can create a safer and healthier workplace for all employees and see significant savings in healthcare related costs. Small changes can include focusing on indoor air quality, providing quit tobacco use resources for employees, educating those living with chronic lung disease and helping employees adopt healthier lifestyles. 

The American Lung Association offers comprehensive support to help employers adopt and implement workplace policies and programs that support a healthy work environment while contributing to a healthier corporate bottom line. 

Educate yourself on lung diseases, the toll of tobacco in the U.S., and how to advocate for lung health

Every year, the American Lung Association helps thousands of people manage their lung disease, overcome their tobacco addiction and live healthier lives, thanks to help from our wide range of education and training resources. Whether you are interested in quitting smoking, facing lung disease or just have an interest in learning more about your lungs, we have the learning opportunity for you.  


Get Involved / Community Action

Family Engagement

Talk to youth

Supporting your child's lung health can be beneficial for the whole family.  

Youth & Asthma: The rebelliousness and need for independence that comes with adolescence can be especially difficult for teens with asthma and their families. Children who have been responsibly managing their asthma for years may start to have more problems with symptoms. This could be caused by hormonal changes, or by attitude and behavioral changes. 

Youth & Smoking: Teens can be easily influenced by their peers, media, and tobacco product advertisements. They may also seek tobacco as an outlet to relieve stress. These factors coupled with misleading information and limited product regulations put teens in danger for developing a dangerous tobacco addiction.  


Set a good example

Set a good example for your kids by not smoking or using tobacco in any form. Parents who smoke are more likely to have children who smoke. If you're a parent who smokes, the best thing you can do is quit. Talk to your kids about how difficult it is to quit smoking and how much easier it would have been if you'd never started smoking in the first place. In the meantime, don't smoke around your children and don’t ever let them have any of your tobacco products.

Create Clean Air at Home

Poor indoor air quality can cause or contribute to the development of infections, lung cancer and chronic lung diseases such as asthma. People who already have lung disease are at greater risk. Find out what makes indoor air unhealthy and how pollution can hurt your body. 

Engage in Family Lung Health Activities

The American Lung Association has created a series of clean air indoor activities and lessons for teachers and caregivers of children pre-K through middle school to teach about clean air concepts in a fun, engaging way. 

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How can the American Lung Association Help?

The American Lung Association can provide helpful resources to schools or organizations to meet the requirements of the School Health Index (SHI), developed by the Centers for Disease Control and Prevention (CDC). The SHI is an online self-assessment and planning tool developed in partnership with school administrators and staff, school health experts, parents, and national nongovernmental health and education agencies to:

Enable schools to identify strengths and weaknesses of health and safety policies and programs.
Enable schools to develop an action plan for improving student health that can be incorporated into the School Improvement Plan.
Engage teachers, parents, students, and the community in promoting health-enhancing behaviors and better health.

Community involvement in schools is important to the learning, development, and health of students.

 The Whole School, Whole Community, Whole Child, or WSCC model, is student-centered and emphasizes the role of the community in supporting the school, the connections between health and academic achievement and the importance of evidence-based school policies and practices. Every school has a unique set of needs. To better serve their students, school leaders and staff can incorporate the WSCC model components as they see fit.

With help from school leaders, community agencies and groups, they can collaborate with schools to provide valuable resources for student health and learning.

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