Asthma is a leading chronic (long-term) disease in children. Currently, there are about 4.5 million children under the age of 18 with Asthma. Experts don’t know exactly what causes asthma in children. But certain risk factors, including exposure to indoor and outdoor air pollution, may make a child more likely to have asthma. 

Buildings can trap harmful air pollution and other asthma triggers inside. And Poor Indoor Air quality in school buildings can affect those with asthma and allergies, especially children. 

Causes of Poor Indoor Air Quality in Schools

We spend much of our time indoors, and for school-aged children, a lot of that time is spent in school. Poor indoor air quality in schools is contributing to the number of school days children miss because of asthma and allergies. Among children ages 5 to 17, asthma is one of the top causes of missed school days. 

A number of factors impact the air quality in school buildings. Aging buildings, poor ventilation, and common allergy and asthma triggers such as mold, all contribute to poor indoor air quality. 

Schools in low-income communities and schools with higher numbers of Black, Hispanic, and Indigenous children tend to have fewer resources to make needed improvements. 

A Closer Look at Race, Poverty, and Asthma Outcomes

In 2020, the Asthma and Allergy Foundation of America (AAFA) released the Asthma Disparities in America report that explores the impact of asthma on Black, Hispanic, and Indigenous populations. 

This report makes clear that the burden of asthma is borne disproportionately by people of color and people of low income. Some key facts include: 

• Black and Hispanic Americans continue to have the highest rates of asthma.
• Hispanics of Puerto Rican descent have the highest rates of asthma compared to any other racial or ethnic group in the United States.  
• Black Americans remain 3 times more likely to die from asthma than white Americans.  
• Black patients are 5 times more likely to be treated for asthma in hospital emergency rooms compared to white patients, a gap that has remained unchanged since 2005.  

The disparities in asthma outcomes are largely driven by structural inequities and social determinants, including socioeconomic status, neighborhood and physical environment. 

Schools that are poorly resourced and ill-equipped to effectively manage indoor air quality contribute to asthma disparities. 

An example from the Bronx

One study of schoolchildren in New York noted that 15.5% of 4 to 5-year-old Bronx children were identified as having asthma compared with 9.2% of New York City students overall and 8.9% of U.S. children 2 to 17 years of age. 

This study and a subsequent study by Columbia University attribute the higher asthma rates to poor indoor air quality and to housing conditions that increase exposure to allergens and airway irritants.

Children in this area are subject to extreme air pollution. This earned one Bronx neighborhood the nickname “Asthma Alley.” Asthma hospitalization rates are five times the national average in this area. 

Improving the School Experience for Children with Asthma

It is important to take steps to improve asthma outcomes by both addressing public policy and helping children manage asthma in their daily lives. 

Policy change

AAFA’s 2023 Asthma Capitals report offers an advocacy toolkit that includes possible policy solutions and a guide on how to effectively communicate with policymakers. 

Taking action to improve school buildings and to address the air quality in the environment around schools is important for better asthma outcomes. 

How physicians can help

Here are some steps physicians can take to help children with asthma have a better experience at school: 

• Work with parents or caretakers to ensure there is an Asthma Action Plan for the child and that the school has a copy
• Talk with parents about ways to help the child develop age-appropriate skills for managing their allergies and asthma (carrying and administering medicines, for example) 
• Provide assistance in keeping up to date on flu, pneumococcal, and COVID-19 vaccines 
• Helping parents understand how to talk with school staff about controlling environmental triggers for asthma and allergies
• Working with parents and school staff on accommodations for children with asthma and allergies (ex. Including appropriate air cleaners in classrooms)

Taking steps to create a healthier environment at school should include both immediate strategies for asthma and allergy management and long-term solutions to improve overall indoor air quality. 

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This content was developed in partnership with the Asthma and Allergy Foundation of America (AAFA). AAFA is the oldest and largest non-profit patient organization dedicated to saving lives and reducing the burden of disease for people with asthma, allergies and related conditions through research, education, advocacy, and support. Learn more about AAFA at: aafa.org

AAFA offers extensive support for individuals and families affected by asthma and allergic diseases, such as food allergies and atopic dermatitis (eczema). You can join our online patient support community at: aafa.org/join