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If you care for someone with asthma, have you noticed that their asthma always seem to get worse in September? If so, you’re not alone. In fact, researchers have studied this issue. Here is what they found.

September Is a Difficult Time for People With Asthma

  • There is a September asthma hospital stay “epidemic.” In fact, the third week of September is considered Asthma Peak Week. Many more people stay in the hospital for asthma shortly after school starts than at any other time of the year. Around 25% of asthma-related hospital stays in children happen in September.1 The number of asthma hospital stays peak for school-age children first. Then preschool children, and then adults.2

  • People who stay in the hospital for asthma often have a viral infection. Serious asthma attacks are often related to respiratory tract infections, especially rhinovirus. Rhinovirus is the main cause of the common cold. Viral infections are responsible for half of asthma attacks in adults and 80% of asthma attacks in children.1

  • Kids tend to get sick when they go back to school. Crowded school classrooms are hotbeds of germs. Cold season also peaks the same time school starts. Kids catch colds at school, get sick, and then expose others in the home to the illness. These infections then set off serious asthma attacks for some people. While there is no vaccine for the common cold, the flu shot is available. Flu season can occur later in the fall or winter. Everyone, including family members, should get a flu shot each year, if possible.

  • Kids are exposed to a lot of allergens when they go back to school. Children are often exposed to mold, pests, pollen, pet allergens, and more in schools. All of these can be triggers for some people with asthma. Children’s clothes or belongings can then carry these allergens, like pet hair, from school to home. And then the allergens may trigger other family members with asthma or allergies.

If you have asthma or care for someone who does, take steps to avoid September episodes or attacks. This is especially important as COVID-19 continues to spread.

Here are some things that can help you protect the people you care for during September and year-round:

  • Have an Asthma Action Plan. This is a written plan that provides information and instructions on how to manage asthma. This will tell you and the person you care for what to do each day to treat their asthma. This includes how to track their symptoms, how to know when their symptoms are getting worse, what to do in an emergency, and more. Get a copy of the Asthma Action Plan for the people you care for so you can help manage their care. If they do not have one, download an Asthma Action Plan, take it to their doctor, and work with them to fill it out.

  • Know the asthma triggers of the people you care for. If you know what triggers their asthma, you can help them try to take steps to avoid these things. Use our Healthier Home Checklist to find and reduce triggers in your home. Exercise is healthy for everyone, including people with asthma. If their asthma flares up during exercise, talk to their doctor about having them take medicine before exercise to prevent asthma symptoms and attacks.

  • Have your household get important vaccines (shots). You can get shots for the flu, COVID-19, and pneumococcal disease. All of these vaccines can help reduce chances of becoming seriously ill or going to the hospital because of these illnesses. Even if everyone in your home doesn’t have asthma, it is best for everyone to get these shots, depending on their age. This is one of the best ways to protect the people you care for who have asthma from getting sick. The flu shot is available for anyone 6 months and older. The COVID-19 vaccine is available for anyone 12 and older. Talk with your doctor about the pneumococcal vaccine.

  • Wear a face mask. One thing the COVID-19 pandemic has taught us is that wearing a mask offers a lot of benefits. It could help you and the people with asthma in your care reduce their chances of having an asthma attack. While they can help reduce the spread of the coronavirus that causes COVID-19, they can also help reduce exposure to pollen, air pollution, smoke, and other respiratory illnesses. During 2020, children had few asthma-related emergency room visits because of masks and other protective steps.3,4 AAFA supports universal masking in schools.

  • Talk with their doctor about taking asthma medicines throughout the summer. Asthma is a chronic disease, which means it never fully goes away. Management often requires taking prescription medicines every day, even when you are feeling fine. Ask the doctor for the person in your care if they should take medicine throughout the summer to control their asthma.

    In one study that looked at a group of school-aged children who had asthma, many of the children got a cold during the back-to-school season. But the children who had been taking prescription long-term asthma control medicine were less likely to have a serious asthma flare then those who had not.5

  • If the person you care for gets off their medicine routine, get them back on schedule. Don’t wait until symptoms occur.

  • Have your entire household take common steps to avoid getting sick. Wash your hands frequently. Avoid touching your mouth, nose, or eyes, and have the people you care for do the same. Teach children to sneeze into their sleeve rather than on their hands. Have everyone in your home eat nutritious meals and get plenty of sleep as much as possible. Try to keep sick family members away from other people in the house.

Asthma is the #1 reason children miss time from school, so staying healthy means more time learning. For parents and caregivers, staying healthy means less time spent missing work or using sick days to take care of family members. It’s not too late to get everyone off to a healthier start this school year!

1. Mullen, R. by A. (n.d.). September epidemic. National Jewish Health.
2. Johnston NW, Johnston SL, Norman GR, Dai J, Sears MR. The September epidemic of asthma hospitalization: school children as disease vectors. J Allergy Clin Immunol. 2006 Mar;117(3):557-62. doi: 10.1016/j.jaci.2005.11.034. Epub 2006 Jan 27. Erratum in: J Allergy Clin Immunol. 2007 Jul;120(1):47. PMID: 16522453.
3. Sheehan, W. J., Patel, S. J., Margolis, R., Fox, E. R., Shelef, D. Q., Kachroo, N., Pillai, D., & Teach, S. J. (2021). Pediatric asthma exacerbations during the COVID-19 pandemic: Absence of the typical fall seasonal spike in Washington, DC. The journal of allergy and clinical immunology. In practice, 9(5), 2073–2076. Simoneau, T., Greco, K. F., Hammond, A., Nelson, K., & Gaffin, J. M. (2020, December 4). Impact of the COVID-19 Pandemic on Pediatric Emergency Department Utilization for Asthma. Retrieved from Annals of the American Thoracic Society:
5. Johnston, N., et al. (2005). The September epidemic of asthma exacerbations in children: A search for etiology. Journal of Allergy and Clinical Immunology.

Medical Review September 2016. Updated September 2021

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