Heading back to school may be especially difficult for children with asthma because of greater exposure to indoor irritants.

A new study shows the start of the school year each fall is associated with a 46 percent spike in asthma-related emergency room visits among grade school children.

Researchers say asthma severity is seasonal with asthma-related complications highest in the fall and lowest in the summer. But these results show that grade school children may be most vulnerable to seasonal variations in asthma severity for a variety of reasons aside from the changing weather.

For example, sudden exposure to many other children in the classroom raises the risk of respiratory infection. In addition, the emotional factors and stress that accompany the start of a new school year may also affect asthma. However, the impact of school-related stress on asthma attacks has not been reported, write the researchers.

Back to School Raises Asthma Risks

In the study, researchers compared the number of emergency room visits by children with asthma during a 60-day time period before and after the September start of the new school year at 11 New York City hospitals.

The results appear in the September issue of the Archives of Pediatric & Adolescent Medicine.

After accounting for other factors known to increase asthma severity, researchers found asthma-related emergency room visits for grade school children aged 5 to 11 were associated with the first day of school. The opening of school was associated with the biggest rise in emergency room asthma visits among this age group (46 percent) compared with the period before school started.

Asthma-related emergency room visits after the first day of school were also higher among other age groups with a 19 percent increase among young children aged 2 to 4 and a 13 percent increase among older children aged 12-17.

In comparison, emergency room asthma visits among adults during the same time period were up only 7 percent.

Researchers say the findings should help school and health officials prepare for the fall asthma season but more research is needed to better understand school-related asthma triggers.

By Jennifer Warner, reviewed by Brunilda Nazario, MD

SOURCE: Silverman, R. Archives of Pediatric & Adolescent Medicine, September 2005; vol 159: pp 818-823.