If your child has asthma, you may have noticed that she was healthier during the summertime. Although some children's asthma is triggered by the summer increase in pollen and air pollution, most children's asthma is triggered by colds and flu, which are rare in the summer. But their return to school in September exposes them again to other children and respiratory illnesses, which can trigger an asthma attack within weeks.

You can prepare your child to go back to school by working with the doctor and the school to keep her on her asthma medications, avoid her asthma triggers and recognize and respond promptly to asthma symptoms. Remember, with good care, children with asthma can return to school and stay healthy and active—avoiding sick days in the process.

The back-to-school medical visit

Make an appointment with your child's doctor during the summer to review her asthma symptoms, triggers, peak flow measurements, medications and asthma plan.

1. Bring everything you need to your appointment. If you have any questions, write them down in advance and bring them to the visit. Bring your child's medications, any records or asthma diary that you have with her asthma symptoms and peak flow measurements. Also bring any health forms that the school requires the doctor to complete.

2. Review your child's medications with the doctor. If your child has moderate to severe asthma, be sure to discuss the long-term control medicines (steroids, leukotriene modifiers or long-term beta agonists) and the quick-relief or rescue medicines (short-acting beta agonists). Ask whether you should continue the same medications and doses or make any changes. There may be new more effective medications with fewer side effects.

3. Make sure you have enough supplies of all your child's medications and equipment (spacer or nebulizer). You will need supplies on hand both at home and for school. Check to make sure that none of the medication has expired.

4. Discuss your child's immunizations. Make sure there's a plan for your child and family members to get the annual influenza vaccine and any other vaccines needed.

5. Have the doctor complete the Asthma Action Plan. This written plan will detail your child's daily control medicines, asthma triggers to avoid, signs of an asthma attack, quick-relief medications and emergency procedures. Everyone who cares for your child—family members, childcare providers, school teachers, sports coaches, camp counselors—must have a copy of the plan, have on hand the medications and equipment, know when and how to give the medication and have telephone numbers for emergency contacts. Your doctor or your child's school may have a form that they use, or you can use the excellent forms from the American Lung Association (www.lungusa.org or call 800-LUNGUSA).

Getting your child's asthma under control for school

Make sure your child returns to school in tip-top shape. In the weeks before the start of school, be sure to avoid her asthma triggers and give her daily medications as prescribed. Make sure that she gets enough sleep, continues physical activity, eats healthy food and drinks plenty of fluids.

Sharing the Asthma Action Plan with the school

Make an appointment with the school administrators to review your child's asthma plan. Set the date before the start of school, or during the first week at the latest. Try to ensure that all of the adults responsible for your child are present, including the teacher, principal, school nurse, physical education instructor and coach.

1. Give each person a written copy of your child's asthma plan, and review all the details. Have an extra peak flow meter and supply of your child's medications for the school to keep on-hand, and demonstrate how to use them. Ask about their plans for sharing the instructions with other adults at school who need to know, such as assistant teachers, substitutes, assistant coaches, recess monitors and parent drivers on field trips. Be sure to address any questions they have.

2. Encourage the school to examine its asthma policies. Under the Americans with Disabilities Act, school officials are required to make reasonable accommodations for children with disabilities, including chronic medical conditions such as asthma. Recommend that the school use the Asthma-Friendly Schools Toolkit at the American Lung Association website. Discuss the following questions with your school administrators:

• Is there a school nurse onsite or regularly available to help write asthma policies, train responsible staff, teach students about asthma, and provide consultation?
• Does the school maintain good air quality to help prevent asthma attacks? Is the school free of tobacco smoke? Does the school minimize allergens such as pets, mold, dust mites in carpets, cockroaches and fumes from pesticides, paint and cleaning products?
• Can children take their asthma medicines at school as recommended by their doctor? Can children carry their own asthma medicines? If not, are the medicines quickly accessible at any time?
• Can students safely participate in physical education class and recess? Can they take their asthma medicines before exercise, and have modified activities when necessary?
• Does the school have an emergency plan for taking care of a child with a severe asthma attack?

3. Be sure to update the asthma plan if there are any changes in medications or emergency contacts.

For more information on childhood asthma, visit The American Lung Association website at www.lungusa.org, and The American Academy of Allergy, Asthma and Immunology website at www.aaaai.org .