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Asthma is the most common chronic disease among school-aged children and is a leading cause of school absences nationwide. In California, more than 6 million children attend one of the state’s public schools. During their time at school, children can be exposed to poor indoor air quality, which can trigger asthma attacks, cause headaches, irritate the eyes, nose and throat, and reduce the ability to concentrate – leading to missed school days and decreased performance. Many schools across the country and in California have been found to have poor indoor air quality and other conditions that contribute to poor indoor environmental quality such as inadequate ventilation. For example, one study found significant problems in California’s classrooms, including poor ventilation, poorly regulated temperature and humidity, air pollutants, floor dust contaminants and excessive moisture and mold.

Overview
The burden of asthma on children and their families is significant. Asthma is a leading cause of school absences, and asthma attacks and symptoms can interfere with a child’s daily activities and quality of life. Appropriate prevention efforts can reduce the likelihood that children miss school or experience frequent symptoms. Recent data indicates:

  • In California, school-aged children miss approximately 1.9 million school days each year due to asthma, a rate of nearly 2.5 days per child with asthma per year.
  • More than one third (35%) of all school-age children in California with current asthma miss at least one day of school during the year due to asthma and more than half (51%) of younger children (ages 5-11) miss school due to asthma.
  • In California, 809,000 children with asthma experience asthma symptoms every year, including 89,000 who experience symptoms every week.
  • More than 350,000 California children take medication to control their asthma every day.

Asthma Management in Schools
Students with asthma need proper support at school to keep their asthma under control and be fully active. Uncontrolled asthma can hinder a student’s attendance, participation in school activities, and affect progress in school. A comprehensive asthma management plan in the school setting would include policies addressing students’ ability to carry and use their asthma medicines, written emergency plans for teachers and staff in case of an asthma attack, current asthma action plans on file, school nurses, education of staff and students about asthma, monitoring of students with asthma, and controlling the environmental triggers (e.g., indoor air quality, tobacco smoke, idling of buses and cars). School staff, parents, and students can work together to minimize risk and provide a healthy educational environment for students with asthma.

Major Indoor Air Quality Problems in Schools That Are Affecting Children with Asthma:

Ventilation
Inadequate ventilation contributes to poor indoor air quality and is associated with negative health effects such as respiratory illnesses, allergies, and asthma. In addition, children in classrooms with inadequate ventilation miss more school and perform less well on school work and standardized tests. A number of studies in California and elsewhere have documented the widespread prevalence of inadequate ventilation in school classrooms. In fact, one study found that ventilation with outdoor air was inadequate during 40% of classroom hours in California’s classrooms. There is evidence that improving ventilation by replacing and upgrading ventilation systems improves air quality and provides health benefits.

Moisture and Mold
Mold, bacteria, and dampness on surfaces or damaged materials in schools have been significantly associated with respiratory symptoms such as wheezing, cough, or exacerbation of asthma, as well as development of allergy.  Moisture-related problems can result from leaks under sinks, in roofs, and under floors or behind walls. Studies in California and elsewhere in the U.S. suggest that moisture-related problems are common in schools. One study of California’s schools found that 21% of portable and 35% of traditional classrooms had visible water stains on the ceiling. Research suggests that repairing moisture damage can reduce exposure and improve symptoms.16, 32, 33

Finishes, Furnishings, and Cleaning and Teaching Products
Volatile organic compounds, or VOCs, are respiratory irritants emitted into the air by cleaning products, building and interior finish materials, furnishings, and some teaching supplies such as paints and markers. Exposure to VOCs in classrooms and other indoor environments has been linked to exacerbation of asthma and other respiratory symptoms. For example, one study found that schools with higher concentrations of formaldehyde or other VOCs had more students with current asthma. Recent studies throughout California have found high concentrations of formaldehyde and other VOCs in the air in a sample of traditional and portable classrooms. Research suggests that using building and interior finishing materials with low VOC emissions can reduce the concentration of VOCs in classrooms. Additionally, cleaning products that contain bleach or are lemon or pine-scented are of particular concern because they are commonly found in schools and they emit chemicals that have been linked with respiratory symptoms and asthma.

Dust
Allergens and toxins can collect in dust on surfaces in schools. Dust in schools has been associated with increases in allergic sensitization, asthma symptoms, and asthma medication use. In schools, dust is found on surfaces like bookcases and smooth flooring, as well as in carpets, rugs, curtains, and upholstered furniture. Carpets and rugs tend to increase air quality problems; studies have reported allergen levels in dust were higher in carpets and rugs than on smooth floors.

Pesticides
To date, few studies have investigated the link between pesticides and children with asthma. However, a growing consensus has developed over the last several years among health and school professionals, public and community health advocates, and even many legislators, that school pesticide use can affect children’s health. A study of portable and traditional classrooms in California found a number of pesticide residues in classrooms. Given what is known about the health risks of pesticides — for example, exposure can harm the nervous system — and concern about how pesticides may affect asthmatic children, many advocates are promoting the use of less toxic or nontoxic alternatives at schools.

What RAMP is doing
RAMP’s work with schools focuses on education for staff and students, improving indoor air quality in schools, and establishing management and support systems for students with asthma. RAMP is also working to shape local, regional, and state policies affecting schools. A few examples of our efforts related to schools include:
· Creating and advocating protocols to prevent and address indoor air quality problems.
· Establish practices and protocols for reducing the presence of environmental triggers in schools by restricting the use of unhealthy cleaning supplies (e.g., Clean and Healthy Schools Act, AB 821).
· Hosting an annual roundtable dialogue that brings together school staff and other interested parties to discuss school and asthma related topics.
· Creating tools and resources (e.g., Asthma in 15! materials designed to educate school staff about asthma in 15 minutes).
· Advocating for school policies that address asthma management and indoor air quality.
· Promoting programs that educate students about the management of their asthma and how to reduce environmental triggers.
· Partnering with schools to increase and improve the use of asthma action plans.
· Working to address similar asthma issues (indoor air quality, education of providers, green cleaning products, policy changes in licensing requirements) in the childcare setting.
· Working to impact racial/ethnic disparities in asthma by focusing and adapting our efforts for settings within predominantly African American and/or Latino communities.

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