School Opens, Asthma Worsens -- Study

NEW YORK (Reuters Health) - The start of school is associated with a marked increase in asthma-related visits to the emergency department, according to a study of New York City children.

"Since rhinoviral respiratory infections are most common at the end of summer and beginning of fall, we speculate that exposure to such viruses in the classroom setting may be responsible for some of the school-related asthma," Dr. Robert A. Silverman, who led the study, told Reuters Health.

The stress of starting school and exposure to indoor irritants may also be involved.

Optimizing the preventive regimens of "children with poorly controlled persistent asthma may lessen the fall peak," Silverman added.

To see whether the previously observed fall increase in asthma emergency department visits by New York City children is related to the start of the school year, Silverman from Long Island Jewish Medical Center in New Hyde Park in New York and his colleagues conducted a time-series study of daily asthma-related emergency department visits to 11 New York City hospitals.

As the researchers report in the Archives of Pediatrics and Adolescent Medicine, they compared the rate of asthma-related emergency department visits 30 days before and 30 after the September school opening for the years 1991 to 2002.

For children ages 5 to 11, school opening correlated with a 46 percent increase in emergency department asthma visits, compared with the period before the start of school.

Smaller increases in emergency department visits were seen among preschool-age children (2 to 4 years), and older children (12 to17 years), Silverman said.

These associations held up in analyses adjusted for other factors that might have influenced emergency department asthma visits, such as temperature, ozone levels, day of the week, and holidays.

The findings in this study may aid schools, healthcare professionals and children "better prepare for the fall asthma season and lead to a better understanding of the causes of school-related asthma worsening," Silverman's team concludes.

SOURCE: Archives of Pediatrics and Adolescent Medicine, September 2005.