Written by Dr Seb Gray, Consultant Paediatrician and CYP Asthma Lead

September is a wonderful time of year.

New pencil cases are purchased. School uniforms suddenly seem two sizes too small. Parents everywhere breathe a cautious sigh of relief as six weeks of snack preparation and sibling negotiations come to an end.

But while families are gearing up for the new school year, paediatricians and asthma specialists are quietly preparing for something much less welcome: the September asthma surge.

The September asthma surge is the predictable rise in asthma attacks and hospital admissions seen among children and young people after schools return. It is thought to be caused by several factors arriving at once, including respiratory viruses, allergens, disrupted medication routines and increased physical activity.

Every year, hospitals across England see a spike in children and young people being admitted with asthma shortly after the start of the new school term.

This seasonal pattern is sometimes called the Week 38 asthma surge because hospital attendances have often been found to peak around the 38th week of the year.

The reassuring news is that many asthma attacks may be prevented through good asthma control, regular preventer treatment and careful preparation for the return to school.

The summer holidays therefore provide the perfect opportunity to make sure your child’s asthma starts the school year in as good shape as their new shoes.

Why does asthma suddenly flare up in September?

If only there were a single culprit we could march into a headteacher’s office and give a detention.

Unfortunately, the September asthma surge is caused by several factors all arriving at once, like an especially unwelcome school reunion.

Rhinovirus: the true head boy of September

Let’s start with the biggest offender.

When children return to school, they do not just bring shiny backpacks and exciting holiday stories. They also bring viruses.

Lots of viruses.

Viral infections are associated with up to 80 to 85% of asthma exacerbations in children, with rhinovirus, the virus behind many common colds, recognised as a particularly important trigger.

Children are exceptionally talented at sharing rhinoviruses. Sadly, this is one area where teamwork really does not make the dream work.

School-aged children can also be highly effective at introducing rhinoviruses into their households and passing them to other family members.

So if your child develops a sniffle during the first week of term, do not be surprised if the whole family joins in shortly afterwards.

The dust has settled… literally

School buildings often spend much of the summer sitting quietly and largely unused.

When classrooms reopen, some children may be exposed to increased levels of dust mites and indoor allergens that have been waiting patiently for their return.

It is rather like the classroom itself has spent six weeks collecting ammunition.

Autumn has different allergic ideas

Many hay fever sufferers feel relieved when summer ends.

Unfortunately, nature rarely misses an opportunity to be difficult.

As autumn approaches, mould spores can increase, windows close and heating systems start up. For some children, these changes provide plenty of opportunities for asthma symptoms to become troublesome.

The great preventer inhaler summer holiday

Let’s be honest. For many families, summer routines bear only a passing resemblance to normal life.

Bedtimes drift. Breakfast happens at lunchtime. Nobody knows what day it is.

In amongst the holiday chaos, preventer inhalers can occasionally be forgotten.

The difficulty is that asthma does not take six weeks off.

Missing preventer treatment over the summer can leave the airways more sensitive just as viruses and allergens return with enthusiasm in September.

PE lessons: the unexpected asthma audit

Some children spend the summer racing around outdoors. Others become highly trained experts in Fortnite, YouTube and sofa-based endurance events.

Returning to PE lessons, football practice and cross-country running can sometimes reveal asthma that has not been fully controlled.

Children who find themselves coughing, wheezing, becoming unusually breathless or struggling to keep up during exercise may be telling us that their asthma needs a review.

When viruses and allergies join forces

If viruses are Batman and allergens are Superman, September is unfortunately the crossover episode nobody asked for.

Research shows that viral infections and allergen exposure can work together to significantly increase the risk of asthma attacks. The combination may be more dangerous than either trigger alone.

This helps to explain why September can create such a perfect storm for children with asthma.

Starting a new school year should not mean accepting asthma symptoms

The vast majority of children with asthma should be able to:

• Sleep through the night
• Run around without troublesome symptoms
• Enjoy sports and activities
• Attend school regularly
• Use their reliever inhaler only as directed within their asthma plan

If your child is coughing regularly, waking at night, struggling with exercise or needing their reliever treatment more frequently than expected, that is not something they should simply have to put up with.

It may be a sign that their asthma could be better controlled.

Better asthma control can mean fewer symptoms, fewer attacks and fewer unexpected trips to hospital.

Which, let’s face it, is a much better way to start the new school term.

Why a summer asthma review makes sense

The weeks before school starts are an ideal time to review your child’s asthma management.

A specialist assessment can help identify:

• Incorrect inhaler or spacer technique
• Medication issues
• Hidden asthma triggers
• Allergy-related symptoms
• Exercise-induced asthma symptoms
• Opportunities to adjust treatment appropriately
• Strategies to reduce the risk of autumn flare-ups

Sometimes small adjustments can make a surprisingly big difference.

A back-to-school asthma checklist

Before your child returns to school, it may be helpful to:

• Check that their inhalers are in date and contain enough medication
• Continue preventer treatment exactly as prescribed
• Check that they are using their inhaler and spacer correctly
• Make sure their personalised asthma action plan is up to date
• Give the school a copy of their asthma action plan
• Confirm where their inhaler and spacer will be kept during the school day
• Tell the school about any recent symptoms, asthma attacks or medication changes
• Arrange an asthma review if they have been coughing, waking at night or struggling during exercise

Your child’s exact treatment and school arrangements will depend on their individual asthma plan. Their clinician can advise you about what medication should be available at school and how it should be used.

How Dr Helen Medical can help

At Dr Helen Medical, I offer private paediatric appointments for children and young people with asthma, recurrent wheeze and other respiratory conditions.

As a Consultant Paediatrician and CYP Asthma Lead, I see many families who feel frustrated because, despite using inhalers, their child still seems to be battling symptoms.

A dedicated asthma consultation provides the time to properly explore what is happening, optimise treatment, review inhaler and spacer technique and create a practical plan for the months ahead.

We can look at the whole picture, including:

• Your child’s symptoms and medical history
• Their current medication
• How often symptoms occur
• Night-time coughing or waking
• Difficulties with sport or exercise
• Possible allergic triggers
• Previous asthma attacks or hospital visits
• Inhaler and spacer technique

The goal is not perfection.

The goal is to help your child breathe comfortably, sleep well, take part in the activities they enjoy and reduce their risk of becoming part of the September asthma surge statistics.

Ready for school. Ready to breathe.

Children will return to school this autumn with new teachers, new classmates and stories about their summer adventures.

Ideally, they should not be returning with poorly controlled asthma as well.

So while you are labelling uniforms and hunting for missing PE kits, it may also be worth asking one simple question:

Is my child’s asthma as well controlled as it could be?

If the answer is “I’m not sure”, the summer holidays are a good time to find out.

To book a private paediatric asthma appointment with me, Dr Seb Gray, at Dr Helen Medical, get in touch today.

Let’s make sure the only thing taking their breath away this September is how quickly the summer holidays disappeared.

Call 01202 022956 or book an appointment here.

Frequently asked questions about children’s asthma and returning to school

What is the September asthma surge?

The September asthma surge is the seasonal increase in asthma attacks and hospital attendances seen among children and young people shortly after schools return.

Respiratory viruses, allergens, changes to medication routines and the return to regular physical activity may all contribute.

Why does my child’s asthma get worse when they return to school?

Children are exposed to more respiratory viruses when they return to classrooms and begin mixing closely with other pupils again.

They may also encounter dust mites, mould spores and other allergens. If preventer medication has been missed during the summer or asthma has not been fully controlled, these triggers can make symptoms worse.

How can I tell if my child’s asthma is well controlled?

Signs that asthma may not be fully controlled include:

• Regular coughing
• Wheezing
• Night-time coughing or waking
• Breathlessness
• Difficulty keeping up during exercise
• Avoiding sports or physical activity
• Needing reliever treatment more often than expected
• Missing school because of asthma symptoms

An asthma review can help establish whether symptoms are being adequately controlled and whether any changes are needed.

When should my child have an asthma review?

Children with asthma should have regular reviews as recommended by their usual healthcare professional.

An additional review may be helpful if symptoms are worsening, reliever treatment is being needed more frequently, exercise is becoming difficult or you are unsure whether your child is using their inhaler correctly.

The weeks before returning to school can be a particularly useful time to check that everything is working as it should.

What should my child take to school for their asthma?

Your child should have prompt access to the medication and equipment included in their individual asthma plan. This may include an inhaler and spacer.

The school should also have an up-to-date copy of your child’s personalised asthma action plan and clear instructions about what to do if symptoms occur.

Treatment plans differ, so follow the specific advice given by your child’s clinician.

Can Dr Seb review recurrent wheezing if my child has not been diagnosed with asthma?

Yes. I see children and young people with recurrent wheeze, coughing, breathlessness and other respiratory symptoms, including those who do not yet have a confirmed asthma diagnosis.

A detailed consultation can help us explore possible causes, assess triggers and decide whether further investigation or treatment may be appropriate.

Important medical information

This article provides general information and is not a substitute for individual medical advice.

If your child is struggling to breathe, their symptoms are rapidly worsening or you are concerned they may be having a severe asthma attack, seek urgent medical help.