Back-to-school season is a well-documented peak period for asthma exacerbations. Exacerbations typically begin increasing in early September, peak around the third week of the month, and gradually decline thereafter. This seasonal rise is associated with several factors, including children returning to school, elevated ragweed pollen levels, increased mold counts, seasonal weather changes, and poor indoor air quality in schools. Although the September peak is most pronounced among children and adolescents, adults may also experience increased asthma symptoms during this period.
Early recognition of triggers and close monitoring of asthma symptoms can help prevent exacerbations. A written asthma action plan (AAP) provides clear guidance for self-management when symptoms worsen. Developing an AAP is a collaborative process between the health care provider and the patient, or the patient’s caregiver. When combined with asthma education and routine follow-up, an AAP can improve symptoms and quality of life while reducing hospitalizations. International guidelines recommend written AAPs for all patients; however, an AAP should not be used as a stand-alone intervention. Education and follow-up are essential to its success. Effectiveness may also vary across patient groups. For example, self-monitoring may be more challenging for elderly patients, while individuals with low health literacy may benefit from specialized tools, such as pictorial rather than text-based materials.
Asthma action plans typically follow a “traffic light” format. The green zone indicates acceptable asthma control and represents the daily goal for the patient, including use of baseline medications. The yellow zone signals a loss of control and provides specific instructions for increasing therapy. The red zone reflects severe symptoms that require immediate, urgent attention. Patients or caregivers use symptoms, peak flow measurements, medication use, and activities of daily living to determine the appropriate zone. Each AAP should be individualized and include evaluation of daily activities, such as whether the patient can attend school or work. If peak flow monitoring is used, the green zone should be greater than 80% of the patient’s personal best, the yellow zone should be 60% to 80%, and the red zone should be less than 60%. The plan should also identify known triggers, list medications to increase or add in each zone, and include emergency contact information. As a personalized tool, the AAP should be developed collaboratively by the health care team and the patient. The National Asthma Education and Prevention Program (NAEPP) recommends that health care providers and patients review the AAP annually.
During the September surge, proactive asthma monitoring is essential. Patients and caregivers should watch for changes in symptoms, increased medication use, decreased peak flow readings when applicable, and limits in daily activity. Recognizing early signs of worsening asthma allows patients to follow their asthma action plan properly, adjust treatment as directed, and seek medical care before symptoms become severe. Consistent symptom monitoring, an up-to-date asthma action plan and ongoing education, can help reduce the risk of exacerbations and support safer asthma management throughout this high-risk season.
Resources
Kouri, A., Kaplan, A., Boulet, L.-P., & Gupta, S. (2019). New evidence-based tool to guide the creation of asthma action plans for adults. Canadian Family Physician, 65.
Do Primary Care Providers Update Asthma Action Plans? – Advance Study