In Case of Emergency: Managing Asthma at School

Teachers and school staff often face unexpected scenarios during a school week. Being prepared makes all the difference when it comes to handling an emergency in a calm manner.

If you’re an educator, it’s likely there are students in your school who have asthma. Does your school have a plan to help these students during an asthma attack?

Knowing what do when a child has an asthma attack is vital. If a child is undiagnosed or does not have an asthma action plan, use protocols from the American Lung Association  and National Asthma Education and Prevention Program  as a guide.

Watch for these symptoms: 

• Coughing, wheezing, noisy breathing or whistling in the chest 
• Difficult breathing, tightness in chest, shortness of breath or chest pain 
• Complaints of discomfort when breathing 
• Breathing hard and fast 
• Nostril flaring  
• Speaking in short sentences or unable to speak 
• Blueness around the lips or fingernails 

If you see any of the above, take these actions: 

• Quickly evaluate the child. Call 911 and administer quick-relief medication  if the child is in severe distress. Signs of stress include inability to speak, blue lips and a peak flow reading that’s less than 50 percent of predicted best.
• Give the student oxygen if it’s available and the child is in respiratory distress. 
• Limit physical activity and allow student to rest. Encourage them to relax and breathe slowly. 
• Place the student in an area where he or she can be closely observed. Never send a student to a new location alone. 
• Check and record their peak-flow meter reading. If their personal best is unknown, use the prediction chart.
• CALL 911 if peak flow reading is less than 50 percent of personal or predicted best. 
• Take the student’s respirations and pulse. Report the rates to a physician or EMS personnel. 
• Administer quick-relief medication. Remember, medication requires a personal physician order or a standing order signed by a school physician or public health physician. If the student does not have a personal albuterol inhaler, administer quick-relief medication from the school supply, if available. Use a spacer and throw away the mouthpiece. 
• Contact the student’s parents even if situation does not appear severe. 
• Look at student again after 10-15 minutes. Check their breathing, peak flow, pulse and respiration. 
• If student is improving, keep them in the health room under supervision until breathing returns to normal. 
• If the student is not improving, contact his or her physician or call 911. 
• With the parents’ permission, provide a report about the asthma emergency to the student’s physician. 
• Obtain a personal asthma action plan from the student’s family or physician. 

Consider displaying an emergency response poster in classrooms and staff locations for easy reference. Provide cardio pulmonary respiratory (CPR) and first-aid training to the school staff.

To learn more about Asthma and the Taking on Asthma initiative, visit our website.

Sources: Asthma-Friendly School Initiative Toolkit,  American Lung Association, 2020; How Asthma-Friendly is Your School,  National Heart, Lung and Blood Institute, 2013; Asthma Basics for Schools, Part 1,  National Asthma Education and Prevention Program; Measuring Your Peak Flow Rate,  American Lung Association, 2020; Management of Asthma Exacerbations: School Treatment,  National Asthma Education and Prevention Program, 2008; Predicted Average Peak Expiratory Flow  Guides, University of Michigan.

Originally published 6/14/2016; Revised 2021