Sandra Luscher is a registered nurse and certified asthma educator in the Paediatric Asthma Clinic at St. Joseph’s

For many in Ontario, the spring and summer months mean sunshine and time spent enjoying the great outdoors.

For kids with asthma, however, it can also mean dealing with pollen storms and heat waves that make breathing difficult.

Sandra Luscher is a registered nurse and certified asthma educator in the Paediatric Asthma Clinic at St. Joseph’s Health Centre. In her role, Luscher provides education to parents and their children, from just a few months old up to 17 years old, who are referred to the clinic. She helps them understand what asthma is and its possible triggers, the inhalers they are going to take, how the medications work in the lungs, and how to know when to replace their inhalers.

“For the families that we follow, I also take their calls if they have questions or concerns about their child’s asthma and do my best to answer them,” she says. “Hopefully, I can keep them out of Emergency Departments or walk-in clinics by helping them to know what symptoms to look for that may require use of their rescue medication, and which ones require more urgent medical care.”

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As kids enjoy their last few weeks of summer vacation and prepare to return to school, we spoke with Luscher about what can trigger kids with asthma and some tips for kids and parents to manage their asthma through the summer and heading back to school.

For kids and parents who are coming to the St. Joseph’s asthma clinic for the first time, how do you explain to them what asthma is?

I try to gear the teaching to the children’s level, so even as young as four years old, if they are willing to be engaged in the conversation, I will provide the education at a level they can understand.

I use pictures to show the differences between an airway in the lung that is well controlled versus one that is affected by asthma. Children with asthma get inflammation or swelling in the small airways of their lungs, also known as bronchioles, and when the swelling occurs there can be mucus production. There are also small muscles that wrap around all of our airways – I compare them to elastic bands – and when they become irritated, they will constrict or tighten and block the airways. These are the two key components of asthma.

One of the common questions we get from parents is whether their child will outgrow their asthma. Children don’t necessarily outgrow their asthma. Their asthma may become dormant. As they get older their lungs mature, their airways become larger and their immune systems become stronger. The symptoms they had in their young life may improve or disappear and they may eventually not need a controller medication on a regular basis. That doesn’t mean later in life they won’t have an exacerbation due to a viral exposure, or an environmental exposure.

What elements of our environment, both indoor and outdoor, can be triggers for kids with asthma?

Pollen allergies are a significant contributor to worsening asthma symptoms. There are different pollens throughout the early spring to fall months. Tree pollens are more common in the spring, and then as we head into May and June, there are the grass pollens.

Allergy symptoms started earlier this year because we had a mild winter and trees began to bud and produce pollens in late March and early April. In the fall, children suffering from ragweed allergies may experience an increase in their asthma symptoms. Fall leaves on the ground results in mold growth, which can also worsen asthma symptoms.

Campfire or wildfire smoke are common triggers at this time of year, especially as kids head off to camp or to a cottage. So far this year, we haven’t seen a lot of effect from the forest fires out west here in Ontario, however, last year, the smoke from the fires in Quebec caused many of our patients to have worsening asthma symptoms. In these cases, keeping your child indoors, making sure they are on their controller medications and taking them as prescribed is important.

The hot, humid days of summer can increase asthma symptoms. The heat and humidity can also cause air pollution levels to rise, which can irritate the lungs and reduce lung function, making asthma symptoms worse.

A key indoor trigger is cigarette smoke. A parent, relative or friend smoking near or in the home of the child can trigger asthma symptoms. Parents or people residing in the home who smoke, should smoke outside of the house and change their clothes when they come into the house, and they should never smoke in a car with a child present.

(Right) Dr. Tania Samanta, Paediatric Respirologist, and Sandra Luscher

Other indoor triggers include dust mites on stuffed animals, beds, pillows and in carpets. There can also be mold in the internal environment, particularly in bathrooms or around windows. Another common trigger can be pets or exposure to animals at friends’ or relatives’ homes. Many kids are allergic to various animals. If they have tested positive to an allergy to a particular animal, exposure to those animals can be a trigger for their asthma.

Last, but not least, are respiratory viruses. Respiratory viruses, including the common cold, RSV (respiratory syncytial virus) and influenza are the most common causes for asthma diagnoses in pre-school and school-aged children.

What are some of your tips for kids and parents to manage these triggers?

Number one is if they’re on a regular controller asthma medication, they should be taking their medication as prescribed, even if they are well. They need to be replacing their inhalers as they’ve been informed and keep track of doses.


If there are pollen storms or high pollen counts, then kids should stay inside, limit outdoor activity or plan outdoor activities after 10 a.m., as pollen counts tend to be lower later in the day than they are earlier in the morning.

Keeping windows closed and using air conditioning, if you have it, helps to keep pollen from coming in the house. If kids have been playing outdoors, they should change their clothes when they come back in the house, and consider having a shower or a bath to get any pollen off the body. Parents can also speak to their child’s health care provider about allergy medications to help with allergy symptoms.

It’s the same with hot, humid weather. If hot, humid weather is a trigger for your child’s asthma then again, have air conditioning on, plan indoor activities or plan outdoor activities earlier in the morning or later in the day when it’s cooler.

During the winter, cold air can be an asthma trigger, including for those who play hockey or participate in rink activities. For children who are triggered by cold air while playing outside, we recommend collar scarves up over the nose and mouth because they help humidify the air as it is breathed in and out through the scarf. Kids playing rep hockey, ringette or who figure skate, and in a rink multiple times a week, we as their healthcare providers need to ensure they are on the right asthma treatment plan to keep them from having regular symptoms.

For children who are allergic to their pets and are having moderate to severe asthma symptoms, we unfortunately may have to counsel their parents to consider rehousing their pet. If a family is considering getting a pet and their child has a significant allergy to that particular animal based on allergy testing, we recommend not purchasing that specific type of pet. Children who will be exposed to animals they are allergic to at a relative’s or friend’s house, we recommend they receive an allergy medication before the exposure, avoid handling the animal, and having their reliever/rescue inhaler (blue inhaler) with them at all times.

For dust mite mitigation, we recommend dust mite covers for pillows, mattresses and box springs. Kids should not sleep with a lot of stuffed animals because they carry dust mites. They should pick one or two of their favourites and then parents should ensure they are washed and dried on a regular cycle. Bed linens should be washed every week in hot water. Keeping floors and furniture dust free, vacuuming
and damp mopping floors also helps.

Anything kids and parents should look out for as they head back to school in September?

As we head into the fall months, children are returning to school and spending more time inside. As a result, we see an increase in the spread of various respiratory viruses and an increase in asthma attacks – we call this the “September Spike”.

Children who have an asthma action plan that includes restarting their controller medication two weeks before school starts, or those who are to continue taking their controller medication, should ensure they are following their plan. Children who are using meter-dosed inhalers should be using an appropriate spacer or aerochamber. Parents should ensure there is medication in the inhalers and purchase new inhalers if they are empty or unsure of how much is left.

Reliever/rescue inhalers (blue inhaler) and aerochambers should be made available to children at school in case of symptoms during school hours.

Flu vaccines are important in the prevention of illness and severe asthma attacks. In the asthma clinic, we educate families about the importance of the flu vaccine, as well as regularly-scheduled vaccinations, and encourage families to ensure their immunizations are up to date.

Luscher also recommends some helpful resources for kids and parents: Asthma.ca; Lung Health Foundation; About Kids Health – Asthma Hub; Weather Network – Pollen Forecast; Video: BC Childhood Asthma: A Guide for Families and Caregivers

By: Danielle Pereira & Photos by Yuri Markarov

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