Dr. Albert Rizzo: Welcome back to Lungcast, the monthly respiratory health podcast series from the American Lung Association and medical news site HCP Live. I'm your host, Dr. Albert Rizzo, chief medical officer of the American Lung Association. Before we introduce our guest today, just a reminder that Lungcast is available on all your favorite streaming platforms. You can subscribe to @Lungcast on YouTube to get new and archived episodes, as well as interview segments and episode highlights as they come out. A link to the show page, as well as the American Lung Association and HCP Live homepages for Lungcast, can be found in each episode description.
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Now, as summer draws to a close, it's important to discuss with parents and their children some tips for making the return to school as smooth as possible, especially regarding lung health. For that reason, we are joined today by two of the American Lung Association's National Medical Spokespersons:
Dr. S. Christy Sadreameli: Pediatric pulmonologist at Johns Hopkins Hospital in Baltimore, Maryland, taking care of pediatric patients of all ages with a variety of pulmonary conditions.
Dr. Wanita Mora: Physician and leader in the field of allergy and immunology, practicing in Chicago.
During the next 20 to 30 minutes, I'd like to hear your views on at least three issues that the American Lung Association feels are important for respiratory health, especially as we plan on getting our children back into the school year. These include: asthma control and the phenomenon sometimes called “Peak Week,” the prevalence and hazards of vaping and e-cigarettes in the school-age population, and the importance of up-to-date vaccine schedules, especially related to respiratory pathogens.
Let's start out with this term “Peak Week.” Please, for our listeners, tell us what that means regarding patients and their asthma, and what are some important messages for parents and children about trying to maintain stability in asthma control during this time of year.
Dr. Wanita Mora: Well, first of all, as an allergist and immunologist, I love this season for many reasons. One is getting kids’ asthma action plans updated when they come to me. I review medications, make sure their inhalers are up to date and not expired, ensure they’re using them correctly, and if they need a spacer, they are using it. I also check for any new triggers for their asthma—like a new cat or dog at home, or seasonal allergens such as ragweed.
It’s also a good time to remind families about updating vaccinations, including the flu and COVID-19 vaccines, to ensure everyone is protected.
Dr. S. Christy Sadreameli: Sure, when we think about “asthma Peak Week” in the fall around back-to-school season, it refers to a rise in asthma exacerbations—periods where patients experience flare-ups, like wheezing, chest tightness, shortness of breath, and needing their rescue inhaler more often. This often happens early in the school year, largely because kids are back together in close settings where viruses spread. Seasonal allergens can also contribute, so multiple triggers at once can increase the risk of an asthma episode. The best preparation is staying on a preventative asthma regimen and being proactive about medication adherence.
Dr. Rizzo: Dr. Mora, how much do you interact with school nurses regarding asthma action plans?
Dr. Mora: Usually, we give parents an asthma action plan, and they submit it to the school along with an inhaler. For kids with severe asthma, the nurse may call the office for updates or adjustments. Communication between parents, schools, and physicians is key.
Dr. S. Christy Sadreameli: In Maryland, like in many states, schools require an official form and asthma action plan for students to have their rescue medication. There are laws, like stock albuterol policies, to provide additional safety in case a child doesn’t have their medication. But these policies don’t replace individualized care plans.
Dr. Rizzo: Do you see changes with combined steroid and bronchodilator inhalers being used as needed in schools?
Dr. S. Christy Sadreameli: Yes, the “SMART therapy” (combined inhaled steroid and bronchodilator) can be used as maintenance and rescue in older children. In schools, we often keep albuterol for practicality—insurance coverage, maximum daily doses, and ensuring access—though some patients do use SMART therapy under supervision.
Dr. Mora: I’ve had a similar approach. We teach school nurses how to administer combined inhalers and follow guidelines for children with more complicated asthma.
Dr. Rizzo: Let’s switch gears. CDC data from 2023 show e-cigarettes are the most used tobacco product among middle and high school students, with 2.1 million students currently using them. Are you surprised by these numbers, and how do you address vaping in your practices?
Dr. Mora: It’s an epidemic. We fight misinformation daily. Parents need to talk to their children about vaping before middle school, because youth access these products earlier. I share real stories from my practice—like teens with asthma exacerbations from vaping—to emphasize the risks.
Dr. S. Christy Sadreameli: Flavored e-cigarettes are especially harmful and addictive. We see both acute harms, like EVALI (vaping-associated lung injury), and chronic effects, including new or worsening asthma. Education and prevention are crucial.
Dr. Rizzo: Regarding vaccinations, how do you begin discussions with families about routine immunizations and COVID-19 vaccines?
Dr. Mora: Post-pandemic, immunization rates dropped, leading to outbreaks of measles, whooping cough, and polio. I review vaccination status at visits, emphasize the safety and importance of vaccines, and encourage catch-up visits. Flu and COVID-19 vaccines are especially critical for kids with asthma.
Dr. S. Christy Sadreameli: Annual vaccines like flu and COVID-19 reduce hospitalization risk in children with asthma. Sharing experiences and encouraging families helps overcome hesitancy.
Dr. Rizzo: What about school environments and air quality?
Dr. Mora: In Chicago, poor air quality from neighborhood demolition affected children’s respiratory health. I spoke to schools about ventilation, filters, and monitoring symptoms, which brought positive changes.
Dr. S. Christy Sadreameli: In Baltimore, older schools with poor ventilation or no central air can worsen lung health, especially during heat waves. Pest control and air filtration are also important for children with asthma. I aim to work with schools to improve air quality.
Dr. Rizzo: Any final thoughts?
Dr. Mora: I urge parents to visit lung.org for information on vaccines, asthma, and vaping. Our resources help families make informed decisions.
Dr. S. Christy Sadreameli: The goal of treating asthma is for children to live as normal a life as possible—running, playing, and being healthy. Avoiding e-cigarettes, following prescribed medications, and staying up-to-date with vaccines support that goal.
Dr. Rizzo: Thank you both for your time and dedication as medical spokespersons for the American Lung Association. For our listeners, be sure to subscribe and rate Lungcast, and visit lung.org and HCP Live.com for more resources. Until next time, I’m Dr. Albert Rizzo reminding you that if you can’t breathe, nothing else matters.
