TORONTO - Oni Joseph used to go to her son's school each fall and explain why he was constantly sniffling and out of breath.
Her son, 13-year-old Toussaint, was "born wheezy," and his asthma has only grown worse with time, the Ottawa poet and mother said.
Now, of course, the teen's teachers and classmates are used to his perpetually runny nose, his stash of tissues and his inhaler, a device used to send medication directly into the airways, his mother said.
But Joseph, 38, still worries about sending him back to school in September, a month when asthma attacks — and asthma-related visits to the emergency room — skyrocket.
Toussaint's symptoms always flare up in the fall, she said, and "he's had so many (attacks) this year," including two that had the family dashing to the Children's Hospital of Eastern Ontario in a panic.
"It's the scariest thing as a parent because you can't do anything," she said. "So I'm very stressed."
Each year, the so-called "September epidemic" strikes legions of children who suffer from asthma, a respiratory condition that affects roughly 10 per cent of children and causes more than 200 deaths annually, according to Statistics Canada.
Studies show the first few weeks of school bring a boom in asthma attacks — violent, often terrifying episodes marked by coughing, wheezing and chest tightness — and trips to the emergency room.
Hospital visits hit a "dramatic peak" 17 days after Labour Day, a holiday generally considered the end of summer vacation, said Neil Johnston, an epidemiologist at the Firestone Institute for Respiratory Health in Hamilton.
For older teens and adults, the spike comes about a week later and isn't as pronounced, said Johnston, who has analyzed the phenomenon in a number of studies.
"Things that are so exquisitely timed don't just happen by accident. There's something going on," he said, noting researchers in Britain and Trinidad have spotted the same pattern.
Back-to-school is a perfect storm of stress, germs and allergens, he said, all known to potentially trigger attacks.
What's more, a lot of kids let their asthma treatments lapse during the summer months, so they're even more vulnerable come fall, the researcher said.
"It's a quadruple-whammy. All these things line up," he said.
Dust, mouse feces and cockroaches in schools can set off coughing fits, as can cat and dog hair on other children's clothes, he said.
But the worst culprit by far is the common cold, which causes 60 to 70 per cent of asthma attacks in children, he said.
"What that suggests to us is that sometime after the school return, there's an epidemic of the common cold," though it's unclear what causes it, Johnston said.
Though the September spike is predictable, it's not entirely preventable, given all the factors at play.
But there's a lot families can do to lessen its impact, said Dr. Paul Ehrlich, a pediatric allergist in New York City and co-author of "Asthma, Allergies, Children: A Parent's Guide."
Parents should visit the school's health clinic to make sure nurses there know how to administer medication with an inhaler, he said.
They should also talk to teachers and explain why their children are itchy, sneezy or wheezy, the doctor said.
And some parents may want to spend a day tagging along with their little ones to spot possible pitfalls, such as dusty mats and rugs for nap time, he said.
But Ehrlich stressed the key to controlling asthma is having a solid treatment plan — and sticking to it.
There are two kinds of asthma medication. Drugs dubbed "rescuers" relax the muscles around the airways to quickly ease breathing in case of an attack, but they don't treat inflammation.
"Control" medications, such as inhaled steroids, help soothe the inflammation that causes asthma symptoms. They must be used consistently to work.
All children with asthma need both kinds of drugs, but they often abandon the control treatments when they start to feel better, said Johnston, the epidemiologist.
Asthma, one of the most common chronic conditions in Canada, can prevent children from sleeping properly and often forces them to miss a lot of school.
Studies show children with asthma score lower in standardized math and reading tests. Those with more severe symptoms have the worst outcomes, the data show.
Christine Hampson, president and CEO of the Asthma Society of Canada, said it's not too late for children to get back on track before the school year starts.
The biggest challenge, she said, is getting people to treat asthma as a chronic disease instead of something that erupts once in a while.
"So going to the ER once a year in September for many people is seen as normal," she said in an interview from Toronto.
"Having your child not be able to participate in certain sports or not be able to sleep through the night sometime in the year, people kind of accept the diminished quality of life," she said.
Paola Loriggio, The Canadian Press