Proper planning, strong partnerships and a thorough school assessment form the foundation of a sustainable, long-term asthma management plan. Since each community has its own unique needs and resources, there is no one-size-fits-all approach to establishing an asthma-friendly school. This makes planning even more important!

The Asthma-Friendly Schools Initiative (AFSI) Toolkit is based on the premise that successful, long-term programs that are grounded in a structured planning process positively impact students with asthma. There are many ways to plan, but this toolkit presents one suggested planning system organized in Four Action Steps.

All resources provided to guide local planning are based on real-life experience among coalitions and schools. Many of the resources are based on the experience of American Lung Association staff and coalition members who piloted the Toolkit. Before you get started, review the AFSI Planning Challenges & Tips.

Below is a brief summary of the Four Action Steps, including tools and templates to support your activities.

Step 1

Action Step 1: Organize Stakeholders

AFSI was designed to be planned and implemented by a community-school coalition of engaged partners. Recruiting and building relationships with key individuals and organizations are critical to the successful planning and project implementation. As with any coalition effort, leaders will emerge, individual strengths and resources should be maximized, responsibilities should be specifically assigned, and partners should be accountable for their share of the work. Remember, a school must agree to full participation and support to ensure a successful program.

Coalition-building is a dynamic process that changes as needs are identified and analyzed, membership grows, and programs are implemented. Local groups can tap into a range of existing resources for guidance on coalition building. Be sure to include representation from a diverse group, both in populations served and function (health, business, youth services, etc.). As your coalition begins to work together, evaluate the effectiveness of the coalition and make adjustments as needed.

Consider any potential members of your AFSI coalition and other collaborators “customers.” Your customer groups are anyone with whom you need to work to implement AFSI locally. You may be considering individuals from any of these groups as potential coalition members, and some will become partners in the actual implementation of the project. 

Understanding how each audience or customer group will benefit from the asthma-friendly schools initiative will be a key to success. Just as few people would buy a product without believing they will benefit from it personally, individuals within the school and civic community will not “buy into” the asthma-friendly schools initiative without understanding how the program (and/or specific activities) will benefit them directly. When working with each customer group or audience, focus your communication on key benefits or “selling points” for that particular audience. Incorporate these in specific written materials, as well as group presentations and small meetings. 

AFSI customer groups and benefits per audience:

Superintendents, principals and school boards or boards of education members should support elements of asthma-friendly school activities—not only in setting policy, but also in supporting the concept, providing staff direction and budget support. Asthma-friendly schools activities benefit school administrators because these activities: 

  • are evidence-based.
  • may greatly reduce or eliminate asthma crises in schools. 
  • may reduce student absenteeism and improve the student learning environment.
  • may increase school income as absenteeism rates decline. 
  • may enhance the well-being of members of the school community and increase teacher productivity. 
  • include strategies for low-cost and no-cost indoor air quality management. 
  • provide resource and potential partnership links within the community, including funders.
  • include education for faculty and staff to improve the school’s asthma management, responses to asthma emergencies and facilities management.
  • can help minimize potential liability issues. 
  • can increase the school’s medical/health resources, which can help with management of other chronic illness. 
  • can improve faculty/staff productivity and performance.

School nurses are the core of the school health services, pivotal in responding to health issues and emergencies. Asthma-friendly schools activities benefit school nurses because these activities: 

  • may decrease the number of acute care visits to the school nurse or clinic. 
  • may improve indoor air quality, thereby decreasing the potential for asthma episodes and other building-related illnesses by students and staff. 
  • include specific asthma training for all school staff. 
  • support strengthened roles and expanded resources for school nurses. 
  • support expanded school health structures, such as creation of a school health council and introduction of a consulting physician or other health care professional into the school.
  • include more coordinated use of Asthma Action Plans by school staff. 
  • may reduce student absenteeism, enhance well-being of members of the school community and improve student learning environment. 
  • clarify communications among school nurses and all other school staff about the needs of students with and without asthma, as well as those students with other chronic health conditions.

These individuals are the first line of response during a student’s asthma episode. Their involvement is critical, as is their understanding of both the broad and specific issues of asthma management. Asthma-friendly schools activities benefit teachers and coaches because these activities: 

  • include specific asthma training for all faculty and staff, including effective and appropriate responses to asthma episodes and other respiratory emergencies.
  • may improve IAQ, thereby decreasing the potential for related student and staff asthma episodes, and improving work environment, which potentially reduces teacher absenteeism, enhances well-being and increases teacher productivity.
  • include more coordinated use of Asthma Action Plans by school staff.
  • may reduce student absenteeism and improve the student learning environment.
  • clarify communication among school staff about the needs of students with asthma.
  • include strategies to coordinate efforts between administration and school employees.

Without bus driver training in asthma response skills, students who ride buses to and from school may be left with a void during the time—up to two hours per day—between their homes and school. Asthma-friendly schools activities benefit bus drivers/transportation company staff because these activities: 

  • include asthma training for bus drivers, including effective and appropriate responses to asthma emergencies.
  • include strategies to improve communication between school and transportation staff.
  • may improve air quality inside buses, thereby improving drivers’ work environment and the well-being of drivers and student passengers.

Because environment plays such a critical role in asthma management, building/facilities staff must understand their vital part in asthma-friendly school activities. Asthma-friendly school activities benefit building/facilities staff because these activities:

  • can help save money through indoor air quality (IAQ) management, including integrated pest management (IPM).
  • include strategies for involving faculty and staff in IAQ management.
  • include IAQ training for staff and focus on IAQ management, which can reduce physical plant and equipment deterioration.
  • include activities that rely on facilities staff, who are recognized as valuable participants in the school’s work to ensure students’ health and well-being.
  • can improve facilities staff working environment and enhance their well-being.

Involving parents will be critical to supporting specific student education, educating parents themselves, and assisting parents in accessing additional community resources. Asthma-friendly schools activities benefit parents because these activities: 

  • include education about asthma for all students, and specific asthma management education for students with asthma.
  • May reduce student absenteeism and improve the student learning environment. 
  • may greatly reduce or eliminate asthma crises in schools. 
  • prepare school personnel to respond to asthma episodes and other respiratory emergencies by providing specific asthma training for all school staff. 
  • may improve IAQ, thereby decreasing the potential for related asthma episodes by students. 
  • include strategies for better communication between nurses and other school staff, including a coordinated use of Asthma Action Plans. 
  • include strategies for improving communication among home, school, and health care providers. 
  • may improve air quality, increasing teacher well-being and increasing productivity, thereby minimizing disruptions to student learning. 
  • are based on programs, documents, and research conducted by medical and public health experts and members of professional organizations.

Asthma issues should and must be on these departments’ agendas, whether or not they are currently focused on asthma. These organizations’ employees can provide resources and information and benefit from direct involvement in asthma-friendly schools efforts. Asthma-friendly schools activities benefit state education and health departments because these activities: 

  • are based on programs, documents and research conducted by education, medical and public health organizations, including American Lung Association, CDC, American Academy of Pediatrics (AAP), National Association of School Nurses (NASN), National Education. Association (NEA), National Heart, Lung and Blood Institute (NHLB) and the Environmental Protection Agency (EPA). 
  • may greatly reduce or eliminate asthma crises in schools. 
  • may reduce student and teacher absenteeism and improve student’s learning and teacher’s working environments. 
  • incorporate community-wide collaboration among the school community, healthcare providers, community-based organizations, civic/business leaders, and insurance providers.
  • help minimize potential liability issues. 
  • increase the school’s medical/health resources which can help with management of other chronic illnesses. 
  • Maximize resources.

Local health departments, hospitals/clinics, and individual primary health care providers can and should play important advisory and hands-on roles in asthma-friendly school activities. Asthma-friendly schools activities benefit community health professionals because these activities:

  • improve compliance with prescribed asthma management.
  • improve the quality of adults’ observation and the validity of history that doctors receive regarding a child’s symptoms.
  • address two significant health issues—asthma and air quality.
  • focus on a holistic, community-wide approach.
  • include opportunities for professional development, such as consulting services, volunteer medical services, and advisory activities (school health council, etc.).
  • may result in decreased asthma episodes and emergencies by students and school faculty and staff.
  • provide positive community relations/public relations opportunities for organizations and individuals.
  • are based on programs, documents, and research conducted by education, medical and public health organizations, including American Lung Association, Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), National Association of School Nurses (NASN), National Education Association (NEA), and Environmental Protection Agency (EPA).

Benefits to children with asthma will reflect the benefits and results of specific asthma and healthy indoor environmental education, such as Open Airways for Schools and IAQ Tools for Schools, from which students may receive the following:

  • specific asthma self-management skills.
  • fewer symptoms.
  • improved self-esteem.
  • opportunity to participate more fully in activities they enjoy.
  • opportunity to relate feelings about asthma and interact with others with asthma.
  • positive reinforcement.
  • focused attention from teacher or asthma education instructor.
  • improved school performance.

Additional benefits of improved/expanded school health services as a result of asthma-friendly schools activities include:

  • more asthma management support by teachers and other school staff.
  • Better access to asthma medications.
  • greater referral to and use of medical and other community resources.
  • better IAQ management.

Classmates of students with asthma may include individuals who have not yet been diagnosed with asthma. Those individuals will benefit from asthma-friendly schools activities by:

  • increased faculty and staff awareness of signs and symptoms of asthma and appropriate responses to the student
  • improved IAQ at the school
  • their awareness of other students’ asthma in general and the warning signs of an asthma episode
  • having increased empathy for those with asthma
  • learning to assist peers with asthma management
  • possibly earning service-learning credit for their involvement in school-based or community-focused asthma awareness activities

These include individuals and organizations who may become involved in an asthma coalition, fund specific activities, or become involved in awareness campaigns and programs. Asthma-friendly schools activities benefit civic and business leaders because these activities:

  • address two significant health issues that affect the entire community—asthma and air quality.
  • focus on a holistic, community-wide approach, which provides networking opportunities.
  • provide positive community/public relations opportunities for organizations and individuals.
  • involve a range of prominent local professionals and organizations.
  • Can save public funds and maximize resources.
  • positively affect students’ and school staff’s health and well-being.

These include community-based organizations that may or may not be related to general health issues or asthma, specifically, or individual professionals who contribute needed skills and/or resources to your initiative. Examples may include community foundations, community development associations, youth organizations, minority business organizations, community housing advocates, environmental justice advocates, attorneys, epidemiologists, university professors, and public relations professionals.

While these organizations and individuals may not at first be priority partners, keep in mind that they offer a variety of resources, including education and leadership training and social and support services. 

These additional partners will be valuable in both planning and implementing your initiative and their experiences may tap into existing resources. They are another link to parents and are often trusted by community members. They provide the home and community component of a community-based strategy, as well as professional skills/services that will strengthen implementation and program outreach. Asthma-friendly schools activities benefit these organizations and individuals because these activities:

  • provide individual referrals between programs.
  • promote community programs/resources.
  • ensure a continuum of community services to a target population (including and beyond asthma services).
  • support resource networking and may minimize duplication of effort.
  • Create joint/increased funding opportunities.
  • Provide opportunities for individual contributions to a community health issue. 

After putting in place a diverse group of coalition members, review the group's goals and establish the project planning process. Although goals and processes may be refined following the needs assessment, AFSI pilot sites found that having a general direction from the beginning was helpful for coalition members.

Step 2

Action Step 2: Conduct a Needs Assessment

To create an effective long-term asthma management plan for schools, the AFSI coalition will need to identify needs, gaps in information and resources, areas of opportunities and available resources.

A needs assessment may be more easily accomplished by a small workgroup or a subset of the larger coalition focused on the specific task. A completed assessment will inform the overall direction of the AFSI project and serve other roles moving forward, including:

  • Document a detailed picture of the school or district needs and community resources
  • Serve as baseline data for interim and long-term evaluation
  • Increase the level of data to build evidence of asthma as a major health concern
  • Document needs of school staff, which will bolster efforts to initiate the project within schools

The primary activities in this phase will be to: (1) review existing assessment tool, (2) assign data collection responsibilities, (3) analyze data and prioritize needs and (4) summarize needs assessment results.

Remember: Needs assessment results present objective data that will be reviewed as you set goals, objectives, and activities related to asthma education, health services, healthy school environments, and physical education and activity. Information should be presented in an unbiased manner that is both clear to read and reference.


Step 3

Action Step 3: Create a 5-year Plan

Once the needs assessment is completed and the results have been compiled, it is time to begin creating a long-term plan. In many cases, a separate workgroup will need to be created to take on the task of brainstorming and outlining the plan.

A strong, long-term plan will consist of the following items in each year:

  • Goals: A set of aims that align with the AFSI project's long-term direction.
  • SMART Objectives: Levels of achievement measures which are Specific, Measurable, Achievable, Realistic and Timely.
  • Activities: Necessary actions to meet objectives and work toward long-term goals.
  • Outcomes: Measurable changes that ultimately affect students (i.e. student absentee rates, academic achievement, disease management)
  • Evaluation: The process of monitoring your progress in meeting objectives and achieving desired outcomes, which may involve modifying plans moving forward.

The most effective way to establish a sustainable asthma management plan is to include a focus on school policies and practices. Once a policy is adopted within a school or district, staff turnover and time will no longer directly impact whether efforts to address asthma management in the school continue. When drafting the 5-year plan, be sure to set long-term policy goals and remember that change of this magnitude takes time. Policy change will not likely happen in year one; however, the groundwork for policy change can be established in the early years through needs assessment and program evaluation results that show the impact of an asthma management plan.

Creating a logic model can provide a visual roadmap that illustrates the relationship between project inputs and long-term outcomes, incorporating evaluation and measurement. A logic model helps to visualize the plan and is the recommended system for public health projects.

A tailored planning grid, based on the logic model, is suggested for all AFSI coalitions building a 5-year plan. This tool helps to provide a framework for program activities, outcomes, evaluation, and will be the foundation for yearly task plans.

After the 5-year plan has been drafted, share the draft with key stakeholders and the coalition-at-large for feedback. Presentations may be needed to address a specific audience, such as a school administrator or potential funder. After modifications are made to the plan, taking into consideration reviewer responses, distribute the plan to all coalition members.

Step 4

Action Step 4: Create a Year One Work Plan

A year one work plan is a task-specific, detailed action plan that aligns with goals and objectives in the 5-year plan. This could be another task for a specific work group, depending on the size of the coalition. A complete plan will include a timeline for each activity, steps needed to complete each activity and an assigned individual or group responsible for the activity. Make sure to include outcomes with result indicators and methods to measure progress.

Budget planning is also a key to a successful work plan. Consider the resources needed to complete the activities outlined in the plan, including staff time, print materials, meeting expenses, staff trainings and incentives.

Once the year one work plan and budget is drafted, have the larger coalition review and provide feedback. By the end of year one, it's time to revisit the long-term, asthma management plan and to begin planning for year two.

Additional Resources

In addition to the American Lung Association, the following websites are managed by reputable organizations and provide numerous resources to support healthy schools and asthma-friendly school efforts. These sites are recommended as part of the initial research conducted prior to creating and implementing a comprehensive asthma management plan in schools.

Page last updated: June 3, 2025

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