In Ahwatukee and other communities in Arizona, the spike in asthma symptoms may occur later in the fall, when night-time and day-time temperatures finally turn cooler, encouraging grass and weed pollination. Bermuda grass pollen peaks in late summer and fall, just when children are returning to school playgrounds and sport fields, all covered with Bermuda grass. Russian Thistle (tumble weed), Careless Weed and Ragweed, some of the most allergenic weeds in the country, encouraged by recent monsoon rains, can be seen covering vacant fields and washes and along road sides next to schools and parks.

Some allergic children may also react to pet dander, either from direct contact with a classroom pet such as a rabbit or guinea pig, or even on the cloths of children who have pets at home.

Poor air quality as a trigger for asthma attacks is an increasing concern for residents of Maricopa County and Pima County, particularly those living or attending school close to busy car and truck traffic.

Although allergen exposure is an important trigger for many children with asthma, the most important cause of asthma flare-ups in children returning to the classroom is exposure to cold and flu viruses. Although allergy is the primary cause of asthma in children, viral upper respiratory infections, such as the common cold, are the primary cause of asthma attacks.

So what should a parent of a child with asthma do to prepare for the fall asthma epidemic? Although it is often possible for children to reduce or even temporarily discontinue their daily asthma controller medications during the months of summer vacation, these medications have been shown to reduce the frequency and severity of asthma attacks and should be resumed when children begin to prepare for their return to the classroom.

Every child with more than very mild, occasional asthma symptoms should have a personal asthma action plan outlined and reviewed with the family by the child's physician. The asthma action plan may be based on frequency of symptoms or peak-flow values or on a combination of the two. The personalized asthma action plan should give clear instructions on what actions to take if a child is having increased asthma symptoms or even what to do at the first sign of a cold. A copy of the asthma action plan should be given to the school health office along with the child's asthma rescue medication. A sample asthma action plan can be found at www. allergywise.com.

Dr. Brian Millhollon is with AZ Allergy & Asthma Specialists, 16611 S. 40th St, in Ahwatukee Foothills. Reach him at (480) 705-8844.