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Is Asthma a Disability?

By Dr. Paul Ehrlich

Our ever-alert editor ran across this item:
TALLAHASSEE, Fla. — The state House has voted to expand Florida’s school voucher program for students with disabilities.
The bill (HB 1329) that passed 98-17 on Thursday would add children with lesser disabilities such as asthma and allergies.

(Read more)

I’m not going to get into the issue of peanut-free schools, which has attracted so much attention in Florida recently and which I’ve commented on, but concentrate on asthma because I have as much hands-on experience with severely asthmatic public school students as anyone. Can asthma be disabling? Yes. But to call it a disability is great disservice to the learning disabled, the wheelchair bound, and indeed to the many asthmatics who struggle not to be excluded from life.

I don’t see the point of segregating asthmatic children from their peers. Asthma is a syndrome—sometimes allergic, sometimes not–that can almost always be controlled to the point where children can enjoy full lives, including sports, mostly by behavior that is taught outside the school. Do public schools have conditions that trigger allergic asthma? Of course. But private schools can have hidden dust and vermin, too. Private and parochial schools in New York are notoriously resistant to demands from parents that they correct mold damage, and will even reject students with severe allergies and asthma because they require too much attention; public schools have to accommodate kids with conditions, although admittedly they don’t always do it well. Besides, most of the environmental triggers for asthma are in the home, or brought from home, like cat dander on the coat of the kid next to your child when they are hanging up.

Are there disabilities that justify school alternatives? Surely. Severely dyslexic kids need special attention from teachers with special skills. Mainstreaming of children with a myriad of behavior and physical handicaps sometimes looks like…well, you know what the road to hell is paved with.

Do asthmatic children face a rough time in school? Yes, if their asthma is uncontrolled. But whose fault is that? Where are the doctors who really understand asthma treatment? Why aren’t there more school-based compliance programs? The payoff from better asthma care is a well-known multiple of the cost.

Are asthmatic children subject to bullying? Yes, by all accounts. But where are the parents? Where are the principals? The accounts I read make it sound like Lord of the Flies out there—a world with no adult supervision. Moreover, private school children can be just as cruel as public school children.

In my own New York City program called Project ERASE, which served extremely disadvantaged schools, we not only reduced exacerbations, ER visits, and hospitalizations by 75% in one year, but the principals, teachers, and parent coordinators turned it into one long teaching moment in which a Project ERASE tee-shirt could be a badge of honor. We have reported similar results for both school-based and non-school-based programs here at AAC.com.

Can school vouchers be a viable and principled alternative for some students? Maybe. But extending them to asthmatic children is the public health equivalent of grade inflation. Florida legislators be forewarned: you can expect what we have in New York for the learning disabled—a legal specialty devoted to winning private-school subsidies for health benefits that could be achieved at a fraction of the price. My asthmatic patients—thousands of them in the course of over 3 decades of practice—have wanted to be normal. And most of them are.

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