Louisville kids with asthma are missing school at 'horrifying' rates

Sleepless nights of wheezing and coughing can leave students too tired to focus during the school day. When children lack access to medication and professional care to manage asthma, they're more likely to miss school, or even end up in the hospital.

"At the most basic level," Stone said, "if a child's not well, they're not going to learn."

Asthma tends to compound with viral illnesses, keeping kids home from school for longer when they catch a cold or flu. Dr. Kristina Bryant, associate medical director for the Louisville Department of Public Health and Wellness, emphasized immunization to curb asthma in schools. Less than one-third of children in Jefferson County were vaccinated for the flu in the 2024-25 season.

"Flu can be the trigger for the asthma exacerbation, and yes, that can contribute to absenteeism," Bryant said. "With flu vaccination, we want to take away the trigger and prevent as many episodes of flu as we can."

A child with well-managed asthma should be able to attend school and participate in other activities just like any other student, experts said. Schools have attendance committees that work to identify gaps in attendance and intervene, often including nurses to address health-related barriers. Staff are working against a big absenteeism problem in a huge school district, one student at a time.

"Every student matters. For me, if a student is struggling with attendance because of a chronic health condition, that matters," said Michelle Vittitow, a JCPS nurse practitioner with a specialty in allergies and asthma.

"It really is about the student that is standing in front of me every day," she said. "If I go in and I see a kid who is suffering or struggling, then my job is to identify what it is that they need, and to treat them. I think it really is about that one kid at a time."

'It's everybody's issue'

School nurses are at the forefront of efforts to protect children with asthma, administering thousands of doses of asthma medication to students each year and serving as a bridge between families and care outside of school.

They can also play a key role in identifying when chronic illness is hindering a student's education or causing them to miss class. School nurses may be the first to recognize a student's unmanaged asthma.

When a child makes unusual, repeat visits to the nurse's office, staff may see a red flag, Vittitow said. Nurses can connect with families and try to bridge gaps in health care access and other barriers.

Reducing asthma and impacts on education requires coordination between parents, school staff and health care providers. Patrick Rich, executive administrator of environmental health at the Department of Public Health and Wellness, emphasized the value of schools using electronic health records, which JCPS recently integrated. Norton Children's also operates a telehealth program with JCPS, allowing students to see a provider virtually from a school nurse's office.

"Education can't say, 'This is a health care issue.' And health care can't say, 'That's an education issue,'" Stone said. "Because it's everybody's issue. It's a child issue."

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Eva Stone, former manager of Jefferson County Public Schools’ Health Services, said many students cannot access the traditional health care system, often leaving their asthma uncontrolled. 

Jeff Faughender/Courier Journal

Gaps in health care access are apparent in schools, experts said. Many Louisville families cannot afford multiple inhalers to keep at school and at home. Some are rationing daily asthma medication, using it only when a child is sick and in urgent need. "They feel like they don't want to waste it, and it costs too much," said Kimber Knight, a community health manager with the public health department.

"We want you to take your medicine as prescribed," said Knight, who also has asthma. "But we understand that everybody doesn't always have that luxury."

For kids without health insurance, or families without access to a doctor or critical asthma medication, school nurses and health staff become even more vital.

"In JCPS, there's lots of kids that do not have health insurance, that do not have access to a health care provider. Their parents may be working two or three jobs. They can't access the traditional health care system," Stone said. "We have to acknowledge and recognize those kids are out there, and make sure that the community has systems in place to address and meet those needs."

Gaps in health care for children seem poised to widen. Since last year, tens of thousands of Kentucky children have fallen off Medicaid and the Children's Health Insurance Program. Further declines are expected in the coming years as nearly $1 trillion in Medicaid cuts, approved by Congress last year, take full effect, said Joan Alker, executive director of the Center for Children and Families at Georgetown University. As kids drop off the rolls of those programs, some may be left uninsured entirely.

"Asthma is the perfect example of why we want children to have health insurance," Alker said. It's a "treatable condition, but it does require having access to a primary care provider so that you can be screened, so that you can be prescribed the medications you need and hopefully stay out of the emergency room."

Keeping schools healthy

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A “Welcome” sign hangs on the door of a JCPS elementary school classroom. 

Marty Pearl/Special To Courier Journal

The average JCPS school building is about 60 years old, and maintaining facilities can be challenging and costly. For students with asthma, the quality of those buildings is a matter of health.

"When buildings have problems, like a leaky roof, or water pooling, or no ventilation system, or poor maintenance, you're going to have poor indoor air," said Claire Barnett, founder and former executive director of the national Healthy Schools Network. "And poor indoor air makes asthma worse."

From January 2025 through the summer of 2026, JCPS fielded about 250 work orders across its facilities related to indoor air quality issues, including more than 100 categorized as mold-related, according to records obtained by The Courier Journal through Kentucky's open records law. A few entries described odors and allergic reactions among students and teachers.

Some work orders referencing mold did not result in a finding of mold, according to JCPS. The district declined a Courier Journal request to interview Rob Fulk, who oversees facilities as chief operations officer.

The facilities problem has frustrated districts nationally. The Government Accountability Office in 2020 found half of U.S. school districts are in need of building upgrades or repairs, and an estimated 36,000 schools are in need of HVAC updates.

For some aging facilities, JCPS has opted to simply start from scratch. In 2020, as JCPS prepared to tear down the old Indian Trail Elementary School, former Superintendent Marty Pollio cited problems with air quality, allergens and an aging ventilation system. "Our children should not be going in a school like this right here," Pollio said at the time.

Betsy Ruhe, a member of Louisville Metro Council, taught at the former Indian Trail Elementary School for much of her career in special education. "Some of the classrooms were just miserable," she said, "for teachers, for students. And the only solution really was to just take it down and start over."

Ruhe saw the impact of asthma and illness in the classroom. She has asthma too, often triggered by Louisville's ruthless allergy season.

"It just seems to be a part of living in Louisville. Everybody's got allergies. If you didn't have allergies when you moved here, you will now – that's kind of the running joke," Ruhe said. "But it's not a joke when your kid can't breathe."

As JCPS makes progress on asthma, gaps in state policy persist

Before she graduated high school five years ago, Habiba Darur was a student with asthma, struggling to find relief.

Attending Jeffersontown High School, she remembers feeling strain in her breathing, and visiting the school nurse. But the school didn't have medication for asthma on hand. Darur returned to class, and tried to manage her breathing on her own.

"The most frustrating part about that was: You need help, and you're talking to your teacher, and you go to the place you expect to get help from, and you don't get it," she said. "I'm glad, in that moment, there wasn't an emergency. But had it been, I don't know what I would have been able to do."

Since Darur's time in school, JCPS has made major improvements. The district now stocks Albuterol, a fast-acting rescue medication, in every school. Last school year, nurses administered those rescue inhalers nearly 500 times, in addition to thousands of doses for students who supplied their own medication.

Keeping the medicine on hand has allowed schools to help students with asthma quickly, instead of sending them home or to a hospital. In some cases, Vittitow said, "those are kids you ended up keeping out of the emergency room."

Schools are able to stock rescue medication and administer it to students thanks in part to a 2021 change in state law. The Kentucky General Assembly, which previously acknowledged asthma as a leading cause of pediatric hospitalizations and school absences, overwhelmingly approved legislation allowing staff to administer emergency inhalers to students when needed and encouraging schools to stock them.

But the law does not require schools to stock the medication, and does not provide funding for schools to do so. Kentucky also lacks numerous other statewide policies that could help students with asthma, according to a 2025 analysis from the Asthma and Allergy Foundation of America.

The state does not require districts to staff nurses in every school, for example, and some Kentucky school districts employ one school nurse for every 1,000 students or more. State laws also lack certain requirements for indoor air quality in schools, including provisions for HVAC maintenance and mold remediation, according to the AAFA.

Kentucky additionally lacks statewide restrictions on idling school buses, which produce harmful diesel emissions. Young children are especially vulnerable to diesel pollution, and they "stand about tailpipe high," said Elizabeth Hauptman, an advocate with Moms Clean Air Force, a national group. Very few Kentucky school districts have made efforts to electrify their bus fleets, according to data from the Electric School Bus Initiative.

Even improving education around asthma in schools, Darur said, could go a long way in helping prevent the worst impacts. "We have first aid. We learn things like CPR," she said. "And yet we're behind when it comes to things like asthma, which is common, especially among younger kids."

Already this school year, seats in Louisville classrooms have been left empty due to asthma. Missed instruction shows up later, on report cards and in less-visible ways: social engagement, academic motivation and opportunities later in life.

A chasm in asthma across Louisville communities leaves some families more exposed to the costs than others. As respiratory distress holds Kentucky children back, local and state policies have allowed strain on the lungs to continue.

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In Part 3: Louisville's asthma burden is felt unevenly. Decisions made decades ago, and continuing today, help explain why.

Read the entire series: Courier Journal investigates asthma's burden on Kentuckians in 'Breathless'

Connor Giffin is an environmental reporter at The Courier Journal. Reach him directly atcgiffin@courier-journal.com.