SSM Cardinal Glennon Children's Medical Center
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Managing Asthma

Learning About Asthma

The good news for most kids with asthma is that it can be controlled — sometimes so well that flare-ups are rare.

The learning process can be the hardest part of controlling asthma. Between diagnosis and good control, there's much to learn and a lot to do.

Don't be surprised or discouraged if your child has flare-ups while learning to control asthma. Asthma control can take a little time and energy to master, but is worth the effort!

How long it takes to get asthma under control depends on a child's age, the severity of symptoms, how often flare-ups happen, and how willing and able the family is to follow a doctor's treatment plan.

All kids need a doctor-prescribed asthma action plan to control symptoms and flare-ups.

Identifying and Controlling Asthma Triggers

Triggers — things that can irritate airways and lead to an asthma flare-up — can change from season to season and as kids get older. Common triggers include:

  • allergens, including microscopic dust mites in house dust, carpets, and pillows; animal dander and saliva; pollens and grasses; molds; foods; medicines; and cockroaches
  • viral infections, including the common cold and the flu
  • irritants, including smoke, air fresheners, aerosols, paint fumes, hair spray, and perfumes
  • exercise
  • breathing in cold air
  • weather changes

Identifying triggers and symptoms can take time and good detective work. But once patterns are known, some triggers can be avoided by using environmental control measures in the home.

Anticipating and Preventing Flare-Ups

Many kids with asthma have increasing inflammation in their airways from everyday trigger exposure — they just can't feel it. Their breathing may sound normal and wheeze-free when their airways are actually narrowing and becoming inflamed, putting them at risk for a flare-up.

Breathing Tests and Tools

Since just listening to a child's breathing (or asking how the breathing feels) can't always give an accurate sense of what's happening inside, other ways to measure breathing might be used.

In the doctor's office, breathing might be measured with a spirometer, a computerized machine that measures the amount of air inhaled or exhaled and how much time each breath takes.

At home, a peak flow meter — a handheld tool that measures breathing ability — might be used. When peak flow readings drop, it's a sign of increasing airway inflammation. The peak flow meter can detect even subtle airway inflammation and obstruction — even when a child feels fine. In some cases, it can detect drops in peak flow readings 2 to 3 days before a flare-up, providing plenty of time to treat and prevent it.

If a doctor feels that a peak flow meter can be helpful, he or she will have a child take a series of peak flow readings for a period of time during the first stages of treatment. The readings help set a child's baseline PEFR, or peak expiratory flow rate — a personal best during a time with few symptoms. Afterward, readings should be taken as recommended and compared with the baseline.

Another way to know when a flare-up is brewing is to look for early warning signs (EWS). EWS are little changes that signal medicine adjustments might be needed (as directed in a child's individual asthma action plan) to prevent a flare-up. EWS can help to detect a flare-up hours or even a day before obvious symptoms (such as wheezing and coughing) start. Kids can develop changes in appearance, mood, or breathing, or they'll complain of "feeling funny" in some way.

EWS are not always definite proof that a flare-up is on the way, but are signals to plan ahead, just in case. It can take some time to "tune in" to these little changes, but over time, recognizing them becomes easier.

Parents with very young kids who can't talk or use a peak flow meter often find early warning signs very helpful in predicting and preventing flare-ups. And EWS can be helpful for older kids and even teens because they can learn to sense little changes in themselves. If they're old enough, they can adjust medication themselves according to the asthma action plan; if not, they can ask for help.

Taking Medicines as Prescribed

Developing an effective medication plan to control asthma can take a little time and experimentation. There's no single remedy that works for every child with asthma. The different categories of asthma are treated differently, and some medication combinations work well for some kids but not for others.

The two main categories of asthma medications are quick-relief medicines (also called rescue or fast-acting medicines) and long-term control medicines (also called controller or maintenance medicines). Quick-relief medicines work immediately to relieve asthma symptoms. Long-term control medicines work over a period of time to help prevent asthma symptoms from happening.

Over-the-counter medications, home remedies, and herbal combinations are not substitutes for prescription asthma medication because:

  • It can be life threatening to rely on them during a flare-up because they cannot reverse airway obstruction quickly and effectively (if at all).
  • They don't address the cause of many flare-ups: hidden airway inflammation. So asthma is not controlled by these non-prescription medicines, and can even become worse if they're used.

Controlling Flare-Ups With the Asthma Plan

Mastering these first steps of asthma control means a child will have fewer asthma symptoms and flare-ups. But anyone with asthma can still have an occasional flare-up, particularly during the learning period (between diagnosis and control) or after exposure to a very strong or new trigger.

With the right patient education, on-hand medicines, and keen observation, families can learn to control nearly every asthma flare-up by starting treatment early, which will reduce ER visits and possibly eliminate hospital admissions.

The doctor provides a written, step-by-step plan (the asthma action plan) that includes exactly what to do between flare-ups and how to recognize and manage them if they happen. The plan is different for each child. Over time, families learn to recognize when to start treatment early and when to call the doctor for help.

Learning More

It's a fact: Those who learn the most about asthma have the most success controlling it. Fortunately, more is being discovered about asthma every day!

Many asthma-related websites and groups can provide information, videos, books, and educational video games, and recommend local support groups where families and kids can meet others dealing with asthma. Together, they share experiences, helpful tips, and coping strategies.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: January 2014