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Asthma Prevention Tips

Asthma in Children
Asthma (also called reactive airway disease) is a common problem in infantsand children, affectingabout 5-10% of children (about 5 million children under the age of 18years of age). The most common symptoms include recurring episodes ofcoughing, wheezing and difficulty breathing, although some children justhave coughing and don't wheeze with each episode.

There is no cure for asthma, but with the right management, your Pediatriciancan help to get your child's asthma under control, minimize symptoms,avoid missed days from school, and avoid visits to the emergency roomor hospitalizations. With good control, your child's asthma should notlimit his activities or slow him down and he should be able to participatein physical activities and sports and keep up with the other children.

Last Updated - 25th October 2005

Possible Causes of Asthma

• Although it is not known what causes asthma, children with asthmado seem to have very sensitive or hyperresponsive airways, and whenthey come in contact with certain triggers, such as smoke, dust, pethairs, exercise etc., they react by tightening (bronchoconstriction)and becoming narrow, inflamed and producing mucus, which can lead tothe air passages becoming smaller and limiting the amount of air thatpasses through them and into and out of the lungs. Although this narrowingmay occur for a short time and reverse with a bronchodilator, it couldalso lead to a longer asthma attack or exacerbation.
• This condition does seem to run in certain families and is more commonin kids that also have allergic rhinitis or eczema. It is also morecommon in children that are exposed to second hand smoke, air pollution,dust mites, mold and pets. If you have a strong family history of allergiesor asthma in your family, then minimizing your children's exposure tothese common triggers my prevent them from developing asthma.
• Asthma is diagnosed in children who have recurrent episodes of wheezing,coughing, difficulty breathing, especially if these symptoms worsenat night or after being exposed to certain triggers, and if they haveevidence of airway obstruction that improves with a bronchodilator.Asthma can be difficult to diagnosis, especially in young children,who may have wheezing and coughing as part of a viral illness, suchas bronchiolitis. And the testing commonly used to detect asthma inchildren, the peak flow meter, can not usually be used in children under5-6 years old (although pulmonary function tests may be performed bya Pediatric Pulmonologist in younger children).
• Asthma is increasing in developed countries such as the United States.It is also probably underdiagnosed and undertreated. Children with asthmamay often be misdiagnosed as having a cold, bronchitis, or pneumonia.Asthma should be suspected in children that have a persistent coughthat is not improving with standard therapies, even if they are notwheezing (cough variant asthma), or recurrent episodes of wheezing andcoughing that do not quickly improve in 7-10 days.

The severity of untreated asthma can vary from havingmild and infrequent symptoms to having severe daily symptoms that interferewith daily activities. Asthma can usually be classifiedinto one of the four following steps:

• Intermittent - asthma symptoms less than once each week(nighttime symptoms less than twice a month), peak flows within 80%of predicted, and with brief and mild attacks or exacerbation. Thisclass of asthma can usually be treated with short acting bronchodilatorsas needed.
• Mild Persistent - asthma symptoms more than once a week,but not everyday, peak flows within 80% of predicted and with attacksor exacerbation that may interfere with regular activities. Childrenwith mild persistent asthma should be treated with a daily controlleror anti-inflammatory medication.
• Moderate Persistent - asthma symptoms daily, requiring dailyuse of a short acting bronchodilator medicine and with attacks orexacerbation that do interfere with regular activities and sleep,peak flows within 60-80% of predicted. Children with moderate persistentasthma should be treated with a daily controller or anti-inflammatorymedication and a long acting bronchodilator medication.
• Severe Persistent - asthma symptoms continuously, requiringregular use of a short acting bronchodilator medicine and with frequentattacks or exacerbation that limit activities and interfere with sleep,peak flows less than 60% of predicted. Children with moderate persistentasthma should be treated with multiple daily controller or anti-inflammatorymedication, including high doses of an inhaled steroid, a long actingbronchodilator medication, and possibly long term oral steroids. Mostchildren with severe persistent asthma should be treated by a PediatricPulmonologist.

Diagnosis

• Up to 80% of children with asthma develop symptoms before age five.The child's physician must rely heavily on parents' observations tomake a proper diagnosis.
• To make a diagnosis of asthma your child's physician will want toknow about the following:
  • Does your child cough, wheeze (a whistling sound when breathing),have chest tightness or shortness of breath?
  • Do colds go right to your child's chest and last much longerthan other siblings?
  • Does your child cough or wheeze with exercise, play and laughteror during temper tantrums?
  • Is there a family history of asthma or allergies?
  • What triggers your child's symptoms - colds, allergens (likethe family pet) or exercise?
  • How often are the symptoms and how bad?
  • Is your child missing school?
  • Is coughing or wheezing keeping you and your child up at night?
  • If your child is old enough (usually older than 5-6), he orshe may do a Pulmonary Function Test. The results will tell thephysician about how the child's lungs actually work. This testhelps not only in the diagnosis but will help the doctor followthe response to medication.

For children, asthma symptoms can interfere with many school and extracurricularactivities. Parents may notice their child has less stamina during playthan his or her peers, or they may notice the child trying to limitor avoid physical activities to prevent coughing or wheezing. More subtlesigns of asthma, such as chest tightness, are often not identified assuch by children. Sometimes they will complain that their "chesthurts" or that they cannot "catch their breath." Often,recurrent or constant coughing spells may be the only observable symptom.

The two most common triggers of asthma in children are colds and allergens(substances that trigger allergies). In fact, most kids with asthmaare allergic and should have an allergy evaluation as part of theircare. Common allergens include dust mite, animal dander, cockroach,pollen and molds. We cannot do a lot about viral illnesses but thereare ways to limit allergen exposure in the home environment if you knowwhat you need to avoid.

Asthma medications include rescue medication or quick relievers totreat symptoms (ie albuterol) and long-term controller medicines tocontrol the inflammation that causes asthma. If a child has symptomsmore than twice a week or wakes more than twice a month at night, theyshould be on long-term controller therapy. For more information on asthmamedications, please see the Tip brochure in this series.

Techniques that will help get your child'sasthma under good control, include:

• Aggressively identifying and treating asthma attacks with a bronchodilatormedicine and sometimes an oral steroid. Your Pediatrician should preparean asthma action plan so that you know what to do when your childbegins to have symptoms.
• Be prepared by always having your child's quick relief asthma medicationshandy, especially on trips, etc. Call in advance for refills so thatyou never run out.
• Let your Pediatrician know if you are needing to use your quickrelief bronchodilator medicine more than once or twice a week.
• Identifying and avoiding triggers. Keeping a daily symptom diarycan be helpful in identifying triggers.
• Monitoring peak flows in older children, which can help predictan asthma attack and help you and your Pediatrician determine howwell your child's asthma is under control.
• For children with persistent asthma symptoms, using anti-inflammatorymedicines to help prevent asthma attacks, such as steroid inhalers,long acting bronchodilators, and anti-leukotriene medications.
• Review your treatment plan with your Pediatrician every 3-6 months.Don't change or stop medications unless instructed to do so by yourPediatrician, even if your child's asthma seems to be under good control.
• Treating allergies if present, since uncontrolled allergies canworsen your child's asthma.
• Learn to identify the signs and symptoms of a severe asthma attackwhich can require immediate medical attention, including breathingrapidly or being short of breath, having retractions, talking in shortwords or phrases (instead of regular complete sentences), being irritableor agitated, wheezing loudly, chest tightness, color changes (paleor blue), nasal flaring (nostrils open wider), grunting, having apeak flow below 50% of his usual or best, and/or having a persistentcough.
• Learn to predict when your child is going to have an asthma attackand begin his medications early. You can learn to predict attacksby watching for warning signs, including a drop in peak flows, worseningallergies, runny nose, cough, exposure to a known trigger, etc.
• Keeping a daily symptom diary can be helpful in identifying warningsigns of an asthma attack.
• Be especially vigilant if your child is at high risk, with a historyof poorly or difficult to control asthma, previous severe attacks(which may include hospitalizations and/or stays in an intensive careunit and which may have required incubation and assisted ventilationwith a breathing machine), or a history of having asthma attacks thatquickly worsen.
• Bring all medications, spacers, peak flow meter, symptom diary andyour record of peak flows to each office visit.
• Avoid using over the counter asthma medications.
• Get your child a flu shot each year.
• Asthma is a chronic disease, but many children do outgrow it asthey get older, although some continue to have problems as teens andadults. With the proper management, your child should be able to runand play without any limitations.
• If your child is not improving with his current medication regimen,then he may need a step up in his therapy, which can include increasingthe amount of anti-inflammatory medications he is on.
• Also, be sure that he does not have uncontrolled allergies or gastroesophagealreflex, both of which can make asthma symptoms worse.

An important thing to keep in mind, especially if yourchild has been diagnosed with asthma and is not improving with standardtreatments, is that not all wheezing in children is from asthma. Otherthings that can cause wheezing include:

• Bronchiolitis - a viral infection of the lungs.
• Foreign body inhalation - such as a button or peanut, etc.which can get lodged in the airways or lung. Children who have wheezingor difficulty breathing that is due to a foreign body usually havea coughing or choking attack or fit before they began wheezing. Theymay also have wheezing on just one side of their chest.
• Other causes of obstruction of the large airways that can causewheezing include vascular rings, laryngotracheomalacia, laryngealwebs, tracheostenosis or bronchostenosis.
• Cystic fibrosis
• Bronchopulmonary dysplasia in premature infants
• Gastroesophageal reflux
• Another reason for your child's asthma to not be getting betterdespite being on a good medical regimen is noncompliance. The medicationscan't help if your child isn't taking them appropriately.
  

Important Reminders

• Advertisement

  Always call your pediatrician to refill your medications beforeyou run out and always have your medicines available in case of anacute attack.
• Call your pediatrician if you are not improving or if you are gettingworse on your current regimen and treatments.
• Do not stop taking your preventative medicines unless instructedto do so by your pediatrician.
• Follow-up appointments are usually every two to three months, orsooner depending on the severity of your child's symptoms.
• With the right treatments, your child's asthma should not limithis activities.
  

Asthma Prevention

Acute attacks can be triggered by many things, including irritants(smoke or strong odors), allergens (dust mites, molds, etc.), exercise(especially in kids with exercise induced symptoms), upper respiratoryinfections, and changes in the weather. The best treatments are to avoidthe things that trigger your child's attacks (keep a diary), followthe environmental controls described below, use any preventative treatmentsthat have been prescribed for your child everyday, and get a flu shoteach year.
Uncontrolled medical problems, including allergic rhinitis and gastroesophagealreflux can also make asthma worse, and should be treated if also present.

You may also be able to prevent asthma attacks if you can predict whenyour child is going to have an asthma attack and begin his medicationsearly. You can learn to predict attacks by watching for warning signs,including a drop in peak flows, worsening allergies, runny nose, cough,exposure to a known trigger, etc.

Environmental Controls

These steps are aimed at controlling the most common allergensthat can trigger an acute attack.

• Get rid of dust collectors, including heavy drapes, carpeting, &stuffed animals.
• Control cockroaches with insect sprays and roach traps, as cockroachallergens are a very common asthma and allergy trigger.
• Use an airtight, allergy-proof plastic cover on all mattresses andpillows.
• Wash all bedding and stuffed animals in hot water every 7-14 days.
• If you must keep pets in the house, at least keep them out of yourchild's bedroom and choose pets without fur or feathers (such as fish).
• Avoid exposing your child to molds by keeping them away from dampbasements, water-damaged areas of the house, wet leaves or gardendebris.
• Keep indoor humidity low (less than 50%), since dust mites and moldincrease in high humidity.
• Provide a smoke-free environment for your child (it is not enoughto smoke outside).
• Vacuum frequently, but only when your child is not at home.
• Avoid the use of ceiling fans.
• Cover air vents with filters.
• Avoid allowing strong odors and sprays in the home. Do not allowyour child to stay at home if it is being painted, avoid using strongperfumes, or room deodorizers and household cleaning products thathave a strong odor.
• For seasonal problems, keep windows closed in the car and home toavoid exposure to pollens and use air conditioning instead. Stay indoorsduring the midday and afternoon when pollen counts are at their highest.
• Avoid being outside on days when pollution or ozone counts are high.
• Consider using a HEPA filter to control airborne allergens.
• Take any allergy medication that have been prescribed on a dailybasis, since uncontrolled allergies can make your symptoms worse.
  

Asthma Treatments

• The medications that are used to control asthma include bronchodilatorsand anti-inflammatories (including steroids). Do not use over thecounter medicines to control your wheezing.
• The goals of treating children with asthma include reducing (orpreferably eliminating) symptoms, limiting how often and how severehis asthma attacks (or exacerbation) are, and allowing him to participatein normal activities, including sports and other physical activities.
• Most Pediatricians practice a step wise approach to treating asthma,with a step up in the amount of medications for uncontrolled asthmaand a step down in the amount of medications for well controlled asthma.
• For acute asthma attacks or exacerbation, your child may also needto be on a short course of an oral steroid medication, such as Preloneor Prednisone.
• A common reason for not getting better despite being on a good medicalregimen is noncompliance. The medications can't help if your childisn't taking them appropriately.
• If your child is having frequent symptoms, frequent asthma attacksor he has a limitation in his physical activities, then you shouldsee your Pediatrician or Pediatric Lung Specialist (Pulmonologist)to reevaluate his treatment plan and possibly change or increase theamount of daily medication he is taking.
• Your child may also need treatment for other medical problems, includingallergic rhinitis and gastroesophageal reflux, both of which can makeasthma worse.

Answers to commonly asked questions

• Will my child outgrow his/her asthma?
  The challenge to the physician who cares for children and the parentis to identify the child who wheezes early in life and will outgrowtheir asthma, vs. the child who will continue to have persistent wheezing.Some babies who wheeze with viral respiratory illnesses will stopwheezing as they grow and their airways get bigger. If a child hasatopic dermatitis(eczema), there is smoking in the home or if themom has asthma, there is a greater chance that the child will havepersistent wheezing. Some children have asthma symptoms that improveduring adolescence, while others worsen. Often, symptoms in youngchildren seem to resolve, but their asthma may flare up later in life.
• Can asthma be cured?
  Currently there is no cure for asthma. However, for most children,asthma can be controlled with appropriate management and treatment.While asthma is a chronic illness, it should not be a progressivelydebilitating disease - a child with asthma can have normal or near-normallung function with appropriate management and medications.
• Should my child exercise?
  Parents may have the urge to restrict their asthmatic child's physicalactivity to prevent wheezing. But once a child is taking proper medications,aerobic exercise needs to become part of his or her daily activities,because it improves airway function. Children must be encouraged toparticipate in normal activities as much as possible. It is also verypossible for a child with asthma to excel in athletics - several Olympicathletes have asthma.

Asthma at school

• The child, family, physician and school personnel must work togetherto prevent and/or control asthma symptoms at school. Many childrenwith asthma are embarrassed about their need for medication. In somecases, children may have difficulty because they are required to goto another part of the school building, such as a nurse's office,to take their medication. School officials and parents must createa supportive environment. With the approval of physicians and parents,school-age children with asthma should be allowed to carry metereddose inhalers with them at all times and use them as appropriate.Many states have now passed laws to allow responsible children tokeep their inhaler in their book bag.
• To ensure optimal care at school, parents can also take the followingproactive steps:
  • Meet with teachers, the school nurse, coach and perhaps theprincipal at the beginning of the school year.
  • Have your child's doctor provide a written asthma plan for schoolsuch as the Asthma School Action Plan.
  • Encourage local educational programs to improve education forschools about asthma.
  • For children with asthma to function normally, school personnel,families and health care providers must effectively communicateand work together to encourage them to fully participate in activitieswith their peers. This team effort will help create a positive,healthy and safe environment for the child - both in and out ofschool - and ensure the best asthma care possible.

General Tips

• Avoid smoke of all kinds. Avoid places where others are smokingand stay away from wood-burning stoves.
• Avoid irritants in the air. Stay indoors when the air pollutionor pollen count is high.
• Avoid strong odors, fumes and perfume.
• Control cockroaches. Use poison bait and traps. Avoid chemicalsprays, which can trigger an asthma attack.
• Avoid breathing cold air. In the cold weather, breathe through yournose and cover your nose and mouth with a scarf or a cold weathermask.
• Practice relaxation exercises as stress may be a factor in triggeringasthma attacks.
• Reduce your risk of colds and flu by washing your hands often andgetting a flu shot each year.
• If you use a humidifier, clean it thoroughly once a week.
• Build up the strength of your lungs and airways by getting regularexercise.
• Swimming or water aerobics are good exercise because you are lesslikely to have an asthma attack when you breathe moist air.

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