Managing your child’s symptoms and medications.
Asthma is a chronic condition of the lungs and airways caused by inflammation and mucus production in the big and little airways. Children with asthma have airways that react (tighten) easily when exposed to triggers such as allergens or colds and respiratory infections. It’s important to understand asthma, your child’s medications and how to manage flare-ups.
Recognizing the Signs of Asthma
Since asthma symptoms vary from person to person, you need to know your child’s symptoms. Those that occur more often or are more bothersome may indicate that asthma is getting worse.
Common symptoms of asthma include:
* Wheezing, a high-pitched whistling sound when breathing out. However, many kids with asthma never wheeze
* Shortness of breath or heavy breathing
* Coughing or wheezing attacks that are made worse with respiratory viruses
* Trouble sleeping because of coughing, wheezing or shortness of breath
* Trouble with activity because of coughing, wheezing or shortness of breath
* Chest pain or chest tightness.
The Role of Medications
Your child may be on one or more asthma medications, depending on the severity of the asthma. There are two main categories of asthma medications: long-term controller medications and quick-relief medications. Oral steroids may also be used during asthma flare-ups.
Long-term medications used for asthma in kids include inhaled steroids and oral medicines called leukotriene modifiers. It is important to remember that chronic inflammation in the lungs is the main problem for those with asthma. Inhaled steroids act directly on the lungs to reduce inflammation, preventing asthma symptoms. Unlike steroids taken by mouth, inhaled steroids are much less potent and have fewer side effects. They are generally safe for children but must be taken daily to be effective. They do not give quick relief and should not be used as needed. Another medicine used to treat asthma is leukotriene modifiers (example: montelukast). Leukotrienes are a substance released by lung and airway tissue that can cause inflammation leading to tightening of the airways. This is a common oral asthma medicine taken daily that blocks the release of leukotrienes, helping to prevent asthma symptoms in some kids. Medications like montelukast do not give quick relief for asthma.
Quick-relief medications are helpful in treating asthma symptoms when they occur during an asthma attack or flare-up. The two most common quick-relief medicines used in kids are albuterol or levalbuterol. They come in both inhaler and nebulizer forms. The small airways or bronchioles may tighten during asthma attacks or flare-ups, making it difficult to get air out of the lungs. Quick-relief medicines act almost immediately to relax the airways, opening the lungs and making it easier to breathe. It is important to remember that these medicines give relief quickly from coughing or wheezing but do not treat inflammation.
Oral steroids are helpful in quickly treating the inflammation associated with asthma and are often prescribed during asthma flare-ups. Prednisone, prednisolone and methylprednisolone are the generic names of steroids that can be taken by mouth at home during an asthma flare-up.
Asthma symptoms will usually improve within 48 hours. Short courses of steroids are generally safe and may help avoid hospitalization. Side effects may include temporary irritability and poor sleeping.
* An inhaled corticosteroid (also known as a preventative inhaler) works directly on the lung tissue to decrease swelling in the lower airways. Preventative medication needs to be taken daily as directed, using the correct technique. An aerosol inhaler should be used with a spacer device. A spacer device with a mask is recommended for children under five years of age. Children five years and older may be ready for a spacer device with a mouthpiece. Your healthcare provider should demonstrate how to use the medication. If medicines are not taken correctly, they may not get into the lower airways and decrease swelling, causing the asthma symptoms. Always rinse your child’s mouth after inhaled corticosteroids to prevent thrush. Talk to your provider if you are considering stopping your child’s medication. Remember that asthma is controlled and your child is without symptoms because of the medication. If you stop asthma medications, the asthma symptoms often return within two to four weeks.
* Always know where your child’s quick relief medicine is, and make sure it is not empty and not expired
* For children who also have allergies:
- Taking antihistamines and nasal steroids can help control allergies
- More expensive measures may include:
- Remove carpets from the home
- Use HEPA vacuum cleaners that have a filter (hospital grade)
- Avoid having animals in the house. If you cannot keep pets outdoors, keep those with fur or hair out of your child’s bedroom
- Consider having your child evaluated by an allergist to discuss possible allergy shots or allergy drops
Monitoring and Responding to Asthma Symptoms
Asthma can be controlled, but recognizing when your child’s asthma is not controlled is also important.
The following signs may mean your child’s asthma is a problem:
* Asthma symptoms need a quick-relief medicine two or more days a week
* Asthma symptoms limit activity
* Your child is waking up at night from asthma symptoms two or more times a month
* Your child needs oral steroids for asthma flare-ups two or more times a year
If you notice any of these problems, make an appointment with your provider to discuss what can be done to get the asthma well controlled.
Keep your child’s asthma well controlled by using daily controller medications prescribed by your provider and by avoiding asthma triggers. Your provider should give you a written asthma action plan specifically for your child, including instructions for asthma medicines to be used daily and a plan for short-acting reliever medications to be used during asthma flare-ups. Flare-ups are more likely to occur in kids who are not taking their prescribed asthma medications regularly. Flare-ups can build up over several days, but can also happen suddenly. However, no matter how hard you try, you won’t be able to stop all flare-ups. The best plan is to be prepared.
You should be able to manage mild asthma symptoms at home according to the asthma action plan if your child:
* Has mild asthma symptoms and no difficulty breathing when resting
* Has only mild difficulty breathing with activity
* Has quick relief of asthma symptoms within 15 minutes of using quick-relief medicine
* Has improvement in asthma symptoms within one to two days
Contact your child’s provider if your child:
* Has no difficulty breathing at rest but does have asthma symptoms that limit or interfere with activity
* Has relief from quick-relief medicine but needs it more often than every four hours
* Does not have improvement in mild asthma symptoms within one to two days.
Go to the local emergency room if your child:
* Has difficulty breathing at rest or cannot carry on a full conversation
* Does not get full relief from quick-relief medicine
* Works so hard to breathe that the skin is sucked under or between the ribs with breathing (called retractions), or nostrils are flaring
Call 911 or local emergency services if your child:
* Has severe trouble breathing and cannot speak
* Is lethargic
* Appears blue
You are a vital member of your child’s asthma team. To help manage your child’s asthma, learn the early signs of a flare-up. Know which medications your child should take and how they should be administered. Have a written plan on how to deal with an asthma flare-up, and share the plan with those who help care for your child.
Deb Hickman, DNP, RN, CPNP, is a PNP at Sanford Children’s Specialty Clinic, caring for children with asthma and other respiratory problems. She is Co-Chair of NAPNAP’S Asthma and Allergy Special Interest Group.