How to manage your child’s symptoms.Asthma is a disease in which airways swell, narrow and fill with mucous. If asthma is not controlled well, it can cause problems, including life-threatening asthma attacks. At this time, there is no cure for asthma, but there is treatment that can control its symptoms. Almost one out of ten children in the U.S. has asthma, and this disease is a very common reason for doctor and emergency room visits.
Asthma is often worsened by triggers, which include: pets, cigarette smoke, cockroach dander, air pollution, mold, dust mites, seasonal allergens (trees, grass or weeds), infections and exercise.
Your child with asthma may experience: shortness of breath, wheezing or whistling noises in the chest, chest tightness and coughing attacks (especially at night).
Signs of worsening asthma include: an increase in the use of rescue medication, asthma symptoms becoming more frequent or serious, trouble sleeping because of asthma, and increasing intolerance of asthma.
To manage your child’s asthma, you need to focus on preventing symptoms or flare-ups. There are many different kinds of asthma medications. The two basic types are controller medications and emergency medications. Most asthma medications are inhaled directly into the lungs, where they are deposited and able to reduce the swelling or squeezing in the airways. The goal of asthma control is for your child to live a normal, healthy life and partake in all activities, including sports.
Your child must take inhaled asthma medications properly for them to be effective. Nebulized medication should be given either by mask or by mouthpiece. When using a nebulizer mask, it’s important to put it directly on your child’s face. Don’t hold it away from the face and give “blow-by” because most of the medication will escape into the air. The nebulizer mouthpiece should only be used by kids who can make a good seal around the tube with their lips and breathe through their mouth and not through their nose while inhaling the medication.
Asthma medication is often in the form of a metered dose inhaler (MDI), also known as a puffer. MDIs should never be used without a spacer device, which is a chamber that holds the medication for the child to inhale, so the medication is not deposited at the back of the throat. Most kids should use a mask with the spacer.
Inhaled corticosteroids are controller medications, which are taken every day to prevent asthma symptoms. It’s important for your child to take these inhaled medications as directed, or they may not be effective. Controller medications work to reduce inflammation and swelling in the airways. They do not become effective immediately, and may take up to two weeks to control symptoms of uncontrolled asthma.
* It is important for kids to rinse out their mouths and wash their faces after administering this class of medication.
* Some metered dose inhalers have counters, and some do not. On medications that do not have counters, it’s important to note the 30-day mark to refill the medication.
* All MDIs contain a mixture of medication and liquid to spray the medication. Shaking the canister will not tell you if there is any medication remaining.
Bronchodilators, such as Albuterol, relieve asthma symptoms almost immediately by relaxing the muscles around the airways.
Bronchodilators should be used only in cases of excessive coughing, shortness of breath or wheezing. This medication may not work as well if it is overused.
There are other treatments for asthma that are not inhaled, but in pill or powder form. Many kids with asthma also have allergies that may trigger their asthma, and they may also take allergy medication.
Asthma management is challenging in today’s busy world, and medication is often skipped. Actually one of the leading reasons for poor asthma control is missed medication doses. Medications are only formulated to last for a certain period of time, so when a dose is skipped the inflammation returns to the airways.
- Give the medication at the same time every day, so that it is part of an established routine.
- Set up a medication reminder on your cell phone or calendar. This can also be done for refill due dates.
- Keep the asthma medication together with your child’s toothbrush, and have him brush his teeth immediately after administering the medication.
Your child’s provider should monitor asthma about three to four times per year, but some children require more frequent visits. At the visits, your provider will ask many questions to determine how well-controlled asthma has been since the last visit, and examine your child. Many offices are equipped with a machine that can measure how well the lungs take in and release air. This test is called pulmonary function testing, orPFTs. Depending on the outcome of the exam, the asthma control, and possibly PFT results, medications may need to be adjusted. Medications may be lowered or stopped if asthma has been very well controlled. Medications might be raised or added if the control is not very good.
Most asthma attacks can be prevented. Avoiding asthma triggers is very important. Children with serious allergies may benefit from seeing an allergy specialist if allergies are a strong trigger for their asthma. Taking controller medications is an extremely important part of keeping asthma under control. Sometimes asthma attacks happen, no matter how carefully someone takes medications and avoids triggers. It’s important to be able to identify asthma attack symptoms and know how to manage them. Some include shortness of breath, wheezing or whistling noises in the chest, chest tightness and coughing attacks. You may have one or more of these symptoms.
Asthma Action Plans
Asthma action plans are used to help guide parents’ treatment of their child’s asthma. The plan guides therapy based on asthma symptoms, and sometimes a measurement called peak flow is used to measure how well the lungs are working.
The first part of the plan shows the daily treatment, including medications. The next part explains what to do in the case of worsening asthma symptoms. The plan should also indicate when you should seek medical care with your provider or go to the emergency room. Asthma can be life-threatening, so it’s important to react quickly if symptoms are severe.
It’s essential that all persons responsible for the care of a child with asthma are aware of the asthma action plan, and are capable of helping in case of an emergency. Schools often have very strict guidelines on asthma management, and usually require a written plan and order for emergency medication from the child’s provider.
Asthma is a treatable disease, and most kids with asthma live normal, healthy lives. The vast majority of children with asthma should be active in sports and play. Kids with well-controlled asthma have a better overall chance of outgrowing asthma than children with poorly controlled asthma.
Kathryn Fitzgerald, DNP, MSN, RN, CPNP, AE-C, is a certified PNP with over 14 years of experience in pediatric nursing. She is also a certified asthma educator. She practices in New York University Langone Medical Center as an NP in the Division of Pediatric Pulmonology.