Asthma in Children (cont.)
Girish Sharma, MD
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
IN THIS ARTICLE
Five Parts of Asthma Treatment Continued
Step 2: Anticipating and preventing asthma flares
Patients with asthma have chronic inflammation of their airways. Inflamed airways are twitchy and tend to narrow (constrict) whenever they are exposed to any trigger (such as infection or an allergen). Some children with asthma may have increased inflammation in the lungs and airways everyday without knowing it. Their breathing may sound normal and wheeze-free when their airways are actually narrowing and becoming inflamed, making them prone to a flare. To better assess a child's breathing and determine risk for an asthma attack (or flare), breathing tests may be helpful. Breathing tests measure the volume and speed of air as it is exhaled from the lungs. Asthma specialists make several measurements with a spirometer, a computerized machine that takes detailed measurements of breathing ability (see Tests Used to Diagnose Asthma).
At home, a peak flow meter (a handheld tool that measures breathing ability) can be used to measure airflow. When peak flow readings drop, airway inflammation may be increasing. In some patients, the peak flow meter can detect even subtle airway inflammation and obstruction, even when your child feels fine. In some cases, it can detect drops in peak flow readings two to three days before a flare occurs, providing plenty of time to treat and prevent it.
Another way to know when a flare is brewing is to look for early warning signs. These signs are little changes in a child that signal medication adjustments may be needed (as directed in a child's individual asthma management plan) to prevent a flare. Early warning signs may indicate a flare hours or even a day before the appearance of obvious flare symptoms (such as wheezing and coughing). Children can develop changes in appearance, mood, or breathing, or they may say they "feel funny" in some way. Early warning signs are not always definite proof that a flare is coming, but they are signals to plan ahead, just in case. It can take some time to learn to recognize these little changes, but over time, recognizing them becomes easier.
Parents with very young children who can't talk or use a peak flow meter often find early warning signs very helpful in predicting and preventing attacks. And early warning signs can be helpful for older children and even teenagers because they can learn to sense little changes in themselves. If they are old enough, they can adjust medication by themselves according to the asthma management plan, and if not, they can ask for help.
Step 3: Taking medications as prescribed
Developing an effective medication plan to control a child's asthma can take a little time and trial and error. Different medications work more or less effectively for different kinds of asthma, and some medication combinations work well for some children but not for others.
There are two main categories of asthma medications: quick-relief medications (rescue medications) and long-term preventive medications (controller medications) (see Treatment of Asthma). Asthma medications treat both symptoms and causes, so they effectively control asthma for nearly every child. Over-the-counter medications, home remedies, and herbal combinations are not substitutes for prescription asthma medication because they cannot reverse airway obstruction and they do not address the cause of many asthma flares. As a result, asthma is not controlled by these nonprescription medicines, and it may even become worse with their usage and their use may result in a catastrophic situation.
Step 4: Controlling flares by following the doctor's written step-by-step plan
When you follow the first three steps of asthma control, your child will have fewer asthma symptoms and flares. Remember that any child with asthma can still have an occasional flare (asthma attack), particularly during the learning period (between diagnosis and control) or after exposure to a very strong or new trigger. With the proper patient education, having medications on hand, and keen observation, families can learn to control nearly every asthma flare by starting treatment early, which will mean less emergency room visits and fewer admissions, if any, to the hospital.
Your doctor should provide a written step-by-step plan outlining exactly what to do if a child has a flare. 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.
Step 5: Learning more about asthma, new medications, and treatments
Learning more about asthma and asthma treatment is the secret to successful asthma control. There are several organizations you can contact for information, videos, books, educational video games, and pamphlets (see Web Links).
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