Asthma

DESCRIPTION (Diagnosis must be confirmed by a physician.)
" Wheezing (a high-pitched whistling or musical sound while breathing out)
" Recurrent attacks of wheezing, coughing, chest tightness, and difficulty in breathing
" Sneezing and a runny nose (often but not always)
" Usually no fever
Asthma is also called reactive airway disease (RAD)

CAUSE
Asthma is an inherited type of "twitchy" lung. The airways go into spasm and become narrow when allergic or irritating substances enter them. These substances cause the lining of the airway to swell and produce mucus (to see a picture, click here). Viral respiratory infections (colds) trigger most attacks, especially in younger children. If the asthma is due to pollens, it flares up only during a particular season. Asthma often occurs in children who have other allergic reactions such as eczema or hay fever. While emotional stress can occasionally trigger an attack, emotional problems are not the cause of asthma. Some common triggers are listed under the section titled "Prevention by Avoiding Asthma Triggers."

EXPECTED COURSE
Asthma attacks may be frightening, but they are treatable. Taking medicines early can shorten the course of an asthma attack and prevent hospitalization. When medicines are taken as directed, the lungs usually return to normal between attacks and there are no permanent changes. Asthma can be a long-lasting disease, but over half of the children who have asthma outgrow it during adolescence.

HOME TREATMENT
Asthma is a chronic disease that requires close follow-up by a physician who coordinates your child's treatment program.
If you have any doubt about whether or not your child is wheezing, start the following asthma medicines. The later medicines are begun, the longer it takes to stop the wheezing. Once treatment with the medicines is begun, keep your child on the medicine until he has not wheezed or coughed for 48 hours. (Your child should be kept on the medicine at least 7 days.)
If your child has three or more attacks of wheezing each week, he probably needs to be on continuous medicines.
1. Asthma inhalers
Your child's metered-dose inhaler is ____________. Your child's dose is two puffs every _______ hours for _______ days.
Carefully follow these instructions for teaching your child to use the inhaler:
- Shake the medicine
- Hold the inhaler upright and 2 inches in front of an open mouth.
- Your child should breathe out (exhale) completely.
- Release the spray when your child starts to breathe in (inhale).
- Your child should inhale slowly until his lungs are completely full.
- Your child should hold his breath for 10 seconds after his lungs are filled.
- After taking a few normal breaths, your child should take the second puff.
Note: These inhalers usually can't be coordinated by children less than 6 years old unless a plastic airway spacer (or chamber) is also used.
2. Oral asthma medicine
Although inhaled medicines work best for asthma, some children also need to take medicines by mouth. Your child's oral medicine is ________________________. Give __________________ every ________ hours for ______ days.
3. Begin treatment early.
Many children wheeze soon after they get coughs and colds. Start the asthma inhaler or oral medicine at the first sign of any coughing, shortness of breath, or wheezing. The best "cough medicine" for a child with asthma is an asthma medicine, not a cough syrup. Always keep the medicine handy and take it with you on trips. If your supply runs low, obtain a refill.
The most reliable way to detect the start of an asthma attack is by using a peak flow meter, which can measure the air flow out of the lungs. It can be used by children 5 years and older.
4. Continuous asthma medicine
Most children with asthma need medicines only during asthma attacks. Children with the following symptoms usually need daily asthma medicines to allow them to engage in normal activities:
- three or more attacks of wheezing per week
- asthma flare-ups lasting several days
- the need for emergency room care despite proper use of an inhaler
- asthma triggered by pollens (use daily asthma medicines during the entire pollen season).
5. Fluids
Normal fluid intake keeps the lung mucus from becoming sticky. Encourage your child to drink adequate amounts of fluids. Clear fluids such as water are best. Excessive fluid intake is not necessary. Normal fluid intake will keep the urine from being dark-colored.
6. Exercise-induced asthma
Exercise can trigger asthma. Most people with asthma also get 10 to 15-minute attacks of coughing and wheezing when they exercise strenuously. Running, especially in cold air, is the main trigger.
This problem should not interfere with participation in most sports nor require a gym excuse. The symptoms can be prevented by using an inhaler 10 minutes before exercise. Children with asthma usually have no problems with swimming or sports not requiring rapid breathing.
7. Going to school
Asthma is not contagious. Your child should go to school during mild asthma attacks but avoid gym on these days. Arrange to have the asthma medicines available at school. If your child uses an inhaler, he should be permitted to keep it with him so he can use it whenever he needs it.
If you child can't go to school because of asthma, he should see a physician that same day for additional treatment.
8. Common mistakes
The most common mistake is delaying the start of a prescribed asthma medicines or not replacing them when they run out. Nonprescription inhalers and medicines are not helpful.
The most serious error is continuing to expose your child to an avoidable cause of asthma. Never keep a cat if your child is allergic to it. Never allow smoking in your home; tobacco smoke can linger in the air for up to a week.

Don't panic during asthma attacks. Fear can make tight breathing worse, so try to maintain calm and reassuring to your child.
Finally, don't let asthma restrict your child's activities, sports, or social life.

PREVENTION BY AVOIDING ASTHMA TRIGGERS
Try to discover and avoid the substances that trigger your child's asthma attacks. Consider strong odors such as cologne, exhaust fumes, and frying foods. Avoid common triggers such as feather pillows and tobacco smoke. Try to keep pets outside or at least out of your child's room. Indoor pets need a weekly bath to remove allergic particles. Learn how to dustproof your child's bedroom. Change the filters in your hot-air heating system or air conditioner monthly.
If your child wheezes after any contact with grass, pollen, weeds, or animals, pollen or animal dander remaining in the hair and clothing may keep the wheezing going. Your child should shower, wash his or her hair, and put on clean clothes.

CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:\
" The wheezing is severe.
" The breathing is difficult
" The wheezing is not improved after the second dose of asthma medicines.
" Your child needs to use the inhaler more than every 4 hours.
" The peak flow rate is less than 50% of the baseline level (personal best).

CALL YOUR CHILD'S PHYSICIAN WITHIN 24 HOURS IF:
" The wheezing is not completely gone in 5 days
" You have other questions or concerns.