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Childhood Asthma: What Parents Need to Know
Asthma is one of the most common chronic childhood medical conditions, affecting approximately one in 10 children. If you have a child with asthma, you need to know that this is a serious condition. Your child can be healthy and breathing well and then suddenly have a serious and even life-threatening asthma attack. The good news is that most asthma attacks are preventable and treatable. Children with asthma can lead normal, healthy lives, be physically active, not miss school because of it and stay out of the hospital.

The Basics of Asthma and Asthma Triggers
Asthma is also known as reactive airway disease because an asthmatic person has lung airways that are especially sensitive to certain substances. These substances, known as asthma triggers, make the airways spasm, swell up and produce mucus, leading to the symptoms of an asthma attack.

Common asthma triggers include:
  • Allergens (pollen, dust mites, mold, animal dander, cockroaches)
  • Respiratory infections (colds, sinus infection, flu)
  • Environmental irritants (smoke, air pollution, household chemicals, perfume)
  • Cold air
  • Exercise
  • Strong emotions (laughing, crying, stress)
Each child with asthma has particular triggers that tend to cause his asthma attacks. Observe your child closely to determine what triggers it. Your child's doctor may also suggest allergy testing to determine his specific triggers.

Symptoms of an Asthma Attack
When your child is healthy, observe his appearance, activity level and breathing so you can recognize when he's not feeling well, which can be the early sign of an asthma attack. Also, if your child is over 3 to 5 years, you can teach him to use a peak flow meter, a simple device to measure how well he can exhale quickly. This can also help determine when your child is having an asthma attack. When your child is healthy, have him use the peak flow meter and record his best number reading as 100 percent peak flow. Then calculate and record the following:
  • Green or healthy zone: 80 to 100 percent of the best peak flow reading
  • Yellow or warning zone: 50 to 80 percent
  • Red or danger zone: less than 50 percent
The signs and symptoms of an asthma attack can include:
  • Persistent coughing, especially at night
  • Wheezing (a whistling sound in the chest with breathing)
  • A pale appearance, unusual fatigue or a lack of interest in playing or eating
  • Faster than usual breathing
  • Flaring nostrils or sucking in the skin around the neck and ribs
  • Complaints that he doesn't feel well, his chest or neck hurts or feels tight or can't breathe
  • A reduction of his peak flow to less than 80 percent of normal, into the yellow or warning zone.
The signs of a severe asthma attack are:
  • Inability to talk or walk due to difficulty breathing
  • Hunching over to breathe
  • Blue or gray lips or fingernails, indicating a lack of oxygen
  • A reduction of his peak flow to less than 50 percent of normal, into the red or danger zone.
If you see these signs, give him his emergency medicine and call 911 or emergency medical services to get immediate medical care.

Asthma Medicines
There are two basic types of asthma medicines:

1. Long-term control medicines. These are designed to prevent asthma attacks by reducing inflammation and relaxing the airway muscles. A child would take them every day over a long period of time, even when he appears healthy and is not coughing, wheezing or having other symptoms. Examples include:

Steroids: These are inhaled either through a nebulizer or a metered dose inhaler and spacer. Examples are beclomethasone (Beclovent®, Qvar®, Vanceril®), budesonide (Pulmicort®), flunisolide (Aerobid®), fluticasone (Flovent®) and triamcinolone (Azmacort®).

Leukotriene modifiers: These are oral medicines. Examples are monoleukast (Singulair®), zafirlukast (Accolate®) and zileuton (Zyflo®).

Long-acting beta agonists: These are inhaled medicines. Examples include salmeterol (Serevent®) and formoterol (Foradil®).

Other less commonly-used medicines: Inhaled medicines Cromolyn and nedocromil (Intal®, Tilade®), and oral medicines with theophylline (Aerolate®, Choledyl®, Elixophyllin®, Quibron®, Slo-bid®, Theo-24®, Theolair®, Theo-Dur®, Theochron®, T-Phyl®, Uniphyl®).

2. Quick-relief or rescue medicines. These act quickly to help relax the airway muscles. A child would take them right before exercise to prevent exercise-induced asthma and during an asthma attack to help him breathe better. These include:

Short-acting beta-agonists: These are mostly inhaled and some are available in oral forms. Examples include albuterol (Airet®, Proventil®, Ventolin®), levalbuterol (Xopenex®), bitolterol (Tornalate®), pirbuterol (Maxair®) and terbutaline (Brethaire®).

Ipratropium bromide: This is an inhaled medicine (Atrovent®).

Oral steroids: These may be given for three to 10 days to help control moderate to severe asthma attacks. Examples include prednisone (Deltasone®, Orasone®), prednisolone (Prelone®, Pediapred®, Orapred®) and methylprednisolone (Medrol®).
Children with very mild and occasional asthma may be prescribed only a quick-relief medicine. However, most children with moderate to severe asthma are prescribed one or more long-term control medicines—an inhaled steroid and another long-acting medication—as well as a quick-relief medicine.

Preventing Asthma Attacks
You can prevent asthma attacks and help your child stay as healthy as possible by:
  • Taking him regularly to the doctor, who will prescribe the right medicine to keep his asthma under control.
  • Giving him his long-term medicine as prescribed.
  • Avoiding exposing him to his asthma triggers.
  • Monitoring his breathing symptoms, recognizing the early signs of asthma attacks and starting the quick-relief medicine early.
Getting Everyone on the Same Page: The Asthma Action Plan
Be sure to work with your child's doctor to develop an asthma action plan for your child. This written plan will detail your child's daily control medicines, asthma triggers to avoid, signs of an asthma attack, quick-relief medications and emergency procedures. Everyone who cares for your child—family members, childcare providers, school teachers, sports coaches, camp counselors—must have a copy of the plan, have on-hand his medications and equipment, know how to give the medication and have a telephone for emergency contacts.

For more information on childhood asthma, visit The American Lung Association at www.lungusa.org and The American Academy of Allergy, Asthma and Immunology at www.aaaai.org. Also read the second article in this series, The Asthma Action Plan.

Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician