What parents need to know about preventing, managing and treating asthma

My five-year-old, newly diagnosed with asthma, had an attack on a frigid, icy winter night. His dad was out of town, his older sister was sleeping, and he was wheezing and coughing late at night. He looked miserable. The medicine didn’t seem to be helping.

I propped him up in our bed and sat on the floor, poring over a paperback from the doctor. Should we go to the emergency room? The book said cold and wind could aggravate asthma. Plus I’d have to wake his sister, get her bundled up, then brave slick hills. The ER nurse I spoke with couldn’t give me advice one way or the other. I felt so powerless.  

What is asthma?

Asthma is a chronic lung disease that can be controlled with appropriate medical care. Symptoms may include difficulty breathing or feeling short of breath, frequent coughing (typically first thing in the morning or at night), wheezing (a whistling sound when breathing), tightness in the chest, shallow breathing or the inability to take a deep breath, even deep fatigue and frequent sighing.

Symptoms are caused by inflammation (swelling), when the airways tighten and become narrower in reaction to an inhaled substance, an allergen, or virus. Cells lining the airways may produce more mucus, making airways narrower.

Untreated, asthma can flare into a full-blown attack, which can be fatal. With symptoms that can escalate quickly, asthma is called the “silent killer.”

New Hampshire has one of the highest rates of asthma in the country. Why? According to Anna Carrigan, MSW, a health promotion advisor for the NH Asthma Control Program, one reason is our rich history. Being one of the original colonies means older housing stock, which means more dust and exposure to conditions which can exacerbate asthma, such as basements prone to dampness and mold.

Also, New England is what’s known as the “tailpipe of America,” meaning that winds from the west blow air pollution to the northeast, which can make air quality, and therefore asthma, worse, Carrigan said.

“Access to care, both physical and financial, can also contribute to higher asthma rates,” Carrigan said. “Asthma is a very expensive condition to treat, and access to consistent treatment and medications is important.”

Asthma can be controlled

“It’s important parents know that the goal of treatment is to prevent symptoms, so controller medications are key for kids with persistent symptoms,” said Susanne Tanski, MD, a pediatrician at Children’s Hospital at Dartmouth-Hitchcock and associate professor of pediatrics at the Geisel School of Medicine.

“The hope is that they won’t need their ‘rescue’ medicine, because they are well controlled with the ‘controller’ medicines. If a child is doing well and not having cough/wheeze, then it’s working!”

 In the vast majority of cases, according to Tanski, asthma can be well-managed by a pediatrician or primary care provider.

“There certainly are kids who have a hard time getting control of their symptoms, and those kids would benefit from seeing a pulmonologist (lung specialist) or allergist (especially since some kids with asthma also have allergies),” she said.

There two most important things parents must know about a child with asthma, Albee Budnitz, MD, a pulmonologist and internal medicine specialist at Downtown Medical Associates/Foundation Medical Partners in Nashua, said:

1. Your child’s asthma triggers, and

2. Your child’s symptoms/signs that their 
 asthma is getting out of control.

“Asthma remains essentially a syndrome, so each individual has to learn their specific disease’s symptoms and signs, so they can intervene with self-management and keep it under control.”

Asthma triggers

Allergens – environmental, seasonal, animals and foods – can trigger an episode of asthma in vulnerable children. Potential triggers include:

• Hay fever in the spring, ragweed and leaf mold in the fall, and cold air in the winter

• Environmental (outdoors and indoors): wood and tobacco smoke; dust and dust mites, other pests such as cockroaches; chemicals such as cleaning products, paint, fragrances, aerosols, kerosene; mold which grows in damp basements; furry or feathered pets, hay or straw

• Exercise. It’s important that kids stay active, but exercise (especially in the cold and wind, or conversely, on hot humid days) can trigger asthma.

• Sulfites in foods and beverages

• Cold and flu

According to the Asthma and Allergy Foundation of America, there is a clear link between secondhand smoke and asthma. Children whose parents smoke also get sick more often, including bronchitis and pneumonia. Asthma can be triggered by secondhand smoke, and kids with asthma who are exposed to secondhand smoke have worse and more frequent asthma attacks.

On the front lines

School nurses, child care providers, and coaches are on the front lines when children with asthma are away from home.

Kathy Barth, BSN, RN is the nurse for Crossroads Academy in Lyme, and is president-elect of the New Hampshire School Nurses’ Association. As part of the basic health questionnaire parents fill out when enrolling their child in school, or when an asthma diagnosis is made by a physician, the professional school nurse gets involved, Barth said.

The discussion includes a copy of the Asthma Action Plan from the physician, with instructions including prescriptions, and permission for inhaler use at school.

“In most cases, kids come down to the office and say they’re wheezing and need their inhaler. Depending on their age and maturity, older students can carry their own.” They need to know how and when to use it, understand that they shouldn’t share their medication, and, if they use it and don’t feel better, they should go to the school nurse.

For emergencies, Barth noted, the nurse’s office does have albuterol as a “rescue med,” in case a student’s medication has expired, or the parent hasn’t brought it in.

Treatment

Asthma must be taken seriously. Medications should be up to date and available, with clear instructions as to how and when to use them (asthma action plan). There are different types of inhalers and “spacers” (which help deliver the prescription directly into the lungs versus the mouth), nebulizer machines, preventive meds that may need to be taken daily, and rescue meds for an active attack, so there is a lot to learn.

“Pharmacists are very knowledgeable about your child’s medications and how to use them, especially when your child is newly diagnosed. They are an often overlooked resource,” Carrigan suggested.

School-age children should participate in their care. According to the National Heart, Lung, and Blood Institute, children age 10, or younger if they are mature enough, should take an active role and work with their doctor to manage their asthma.

Have them play detective, paying attention to and noting what they feel like when their asthma is flaring up (cough first? chest tightness? can’t take a deep breath?), and associating what they were doing, where they were, what they ate, etc. As children learn to recognize the feeling, they can alert you or the school nurse when they need to use their medicine.

Knowing the signs and what to do next makes an episode less scary for children—and grownups.

“When it comes to co-managing asthma, a lot depends on the kids themselves,” according to Dr. Tanski. “Since prevention and adherence to medication is so critical to prevent symptoms, I rely on parents to make certain that the preventive medicines are being taken, at least through elementary/middle school. The kids are the best reporters on their symptoms, though.”

What’s the plan?

Families should work with their doctor to create an Asthma Action Plan, which should be shared with the school nurse or child care provider. Using the analogy of a stoplight, it has questions to ask and steps to take at each level, with red being critical—the get to a doctor or emergency room now action step. You’ll find a sample plan at www.breathenh.org.

Well-managed, asthma shouldn’t get in the way of a child doing whatever they want to do.   

Mary Ellen Hettinger, APR, is an award-winning reporter, editor and writer, and accredited public relations professional. She’s the Director of Public Relations and Communications for Breathe New Hampshire.

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