Asthma

What is asthma?

Asthma is a breathing problem that causes:

• 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 there is no fever with asthma.

Asthma is a chronic disease that requires close follow-up by a physician who coordinates your child's treatment program.

What is the 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. Viral respiratory infections (colds) trigger most attacks, especially in younger children. If the asthma is due to an allergy to pollens, it usually flares up only during a particular season. Asthma often occurs in children who have other allergic reactions such as eczema. 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 "How can asthma attacks be prevented?"

Why was my child admitted to the hospital?

Main complication:___________________________________________

___ Needs frequent or continuous medication to ease breathing.

___ Needs oxygen or other medicine.

___ Needs IV fluids.

___ Other reason: ____________________________________________

How long does it last?

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.

What are the requirements for discharge?

• _______________________________________________________
• _______________________________________________________
• _______________________________________________________

What type of medicine does my child need?

Your child may need more than one type of medicine. One medicine is for helping stop an attack once it has started (rescue medicine) and another is for preventing attacks (preventive medicine). Ask your doctor when each medicine should be used.

• Rescue Medicine

  Rescue medicines quickly open your child's airways and are used during an asthma attack. These medicines are called bronchodilators.

  Your child's rescue medicine is ___________________________.

  This medication is delivered by:

  ___ Metered dose inhaler. Take ____ puffs every _____hours for ____ days.

  ___ Nebulization machine. Give a nebulizer treatment every ____ hours for ___ days.

  ___ Other ____________________. Take _______ every ____ hours for ___ days.

  After asthma attacks are over, your rescue medicine is stopped or used less often. Check with your doctor about when and how much to reduce this medicine.

• Preventive Medicine

  Most children with asthma do not need preventive medicine and only need rescue medicines during asthma attacks. Children with the following symptoms usually need to take preventive medicines every day to allow them to participate in normal activities:

  • 2 or more attacks of wheezing per week
  • asthma flareups lasting several days
  • the need for emergency room care despite proper use of inhaler
  • asthma triggered by pollens (use daily asthma medicines during the entire pollen season).

  Preventive medicines are anti-inflammatories. They help keep the airways in your child's lungs from becoming inflamed and irritated and help prevent asthma attacks.

  Your child's preventive medicine is __________________________.

  This medication is delivered by:

  ___ Metered dose inhaler. Take ____ puffs every _____hours every day.

  ___ Nebulization machine. Give a nebulizer treatment every ____ hours every day.

  ___ Other ____________________. Take _______ every ____ hours every day.

What is a metered-dose inhaler?

A metered-dose inhaler is a canister of medicine that releases a mist into your child's mouth and down into the airways of the lungs. The inhaler can be used by itself, but usually works better if it is used with a spacer (chamber) device. The spacer traps the asthma medicine and gives your child time to breathe it in. Children less than 6 years old can't coordinate all the steps required for using an inhaler. They must use a spacer because it provides for better delivery of the medicine to the lungs. Older children and adults should also consider using a spacer because it provides for better delivery of the medicine to the lungs.

Your child's spacer is _________________________________________.

What are nebulizer treatments?

Children younger than 1 year old can't use inhalers with a spacer. They need nebulized medicine treatment, using a machine. Your child needs to take nebulizer medicine as prescribed by your physician. Your child's nebulizer should contain ____ ml of _________________ mixed with ____ ml of _______________. Give a nebulizer treatment every ____ hours for ____ days.

What is a peak flow meter?

Peak flow meters (PFM) measure how fast your child can move air out of the lungs.

Measuring the peak flow regularly can help you:

• see if an asthma attack is becoming severe (if the peak flow is dropping)
• see how well the medicines are working
• see if your child is getting better after an asthma attack.

Every child with asthma over age 6 should use a PFM. These measurements will tell you when to increase medications (flow rate less than 80% of baseline) and when to see a doctor immediately (less than 50%).

When should my child take the asthma medicine?

If your child is taking a daily preventive medicine, take it exactly as prescribed by your health care provider.

If your child is prescribed a rescue medicine, then he or she should take it in the following situations:

• Asthma attack: If your child is having trouble breathing, he should take his asthma rescue medicine. If you have any doubt about whether or not your child is wheezing, have your child start taking his asthma medicine. The later medicines are begun, the longer it takes to stop the wheezing. Once treatment with the medicine is begun, keep giving your child the rescue medicine according to the dose prescribed by your health care provider. (Your child may have to take the rescue medicine for several days.)
• Colds: Many children wheeze soon after they get coughs and colds. If this is true for your child, start the asthma medicine at the first sign of any coughing or wheezing. The best "cough medicine" for a person 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, get a refill.
• Exercise-induced asthma (EIA): Most people with asthma also get 15- to 30-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. Your child can avoid the symptoms by using an inhaler (rescue medicine) 10 minutes before exercise. Teenagers with asthma usually have no problems with swimming or sports not requiring rapid breathing.

How can I take care of my child?

• Fluids

  Drinking fluids keeps the lung mucus from becoming sticky. Encourage your child to drink enough fluid. Clear fluids such as water are best. Excessive fluid intake is not necessary. If your child is not getting enough fluid he will have dark-colored urine.

• Hay fever

  For hay fever symptoms, it's OK to give antihistamines. Poor control of hay fever can make asthma attacks worse. Recent research has shown that while antihistamines can dry the airway, they don't make asthma worse.

• Going to school

  Asthma is not contagious. Your child should go to school during mild asthma attacks but avoid gym or sports 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 your child can't go to school because of asthma, he should see a physician that same day for additional treatment.

• Common mistakes

  The most common mistake is delaying the start of 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 remain calm and reassuring to your child.

  Finally, don't let asthma restrict your child's activities, sports, or social life.

• Other medicines

  For pain or fever over 102°F (39°C) give ______________________________

  _______________________________________________________________

  _______________________________________________________________

• Additional instructions

  _________________________________________________________________

  _________________________________________________________________

  _________________________________________________________________

How can asthma attacks be prevented?

Try to discover and avoid the substances that trigger your child's asthma attacks. Tobacco smoke is a common offender. If someone in your household smokes, your child will have more asthma attacks, take more medication, and need more emergency room visits. 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 on your hot-air heating system or air conditioner monthly. For allergies to molds or carpet dust mites, try to keep the house humidity less than 50%. Consider using a dehumidifier.

If your child wheezes after 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 hair, and put on clean clothes.

When should my child be seen again?

___ Your child needs to be rechecked and has an appointment on _____________ at _______ with _________________________.

___ Your child needs to be rechecked in ________ days. Call your child's doctor to make an appointment.

___ A follow-up appointment is not necessary. Call the doctor if you have any concerns.

When should I call my child's health care provider?

Call IMMEDIATELY if:

• The wheezing becomes severe.
• Breathing becomes difficult or tight.
• 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 during office hours if:

• The wheezing is not completely gone in 5 days.
• You have other questions or concerns.