Asthma Day to Day

Will this disease necessarily keep children from climbing on jungle gyms, riding bikes, skateboarding, swimming, dancing, and doing all the other things that youngsters want to do? No. With proper medicine and recognition of symptoms, children with asthma should have no symptoms, no missed school days, and no restrictions on their activities. If you or your child don't quite believe that, take a look at the Olympic gold medalists, professional athletes, Oscar-winning actors, doctors, and even presidents of the United States who have this disease (for example, Charles Dickens, John F. Kennedy, Kristi Yamaguchi, Sharon Stone, and Ricki Lake; see Resources for a long list of famous people with that disease). A "normal life" with this disease means children should have no cough-ing, wheezing, shortness of breath, or chest pain during the day or night. They should be able to participate in activities without limitation. Flares should be rare when that disease is properly controlled, as discussed in former article. Minimal side effects from medicine are another important goal of good asthma care. Children should grow to normal adulthood without any lifelong side effects or disabilities. It's important, therefore, to work with your physician to make sure that your child is on the right medi-cines. Your mutual goal is for your child to lead a normal life, so proper medicine is necessary to prevent, control, and treat symptoms. The med-icines should not be too many or too few. Identifying triggers that set off symptoms is another essential ingre-dient in preventing flares and assuring a normal life for children with this disease. These triggers include various allergens such as pet dander, dust, pollen, and viral infections. Some triggers are easier to avoid or eliminate than others. Viral infection is the most common trigger in young children and nearly impossible to avoid. But an annual influenza vaccination (a flu shot) will help prevent asthma flares from the flu virus.

If your child's physician or nurse practitioner hasn't already helped you make a written asthma management plan, be sure to ask about one at your next appointment. Your child's plan should detail a specific course of action to start whenever symptoms appear. Plans will vary from physician to physician and patient to patient. An asthma management plan used at The Children's Hospital of Philadelphia is included on pages 220-222 in Resources. You're encour-aged to copy it, take it to your child's doctor, and use it as a model to construct your child's individual plan. Whether you use this or any other form, a clearly written asthma management plan should contain the fol-lowing components that are tailored to your own child:

• A list of everyday controller medicines, with instructions about which medicines to give, how much, and how often;

• Your child's "personal best" reading if he or she uses a peak flow meter;

• Instructions for using an inhaler when breathing becomes trouble-some during exercise or sports, how many puffs to take and when to take them (usually fifteen to thirty minutes before exercise)

• Instructions about what to do when symptoms start, which quick-relief medicine to use, how many puffs to inhale and how often,or what medicine to give by nebulizer and how often;

• Instructions about what to do when a flare starts, with a range of peak flow meter readings during a flare; Instructions about when to give extra anti-inflammatory medicine, name of the specific medicine, how many days to continue giving it, and number of times per day;

• An emergency section: what to do if symptoms get worse, name and number of physician to call, when to call 911 or go to an emergency room.

An asthma management plan has three levels. Think of it as a ladder. You move up a level or step as symptoms become more serious or fre-quent. Doctors have developed a color-coded system modeled after a traffic light to represent the three levels of severity:

1. Green Go! The first level is the everyday plan the daily con-troller medicines your child takes to keep asthma symptoms away even when she's feeling well.
   
2. Yellow—Caution! Move to the second level when symptoms appear (coughing, wheezing, or chest tightness). This level includes use of the quick-relief medicines (usually albuterol) that your child needs right away to get the symptoms back under con-trol and usually includes increasing the dose of inhaled cortico-steroids or adding an oral corticosteroid.
   
3.  Red—Medical Alert! The third level is more serious. It is used when symptoms continue or get worse. This part of the asthma management plan helps you decide how much more quick-relief medicine to give and if your child needs to see the doctor or go to the emergency room.

The key to asthma control is finding the right controller medicine. Controller medicines must be taken every day, although for some chil-dren they sometimes can be stopped in certain seasons. But don't stop the medicine without first checking with your child's physician or nurse practitioner.