Managing an Asthma Flare

One of the characteristics of asthma is that it changes over time, sometimes unexpectedly. Every child with disease has some episodes of increased symptoms. The overall pattern of symptoms—how consistently she is at her best and how often flares occur—will determine the type of treatment plan prescribed. Children with persistent or daily symptoms and those with frequent flares need daily controller medicines. But all children with asthma, even those who don't take daily medicines, To use the plan properly, the family and child must know when to start it. New flares can begin at any time and in unpredictable ways. But all new flares can be recognized at their very beginning. As a parent, you can best help your child through a flare by being prepared and staying calm. Use your child's asthma management plan and your own understanding of your child to give him the appropriate medicines right away and get her to her doctor or an emergency room if necessary. A major reason children with asthma end up in the hospital is because a flare has gone on for too long. Learn to recognize the warning signs of a flare and act immediately to treat them.
Caryn is an active seven-year-old with ten-year-old twin brothers. She always seems to be in motion—dancing to CD's, taking ballet lessons, running around outside with her neighborhood friends. Since Caryn's asthma was diagnosed two years ago, her parents have seen that she takes her controller medicine twice a day.She needs a plan to manage Asthma flares. She very rarely has asthma symptoms, but when they do appear she uses her albuterol inhaler for quick relief. Caryn caught a cold in early January. Her nose ran, she sneezed and coughed occasionally, but her parents didn't think it necessary to keep her home from school. Caryn seemed otherwise normal she teased her brothers, ran away from them when they dished it back, and occasionally got into a fairly friendly wrestling match with one or both of them.
A few days into the cold, Caryn's parents heard her coughing more often, especially after laughing with her brothers. And she seemed more tired than usual. Instead of actively playing, she lolled on the sofa and watched TV. Caryn's parents heard her coughing in the middle of the night, but she didn't wake up. When they heard the coughing, they assumed it was another symptom of her cold, that it had moved from her head to her chest and was perhaps bronchitis. "Maybe we should call the pediatrician tomorrow," they thought.

A basic definition of a flare is any worsening of asthma symptoms. In the simplest terms, mild increases in symptoms need less medicine than severe or prolonged symptoms. In general, if your child needs more than one dose of albuterol or quick-relief medicine in a day, a new flare may be starting. A sure sign that a flare has started is when symptoms such as night cough (after midnight) are present. As discussed in former article did you read that?, the family and child can use either "symptom recognition" or peak flow monitoring to detect the beginning of a new flare. Each is effective, but symptom recognition is most commonly used. Whether mild or severe, worsening symptoms means that inflammation is increasing in the lungs. The more rapidly symptoms rise or the more severe they become, the greater the increase in inflammation. Therefore, for any level of severity, increased doses of anti-inflammatory or controller medicine should be given. Detecting a new flare is easy in a child who is under good control and has no daily symptoms and normal lung function. The start of symptoms such as cough, wheezing, shortness of breath, chest pain or tightness usually tells us that control is slipping and a flare may be starting. Another sign may be your child's decreased activity or need for quick-relief medicine such as albuterol.
Many parents find it helpful to think about their child's previous flares in order to identify which symptoms indicate that a flare is beginning. For example, have past flares usually been triggered by a cold virus? The trigger may not be a single symptom; it's also important to know what mixture of symptoms your child commonly has in a flare. Most children cough a lot when asthma worsens. This is hard to miss. Some children only cough a little at the start of a flare, unless their flare is severe. For these children, flares may be characterized by shortness of breath, chest pain, wheezing, or decreased activity. Children with less obvious symptoms may get worse without their parents noticing, unless they have learned to recognize the typical pattern of symptoms for their child. Some children may wheeze infrequently or rarely. In these youngsters, obviously, wheezing cannot be used to detect a flare. But most children will have a mixture of symptoms including cough, shortness of breath, chest pain or tightness, wheeze and/or fatigue. And parents can learn to remember this typical "snapshot" of their child when she has worsening symptoms. It is very helpful for parents to discuss this picture with their child's asthma caregiver. In this way, everyone will learn more about the child's disease, and symptom recognition will get better and better over time.Parents should also remember how their child tends to handle her symptoms. Most children cannot hold back their symptoms, but some will attempt to hide them because they want to please their parents or not make them worry. A child who conceals or denies symptoms can delay the detection of a new flare unless peak flows are monitored on a regular basis. Obviously, other circumstances can interfere with recognition of symptoms, such as separation of parent and child during work or school hours.