Clinical Reference Systems: Pediatric Advisor 10.0
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Description (Diagnosis must be confirmed by a physician.)

• 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 no fever.

Asthma is also called reactive airway disease (RAD).

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 pollens, it flares up only during a particular season. Asthma often occurs in children who have other allergic reactions such as eczema or hay fever. 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 "Prevention by Avoiding Asthma Triggers."

Expected Course

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.

Home Treatment

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

Asthma Medicines

• Asthma inhalers

  Your child may need a metered-dose inhaler prescribed by your physician.

  Carefully follow these instructions for teaching your child to use the inhaler:

  • Shake the medicine.
  • Hold the inhaler upright and 2 inches in front of an open mouth.
  • Your child should breathe out (exhale) completely.
  • Release the spray when your child starts to breathe in (inhale).
  • Your child should inhale slowly until his lungs are completely full.
  • Your child should hold his breath for 10 seconds after his lungs are filled.
  • After taking a few normal breaths, your child can take the additional puff(s).

  Inhalers usually can't be coordinated by children less than 6 years old unless a plastic airway spacer (or chamber) is also used. The spacer (chamber) will trap the asthma medicine and give your child time to breathe it in. Some children need to use a spacer until they are teenagers.

• Asthma nebulizer treatments

  Children younger than 4 years old can't use inhalers. They need nebulized medicine treatment, using a machine. Even older children get more of the medicine delivered to their lungs using a nebulizer rather than an inhaler. Your child needs to take nebulizer medicine as prescribed by your physician.

• Oral steroids or other asthma medicine

  Although inhaled medicines work best for asthma, some children also need to take medicines by mouth. Your child may need oral asthma medicine prescribed by your physician.

• Continuous asthma medicine

  Most children with asthma need medicines only during asthma attacks. Children with the following symptoms usually need to take asthma medicines everyday to allow them to engage in normal activities:

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

When Asthma Medicines Should Be Taken

• Wheezing. 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 medicines is begun, keep your child on the medicine until he has not wheezed or coughed for 48 hours. (Your child should be kept on the medicine at for at least 7 days.)
• Colds. Many children wheeze soon after they get coughs and colds. Start the asthma inhaler or oral medicine at the first sign of any coughing, shortness of breath, or wheezing. The best "cough medicine" for a child 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.
• Peak flow meters. The most reliable way to detect the start of an asthma attack is by using a peak flow meter, which can measure the air flow out of the lungs. Peak flow meters (PFM) measure how fast your child can move air out of the lungs. Every child 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%).

Other Treatment Guidelines

• 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.

• Exercise-induced asthma

  Exercise can trigger asthma. Most people with asthma also get 10- to 15-minute attacks of coughing and wheezing when they exercise strenuously. Running, especially in cold air or polluted air, is the main trigger.

  This problem should not interfere with participation in most sports nor require a gym excuse. The symptoms can be prevented by using an inhaler 10 minutes before exercise. Children with asthma usually have no problems with swimming or sports not requiring rapid breathing.

• 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.

Prevention by Avoiding Asthma Triggers

Try to discover and avoid the substances that trigger your child's asthma attacks. Second-hand tobacco smoke is the biggest 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 any contact with grass, pollen, weeds, or animals, there may be pollen or animal dander remaining in the hair and clothing that keeps the wheezing going. Your child should shower, wash his or her hair, and put on clean clothes.

For further information, see

Environmental Control and Asthma

Tobacco Smoke and Asthma

Call Your Child's Physician Immediately If:

• The wheezing is severe.
• The breathing is difficult or tight.
• The wheezing is not improved after the second dose of inhaled asthma medicine.
• 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 Your Child's Physician Within 24 Hours If:

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

Resources

1. Books

   ONE MINUTE ASTHMA; by Thomas Plaut, M.D.; Pedipress, 1990

   ASTHMA: THE COMPLETE GUIDE TO SELF-MANAGEMENT OF ASTHMA AND ALLERGIES FOR PATIENTS AND THEIR FAMILIES; by Allen M. Weinstein, M.D.; Fawcett, 1990

   A PARENT'S GUIDE TO ASTHMA; by Nancy Sander; Doubleday, 1989

   CHILDREN WITH ASTHMA: A MANUAL FOR PARENTS; by Thomas Plaut, M.D.; Pedipress, 1986

2. Newsletter (monthly)

   Mothers of Asthmatics, Inc.
   10875 Maine Street, Suite 210
   Fairfax, Virginia 22030

For further information, see

Metered-Dose Inhalers: How to Use

Home Nebulizer Treatments

Bronchodilator, Inhaled

Cromolyn

Steroids, Inhaled

Steroids, Oral

Theophylline

Peak Flow Meter.