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Clinical Reference Systems: Pediatric Advisor 10.0

Asthma (for Teenagers)


  • 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
  • confirmation of this diagnosis by your physician is essential.

Asthma is also called reactive airway disease (RAD).


Asthma is an inherited type of "twitchy" lung. The airways go into spasm and become narrow when allergic or irritating substances enter them. Viral respiratory infections (colds) trigger most attacks. If the asthma is due to pollens, it flares up only during a particular season. Asthma often occurs in people 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."


Asthma attacks may be frightening, but they are treatable. When medicines are taken as directed, the symptoms completely clear up and there are no permanent lung changes. Asthma can be a long-lasting disease, but over half of young people who have asthma outgrow it during adolescence.


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

If you have any doubt about whether or not you are wheezing, start the following asthma medicines. The later medicines are begun, the longer it takes to stop the wheezing. Once treatment with the medicines is begun, take the medicine until you have not wheezed or coughed for 48 hours. (Stay on the medicine at least 7 days.)

If you have one or more attacks of wheezing each month, you probably need to be on continuous medicines.


  1. Asthma inhalers

    You need the metered-dose inhaler prescribed by your physician.

    Make sure you carefully follow these instructions for using the inhaler:

    • Shake the canister.
    • Hold the inhaler upright and 2 inches in front of your open mouth.
    • Breathe out (exhale) completely.
    • Release the spray when you start to breathe in (inhale).
    • Inhale slowly until your lungs are completely full.
    • Hold your breath for 10 seconds after your lungs are filled.
    • After taking a few normal breaths, take the second puff.

  2. Oral asthma medicine

    Although inhaled medicines work best for asthma, during some attacks you will also need to take medicines by mouth. You need the medicine prescribed by your physician.

  3. Continuous asthma medicine

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

    • two or more bouts per week of wheezing lasting more than 1 hour after using a metered-dose inhaler
    • two or more bouts per month of wheezing lasting more than 1 day
    • almost continuous low-grade coughing
    • asthma that frequently interrupts sleep or limits sports or other activities
    • asthma triggered by pollens (use daily asthma medicines during the entire pollen season).

Other Treatment Guidelines

  1. Begin treatment early.

    Many people wheeze soon after they get coughs and colds. Start the asthma inhaler or oral 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, obtain a refill.

  2. Fluids

    Fluids keep the normal lung mucus from becoming sticky. Try to drink one glass of fluid every 2 hours during waking hours. Clear fluids such as water are best. Sipping warm fluids may improve your wheezing.

  3. Exercise-induced asthma

    Most people with asthma also get 20- 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. The symptoms can be prevented by using an oral asthma medicine 90 minutes before exercise or an inhaler 10 minutes before exercise. Teenagers with asthma usually have no problems with swimming or sports not requiring rapid breathing.

  4. Going to school

    Asthma is not contagious. You should go to school during mild asthma attacks but avoid gym on these days. Arrange to have your asthma medicines available at school. If you use an inhaler, get permission to keep it with you so you can use it whenever you need it.

    If you are wheezing all the time, you should be seeing your physician daily.

  5. 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.

    Another common error is keeping a cat that you are allergic to. Also, avoid all smoking; tobacco smoke can linger in the air for up to a week.

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


Try to discover and avoid the substances that trigger your asthma attacks. Consider strong odors such as cologne, exhaust fumes, and frying foods. Avoid common triggers such as feather pillows and tobacco smoke. Try to keep pets outside or at least out of your bedroom. Learn how to dustproof your bedroom. Have your parents regularly change the filters on your hot-air heating system or air conditioner.

If you wheeze after any contact with grass, pollen, weeds, or animals, pollen or animal dander remaining in your hair and clothing may keep the wheezing going. Shower, wash your hair, and put on clean clothes.


  • The wheezing is severe.
  • The breathing is difficult.
  • The wheezing is not improved after the second dose of asthma medicines.


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

Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright 1999 Clinical Reference Systems