Definition of Asthma:
(Diagnosis to be confirmed by a
physician)
What It Is and What To Do About It
¨
It is a chronic disease --- and it
is reversible
¨ Wheezing
(a high-pitched whistling or musical sound while blowing out)
¨ Recurrent
attacks of coughing, chest tightness, and problems breathing
¨
Decreased activity/low energy
¨
Coughing when running
Causes
Asthma is an inherited type of “twitchy” lung. The airways go into spasms 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. Asthma is never contagious.
Expected
course
Although asthma attacks may be frightening, remember that
they are treatable. Taking
medicines early shortens the course of an asthma attack and can prevent
hospitalization. When medicines are
taken as directed, the lungs usually return to normal after an attack. Asthma can be a long-lasting disease, but
many children who have asthma outgrow it during adolescence.
Home treatment
1.
When to start medication
Asthma is a chronic disease that requires close follow-up
by your child’s regular doctor. If you
have any doubt about whether or not your child is wheezing, get medical advice
or follow your child’s Asthma Home Plan at the “yellow zone” stage. (Check a peak flow
meter if possible.) 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 s/he has not wheezed or coughed for two
days. In general, most children need
their medications for five to seven days.
If your child has two or more attacks of wheezing each week, s/he
probably needs to be on daily prevention medications. Please discuss this with your doctor.
2. Begin
treatment early!
Children often wheeze soon after they get coughs and
colds. Begin using an asthma inhaler or
oral medicine at the first sign of any coughing, shortness of breath, or
wheezing. The best (and only) “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 the
medicine refilled. School-age children
may need to keep medication at school, as well.
The best 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. It
can be used by
children five years old and older.
3. Daily
asthma medicine
Most children with asthma need medicines only during
asthma attacks. Children who have
frequent coughing or wheezing need special daily medicines. Your doctor will
decide this for you if you have :
¨
Two or more attacks of wheezing per
week
¨
Recurrent asthma flare-ups lasting
more than a week
¨
The need for repeated emergency room care despite proper use of
medications
¨
Asthma triggered by pollens. (Use daily asthma medicines during the
entire pollen season.)
4. 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, can start an asthma attack.
This problem should not interfere
with playing in most sports or with participation in gym class. Using an inhaler 10 - 45 minutes before
exercise will effectively prevent symptoms.
An important goal is to control asthma well enough to allow regular,
normal participation in sports.
5. Going to school
Asthma is not contagious. Your child should go to school during mild
asthma attacks but should avoid vigorous exercises (such as running) on those
days. Arrange to have the asthma
medicines available at school. If your
child cannot go to school because of asthma, s/he should see a physician that
same day for additional treatment.
Frequent missed school days may be a sign that your child’s asthma is
not well controlled. Talk to your doctor
about the situation.
6.
Common mistakes
The most common mistake is delaying
the start of prescribed asthma medicines or not replacing them before the
supply is gone.
Non-prescription inhalers and
medicines are not helpful and should
not be used.
¨
The most serious error is continuing
to expose your child to an avoidable cause of asthma, like tobacco smoke of any
kind.
¨
Do not panic during asthma attacks. Fear can make tight breathing worse, so try
to stay calm and reassure your child.
Speak to him/her in a soothing voice, remind them how they have
recovered before, and tell them they will feel better very soon.
Anatomy and Physiology of Asthma
Trachea
(windpipe)
Bronchioles
(small
airways)
Alveoli (air sacs)
Left
lung
Adapted
from Clinical Reference Systems, LTD, by Breathing Easier Program at the San
Francisco Health Plan.
Environmental Control and Asthma
Children with asthma have
extra-sensitive airways. Many things in
the environment trigger asthma symptoms, and they are unique to each
child. Some common triggers of asthma
symptoms are cigarette smoke, perfume, strong odors, and cold air. Other
factors include weather and climate changes, pollens and house dust, truck
exhaust, molds and animals. Limit
your child’s contact with these triggers, especially where the child spends the
greatest amount of time, such as at home and school. Keep his/her room especially trigger-free.
Smoking
Pipe, cigarette, and cigar smoke harm children and adults, but they pose
a special problem for ALL children with asthma. Even the smell of smoke on clothes
triggers asthma symptoms in a child with sensitive airways. Smoking at home or in a car can be life
threatening to an asthmatic child and is unacceptable.
Pollens
Lightweight airborne pollens from
grasses, weeds and some trees are carried for miles. These pollens strike the eyes, nose, and
airways, triggering the symptoms of asthma in some children. Although it is
difficult to totally avoid them, here are some suggestions to decrease exposure
to pollens:
¨ Keep
the child’s bedroom windows shut during the allergy season, especially in early
morning hours because this is the time many plants release pollen.
Molds
Molds can be a major trigger for
many asthmatics. They may grow
year-round throughout the house and.
Bathrooms and damp basements are two common areas for mold growth. Here are some suggestions to decrease mold
growth:
¨ Light
and air help stop mold growth.
Thoroughly clean bathroom tile, floors, shower curtain, and tub
surrounding and under plumbing fixtures weekly.
Use dilute household bleach if necessary.
¨ Vaporizers
and humidifiers with a reservoir make mold worse. Molds spread throughout the house when these
are used.
¨ Homes
with many plants also are sources for molds.
Cover the potting soil of houseplants with foil to decrease spreading of
mold spores. Plants should not be in
your child’s room.
House
Dust
House dust contains many things,
including dirt, insect debris, dust mites, food crumbs, and other
materials. This dust collects on every
item in the home, including mattresses, stuffed animals, furniture, clothes, rugs
and drapes.
It is difficult to avoid house dust,
but these recommendations will decrease your child’s contact with it:
¨ Avoid
clutter and things that collect dust, particularly in the bedroom. These include wall hangings, drapes, and
blinds.
¨ Give
your child washable, “non-allergenic” stuffed toys when possible. Store ordinary toys, dolls, and play
equipment outside the bedroom or in the closet. Remove all stuffed
animals from the bed.
¨ Keep
the bedroom closet door closed.
¨ Bare
floors are best. Carpeting is okay only
if you vacuum frequently and thoroughly.
Ideally, you should vacuum and dust at least weekly. Be sure to clean under furniture and in the
closet.
¨ Talk
to your doctor about special mattress covers.
These can help your asthma a lot. Use only polyester pillows and wash
them several times a year. Bed liners
and covers should be washable cotton or synthetic fibers. Avoid use of feather, wool, or foam products
for the bed.
¨ Forced-air
furnaces must have dust-filters; change filters every two weeks during the
heating season.
Animals/Bugs
Animals,
and some insects/bugs, (especially cockroaches) can cause wheezing in many
people. Children may be more sensitive
to one type of animal (such as cats) than another. This is a serious problem in San
Francisco. You can reduce or eliminate
cockroaches by limiting their access to food (garbage) and water. Seal up the places where they
enter/exit. Consider using bait or
careful spraying for heavy infestations.
If you are a renter, talk to your landlord. Your doctor can write a letter stating that
cockroaches trigger asthma attacks, to help you make your case.
Dogs, cats, and rats can cause
allergic asthma symptom problems.
Removing a family pet is very
difficult, but if your child has asthma, it may be best. After you remove a pet from the house, clean
stuffed furniture, rugs, drapes, and the heating system. If you have a pet, the pet should live
outside and never be in the child’s bedroom.
Adapted from
Clinical Reference Systems, LTD, by Breathing Easier Program at San Francisco
Health Plan.
Tobacco Smoke and Asthma
How does tobacco smoke affect children with asthma?
¨
Second-hand smoke from tobacco is
harmful to the lungs of ALL children.
¨
Children who live in a household with a
smoker have more asthma and need to take more medications, and have more
emergency room visits than
children who live in smoke-free homes.
Tobacco smoke is irritating to the
airways in several ways. Smoke stays in
air a long time. Children breathe in the smoke, which cause an asthma attack,
making it difficult for the child to breathe.
Smoke stays on clothes, furniture and in cars, causing permanent harm to
lungs of child and other non-smokers.
|
SMOKING IN THE HOME OF A CHILD WITH ASTHMA IS UNACCEPTABLE!!!
|
What will help me stop smoking?
1.
Set a date for quitting
2.
Get rid of cigarettes, ashtrays,
matches, and lighters from your home, workplace, and car.
3.
Keep handy a supply of low calorie
snacks.
4.
Spend more time in places that do
not allow smoking.
5.
Tell everyone you are going to stop
smoking.
6.
Call a friend if you need help.
7.
You can call San Francisco General
Hospital’s Smoking Cessation & Relapse Prevention Program at
415/206-5449.
8.
Go on! Save a life, your own or a loved one’s!
Adapted from Asthma Commission at Children’s Hospital in
Denver Colorado by Breathing Easier Program at San Francisco Health Plan.
Bronchodilators,
Inhaled
What are
the names for this type of medication?
Some generic
& brand names for this medication are albuterol (Proventil, Ventolin),
metaproterenol (Alupent/Metaprel), and salmeterol (Serevent).
What
does this medication do?
Bronchodilator
drugs relax the muscles of the airways, and make exercise easier for persons
who have asthma.
How is
it taken?
This medication
may be taken as a fine spray made by a machine or from a metered-dose inhaler
(MDI), also known as a “puffer.” Usually
this medicine is used only for asthma attacks.
What is
the usual dose?
The most common
dose from a metered-dose inhaler is 2-4 puffs.
A dose may be taken 15 to 45 minutes before exercise. A dose should not be repeated more often than
every four hours without calling your doctor.
What
side effects can this drug cause?
The most common
side effects are tremors or shakiness, feelings of nervousness, and a short
period of feeling the heart beat rapidly.
This often resolves quickly.
What
special instructions should be followed?
Don’t use more
often than your doctor says.
If you are using albuterol DAILY, or more than a can
(for MDI) per month, you are using too much.
Talk with your doctor to adjust your home plan.
Adapted from
Clinical Reference Systems, LTD, by Breathing Easier Program at the San
Francisco Health Plan.
Cromolyn
Sodium and Nedocromil
What are
other names for these medications?
The brand names
for this drug are Intal and Tilade.
What do
these drugs do?
Regular use of
cromolyn or nedocromil prevents episodes of wheezing by making lungs less
twitchy.
Cromolyn
and nedocromil are not to be used for wheezing or an acute asthma attack.
How are
they taken?
Cromolyn can be
taken with a machine, metered-dose inhaler (MDI), or spinhaler. An MDI is used for nedocromil. You will feel a puff, or spray like mist or
fog going down your lungs. This is
normal and not harmful.
What is
the usual dosage?
They are
usually taken three to four times a day.
You can also use before exercise
What
side effects can this drug cause?
Side effects of
these medicines are rare. Some patients
report dry mouth, cough, and irritation of the throat but overall these are
exceptionally safe drugs. This is a very
safe medicine.
What
special instructions should be followed?
To prevent
asthma, cromolyn must be taken daily. It
should also be taken 15 minutes before exercise or allergen exposure.
Adapted from Clinical Reference Systems,
LTD, by Breathing Easier Program at the San Francisco Health Plan.
Steroids, Oral
What are
other names for this type of drug?
The bottle name
may read: prednisone (Deltasone), methylprednisolone (Medrol), and prednisolone
(Pediapred/Prelone).
What
does this type of drug do?
Oral steroids
reduce swelling, inflammation, and mucus production in the lungs. They help control and prevent symptoms of
asthma. They are used as potent for
serious asthma attacks.
How is
it taken?
Oral steroids
can be taken as pills or syrup.
What is
the usual dose?
Use the amount
your doctor says. More or less can taken
can be harmful. Do not stop early
without telling your doctor.
What
side effects can steroids cause?
Side effects
are rare and depend on how much, how often, and how long the medication is
taken. The side effects of steroids can
include increased appetite, a feeling of well-being, irritability, and poor
sleeping. These resolve once the
medication stops. Also, chickenpox is
dangerous while taking oral steroids.
Report suspected cases immediately!
If you are worried about side effects talk to your doctor.
What
special instructions should be followed?
Always take the
prescribed amount for the time prescribed.
Do not stop taking the prescribed dose before checking with your doctor.
Note: Steroids
can be essential and life saving in the treatment of asthma. Discuss any concerns with your doctor.
Adapted from Clinical Reference Systems,
LTD, by Breathing Easier Program at San Francisco Health Plan.
Steroids,
Inhaled
What are
other names for this type of medication?
Some names you
may see on labels for inhaled steroids are beclomethasone (Vanceril,
Beclovent), triamcinalone (Azmacort), and flunisolide (Aerobid) budesomide
(Pulmicort).
What
does this type of drug do?
Regular use of
inhaled steroids prevents asthma attacks by making lungs less twitchy; and by
taking extra mucous and water out of lungs, making room for air. Inhaled steroids will not help an acute
asthma attack.
How are
they taken?
Inhaled
steroids are taken with a metered-dose inhaler (MDI). Use a spacer or holding chamber to help. It takes 1-2 weeks before they do their
job. Do not expect to see less coughing/wheezing
in the first few days. Be patient!
What is
the usual dose?
The usual dose
is two to three puffs, taken two to four times a day every day. You must use daily for them to work.
What
side effects can this drug cause?
Thrush, a mild
infection of the mouth and throat, is possible but rare. Sore throat and tongue, hoarse voice, and dry
mouth occur rarely and do not cause harm.
Using a spacer may stop these problems or prevent them.
What
special instructions should be followed?
Rinse the mouth
after each treatment and use a spacer device to prevent infection. Never stop using these medicines without
talking to your doctor.
Adapted from Clinical Reference Systems,
LTD, by Breathing Easier Program San Francisco Health Plan.
Cleaning Metered Dose Inhaler and Spacers
Please follow these steps to
clean your MDI once or twice a week:
The medicine
spray may stop if the plastic piece is not cleaned regularly.
1. Take
the metal can containing the medication out of the plastic mouthpiece.
2. Soak
the plastic pieces -- mouthpiece, cap, and spacer -- in hot water.
3. Shake
the excess water off the plastic pieces and let them air-dry.
4. The
metal can containing the medication may also get dirty. Check the small holes
on the stem of the can. You can clean
out the stems with lukewarm water. Do NOT use soap.
5. Shake the excess water off the
metal can and let it air dry.
6. Reassemble your metered dose inhaler
when all the parts are completely dry.
7. Never put parts in dishwasher.
How Much Medication is Left in your Inhaler?
You
can check the amount of medication in your inhaler by following the
instructions
below. (Just shaking and feeling the canister
will also give you a good feel for the
amount
left.)
1. Take the metal can containing the
medication out of the plastic mouthpiece.
2. Place the metal can in a container (mixing
bowl or a pot) of cool or lukewarm water.
*
Full cans sink to the bottom and stand upright.
*
Half-full cans float upright at the top of the
water.
*
One-quarter full cans float with the top of the
canister partly in the water.
*
Empty cans float sideways on the top of the
water.
3. Let the can air dry completely
before reassembling your metered dose inhaler.
Adapted from Clinical Reference Systems,
LTD, by Breathing Easier Program at the San Francisco Health Plan.
Peak
Flow Meter: How to Monitor Asthma
What is the purpose of the peak flow meter?
The peak flow meter measures how
fast air is exhaled in one breath.
Measuring the peak flow regularly can help predict early signs of an
acute asthma episode and how well medications are working.
When should the peak flow meter
be used?
Ideally, measure the peak flow each
day before and after each albuterol treatment and when an acute asthma episode
occurs. Record the measurements in a
daily log to help your doctor know how well medications are working.
What is a normal peak flow?
A peak flow is generally considered
normal when it is within 20% of the peak flow predicted for your child’s age,
sex, and size. Your doctor can show you
how this works. Make sure you understand
his/her instructions.
How is the peak flow meter used?
Each brand of peak flow meter works a little
differently. Ask your doctor if you are
not sure how to use it.
General Instructions are:
·
Place the mouthpiece on the peak
flow meter.
·
Place the marker at the bottom of
the scale close to the mouthpiece.
·
Hold the peak flow meter as shown by
your doctor or pharmacist, being careful that fingers do not block the opening.
·
Inhale as deeply as possible. Place the mouth firmly around the mouthpiece
beyond the teeth, making a tight seal with the lips. This is very important so that air does not
leak out.
·
Blow out as hard
and fast as possible.
·
The marker will
move and show the peak flow reading.
Note the number, return the marker to the base of the scale, and try
again.
·
Write down the
date, time, and the highest of the two measurements in
·
the log.
·
Bring your log
to your next visit to the doctor.
When and how should the peak flow
meter be cleaned?
Once a week clean the mouthpiece of the meter with warm
water and dry it thoroughly. Do not put
it in dishwasher.
Adapted from Clinical Reference Systems,
LTD, by Breathing Easier Program at the San Francisco Health Plan.
