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.

Some Possible Asthma Triggers

Allergies

¨ Food such as nuts, chocolate, eggs, orange juice, fish, milk, peanut butter.

¨ Pollen from flowers, trees, grasses, mold.

¨ Animals such as rabbits, cats, dogs, birds, rats.

¨ Feather pillows, down comforters.

¨ Cockroaches, dust mites.

¨ Aspirin.

Household Products

¨ Smell from cleaning supplies, paint, paint thinner, liquid chlorine bleach.

¨ Sprays from furniture polish, room deodorizers.

¨ Spray deodorants, perfumes, hair spray, scented cosmetics.

Dust

¨ Upholstered furniture, carpets, draperies.

¨ Sweeping that raises dust.

¨ Dirty filters on hot air furnaces that put dust into air.

On The Job

¨ Chemicals on clothes and/or hands.

¨ Dust, vapors or fumes .

¨ Painting

Weather

¨ Exercise in cold air.

¨ Changes in temperature and/or humidity.

Some Possible Asthma Triggers

Air Pollution

¨ Industry and truck/car fumes.

¨ Traffic jams.

¨ Smoke-filled rooms.

Exercise

¨ Wheezing may begin after vigorous activity (like sprinting), especially in cold weather.

Infections

¨ Colds, other viruses, ear infections, sore throat.

Nighttime

¨ Lying down, tiredness, accumulating mucus overnight.

Emotions

¨ Fear, anger, frustration, laughing too hard, crying, coughing.

Smoke

¨ From cigarettes, cigars, pipes.

© 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.