By Chris Woolston
CONSUMER HEALTH INTERACTIVE
If your child has asthma, a simple wheeze can be the worst sound in the world. Naturally, you'd do anything to prevent asthma attacks, but how do you go about it? You don't have to watch him 24 hours a day or even slow down his activities. With the right treatments -- and a few changes around the house -- your child can breathe easily and life can get back to normal.
What is an asthma attack?
When a child has asthma, his bronchial passages (tubes that carry air to the lungs) become inflamed and ultrasensitive. Just about anything out of the ordinary -- a little dust, a blast of cold air, a puff of smoke, a cold virus -- can make the tubes suddenly squeeze tight, leaving little room for air to pass. This is called an asthma attack.
Preventing asthma attacks is a two-step process. First, your child needs medications to control her disease. Second, she should avoid the irritants, or "triggers," that can bring on an attack.
What medications can help prevent asthma attacks?
Many children with asthma take daily medications to keep their condition in check. If your child has more than two attacks each week for more than a month, he probably needs a daily dose of a corticosteroid such as beclomethasone or budesonide.
This type of medication, which is taken through an inhaler, can ease inflammation in the bronchial tubes. As a result, the airways will become less sensitive and less likely to go into spasms. Inhaled corticosteroids are generally quite safe, although high doses may be associated with side effects involving the bones, eyes, or adrenal glands.
While cromolyn and nedocromil are relatively mild drugs that can reduce inflammation with few or no side effects and can be taken alone or in combination with corticosteroids, a 2007 expert panel review of the latest asthma guidelines stresses that inhaled corticosteroids alone are the preferred treatment for children with persistent asthma.
A class of drugs known as bronchodilators can prevent attacks by opening the airways. The most commonly used bronchodilators, such as albuterol, are "quick relief" medications that work within minutes. Your child can inhale these drugs whenever she feels an attack coming on. She can also use bronchodilators as a hedge against situations that might cause an attack. For instance, if exercise makes her wheeze, many doctors recommend taking one to two puffs of albuterol or a similar drug 15 minutes before vigorous play or exercise.
Have your doctor help you prepare a written asthma action plan to give to your child's school. An action plan should include how to handle asthma as symptoms get worse, drug information, and when to seek professional medical care. Most schools in most states allow children to self-administer asthma medication. If school rules don't allow your child to carry an inhaler, one should be available in the school nurse's office or another convenient place. (The location should be unlocked and always accessible, notes the American Lung Association; if you're worried the medicine is too far away, you may want to ask the coach or gym teacher to carry your child's inhaler.) If he starts to have an attack, a few puffs of albuterol or a similar medicine can open his airways and restore his breathing. Remember: An untreated attack can be dangerous, even deadly.
Because bronchodilators bring such rapid relief, it can be tempting to overuse them. But taking these drugs too often is a sign that the asthma is getting worse. Ask your doctor how often your child should be using her quick-relief inhaler. Overuse of the inhaler may be a sign that she needs more corticosteroids or other medications to control her disease.
An instrument known as a peak-flow meter can help your child manage his medications -- and condition. This small, handheld device measures the force of the breath. If the readings are consistently high, he may be able to cut back on his medication, according to your doctor's instructions. But if the meter readings are consistently low, he may need more aggressive treatment.
How can I help my child avoid asthma triggers?
While medications fight your child's disease, you can do your part by helping her avoid the things that irritate her lungs and trigger attacks.
One of the worst offenders is tobacco smoke. (See our primer on Smoking and Asthma for more information.) Children with asthma who live in smoke-filled homes have more wheezing fits, need more medications, and make more trips to the emergency room than other asthma patients their age. If you have to smoke, take it outside. Better yet, set a fine example and quit for good.
Many children with asthma have allergies that can set off attacks. The dust mites that live in pillows and mattresses are common culprits. You may be able to improve your child's breathing dramatically by washing bed linens and blankets once a week, encasing pillows and mattresses in zippered airtight covers, and removing carpet from the bedroom.
Cats can also aggravate asthma. If your child is allergic to cat dander, ask yourself if you really need a cat in your life. If you (or your child) can't live without one, keep it out of your child's bedroom and bathe your cat regularly. Keep the kitty litter box in a room that your child doesn't frequent, and don't forget to have your child wash his hands after he's played with his beloved feline.
You can control pollen allergies by keeping your windows closed during pollen season. You might also consider installing a special allergy filter in your air conditioner, though the jury is still out on how effective these filters are at reducing allergic reactions. If your child is allergic to molds, clean damp areas frequently and consider buying a dehumidifier to keep the air dry.
If it's impossible to avoid dander, pollen, or other things that cause allergic reactions, talk to your allergist about immunotherapy. This treatment involves small injections of the proteins that trigger the allergies. After a while, your child may become less allergic to the proteins.
It's generally wise to avoid asthma triggers, but there's one big exception to the rule. If your child suffers asthma attacks during exercise, DON'T encourage her to quit exercising. As already mentioned, a bronchodilator taken before a workout can prevent an attack. She may need to take a break on days when her asthma is particularly troublesome, but usually she'll be able to play and run just as hard as any other kid.
No matter how careful you are, your child may still have an attack every once in a while. A cold virus, for instance, may sneak into his airways and cause a wheezing fit. The ultimate goal is to make the attacks so rare that they never slow down a child's life. And when you, your child, and your child's doctor work together, that goal is well within reach.
-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. Based in Billings, Montana, he is a former staff writer for Hippocrates and has written for Time Inc. Health, WebMD, and the Chronicle of Higher Education, and has received a northern California Society of Professional Journalists award for his reporting on occupational health.
American Academy of Allergy, Asthma, and Immunology
American College of Allergy, Asthma, and Immunology
American Lung Association
800-LUNG USA http://www.lungusa.org
Asthma and Allergy Foundation of America
National Heart, Lung, and Blood Institute. Your Asthma Can Be Controlled: Expect Nothing Less. 2001.
National Heart, Lung, and Blood Institute and National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. August 2007. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
Reviewed by Martha Vetter White, M.D., director of research at the Institute for Asthma and Allergy in Washington, D.C.
Last updated September 25, 2009
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