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A Guide For Parents of Children With Asthma
When your child has an asthma attack, it can be a very scary time. Some parents feel that they do not know enough about how to treat asthma or help their child during an attack. This booklet gives some very basic information about asthma, what it is, how it is treated, and how you, as the parent of an asthmatic child, can better deal with the attacks as they happen. This booklet also includes a glossary of defined terms so that you and your child can understand the meanings of some of the words used to describe asthma.
By reading this booklet, you will learn how to prevent asthma attacks by using medications and a peak flow meter. You will be given a list of early warning signs, and how to stop an attack if your child is having one. This booklet also gives you information on recognizing a severe attack and how to single out the most common triggers of an asthma attack. You will even learn what information to give to your doctor so your doctor can best help your child.
At the end of this booklet, some support groups are listed that can help you even more with managing your child's asthma. Your child may seem panicked during an asthma attack. More often than not, it is the parents who panic while the child is only struggling to keep breathing and might be a little embarrassed about all the attention. In the long run, your patience and ability to remain calm during your child's attacks will help your child most of all.
What Is Asthma?
Asthma is a disease of the lungs. It is not something you can catch from someone, but it is a hereditary condition, meaning that it does pass down through families. Asthma is a treatable condition, but is not curable. Your child will have his asthma all of his life, and at times it may get better or worse, but if he does what is necessary to control it, he won't be bothered by symptoms very often.
When someone has an asthma attack, you often see a red-faced, panting person looking as if she cannot catch her breath. What is happening inside her lungs is not letting her catch her breath. During an attack of asthma, the airways react to something they were exposed to and constrict, not letting enough air into the lungs.
An irritant (dust, pollen, something she is allergic to) caused the bronchial tubes, or breathing tubes that lead to the lungs, to become tight and they often become inflamed, or swollen. The breathing passage gets narrow, which does not allow much air into his lungs. At the same time, mucous starts to fill up the bronchial tubes. Breathing becomes difficult, and the person may wheeze or gasp to try to get enough air. Only after the asthma attack passes can the person breathe comfortably again.
Some common asthma attack symptoms are:
- Difficulty breathing gasping for air, panting
- Wheezing a high-pitched sound like letting the air out of a balloon
- Coughing some mucus may be brought up during a coughing spell
Why Does an Asthma Attack Happen?
There are many things that cause, or trigger, an asthma attack. Here is a list of the most common triggers of asthma attacks. You might want to mark any triggers that are present in your home or that your child is exposed to often.
rapid temperature changes
aspirin (in some children)
certain foods, such as eggs, chocolate, nuts, dairy products and seafood
other chemical fumes or smells
How Can I Prevent My Child's Asthma Attacks?
Many times, it is not possible to keep an attack from happening. But there are many things you as a parent can do to keep attacks away.
These include keeping your home free of irritants and triggers, and limiting your child's exposure to outside triggers, such as pollution and pollen.
- Keep your home free of dust and pet hair. If you have pets, make sure to vacuum once a day. Make sure to dust often, and if you can, use a cloth, not a feather duster, and very little chemical sprays.
- Keep your child's room as fabric-free as possible. Use wood furniture and window shades instead of drapes. Place a dehumidifier in or near the room, and wash all linens often, at least once a week, in very hot water.
- Do not allow anyone to smoke in your house or around your child. If anyone in your family smokes, encourage them to quit, not only for the health of your child, but for their own.
- Change your air filters often, at least twice a year, in spring and fall.
- Be careful about using hair spray, powder, perfume or make-up around your child.
- Find out what foods may trigger an asthma attack in your child. Remove those foods from his diet.
- During pollen season, make sure to keep your windows tightly closed. Limit the amount of time your child spends outside during these seasons.
- If aspirin causes an asthma attack in your child, ask your doctor about what other medicines she can take when she has a fever or a cold.
Support In Trigger Situations
- Encourage your child to do some moderate exercise every day. The more he stays in shape, the less likely exercise will trigger an attack.
- If your child is going to be moving from one temperature extreme to another, try to make the change an easy one, such as wrapping her up in a coat and muffler before she exits a warm house to the cold outdoors.
- Keep your child indoors when pollution levels are high. Don't let him play near streets or parking lots where many cars are coming and going.
- If stress triggers your child's attacks, encourage open communication. Keep your child calm during crisis situations. Let her know that she will handle any situation best if she is cool, calm, and collected. This could prevent future asthma attacks if you are not around to assist her.
- Sometimes, an older child may want to ignore his asthma. He may sometimes "forget" his inhaler or lose it if he takes it with him on an outing. He is probably very frustrated with his disease and wishes he could live a life uncomplicated by wheezes and medicine. The best way you can support your child if this happens is let him know you understand how he feels. Make sure to listen and if he knows he has you on his side, he'll listen to you as well. After hearing him out, explain how important it is to follow his treatment plan so that he can go through his day without being bothered by asthma. If you project a helpful, understanding attitude, rather than a demanding one, he will probably take your advice and stay healthy by following his doctor's orders.
What Is A Peak Flow Meter?
Sometimes your child may think she is doing well when an attack could be just around the corner. "Well, how can I know?" you ask yourself. There is now a device that allows you and your child to know how well he is breathing. A peak flow meter looks like an oversized inhaler, but your child breathes into it, not from it. When your child blows hard into the meter as fast as she can, it measures how quickly she can breathe out. Your child should use the peak flow meter twice daily, once during the day and once at night. The highest score should be recorded daily on a chart that goes with the peak flow meter. Share this information with your child's doctor and use it as a tool to prevent asthma attacks before they happen.
How To Use Your Peak Flow Meter:
- Make sure your child is standing.
- Make sure the arrow indicator is set to zero.
- Have your child take a very deep breath, then, holding the meter tightly between his lips, have him blow out hard and fast.
- Write down the number where the arrow indicator stopped.
- Have your child blow into the meter two more times.
- Record on your peak flow meter chart the highest number, which is your child's "peak flow."
The Peak Flow Meter Chart
The peak flow meter chart will help you prevent your child's attacks and help you to find out what causes asthma attacks in your child. It is also a helpful summary of your child's condition during your doctor's visit.
To set up your chart, have your child use the peak flow meter twice a day for two weeks, and record the best score for each use. Take the highest score during the entire two weeks, and use this number to represent your child's peak flow. It will be this number that you will compare all of his future scores to and be able to identify the zone your child is in each day.
Peak flow scores will fall into one of three zones: green (safe), yellow (warning) or red (danger).
Green Zone: This zone represents 80% or more of your child's best peak flow. If your child's score falls into this zone, it usually means that her medication is working well. To find out what your child's 80% score is, multiply the peak flow score by 0.8. Yellow Zone: This zone represents 50% to 80% of your child's best peak flow. This is a warning zone, and if your child's score falls into this zone,
his asthma is not being controlled with the medication he is taking and he may need to take additional medications, or use a bronchodilator. Have your child use the peak flow meter again in 20 minutes, and if the score does not fall into the green zone, an asthma attack could happen soon. You may need to prepare to handle the attack as advised by your doctor, or even contact your doctor if it appears the attack may be severe. To find out what your child's 50% score is, multiply the peak flow score by 0.5.
Red Zone: This zone represents less than 50% of your child's best peak flow. This zone means danger, and your child will probably have an asthma attack. Use the medicines your doctor prescribed to stop an attack, and if your child gets no relief, contact your doctor as soon as possible.
What medicines can my child take to prevent attacks?
There are a few medicines available that might keep your child from having asthma attacks. Because these medicines work by reducing the inflammation in her lungs, they are called anti-inflammatories. These type of medications must also be taken on a regular basis, not when your child is having an attack. During an actual asthma attack, these medicines will not work well because they take too long to take effect. Your child will need "rescue medicines" to treat attacks directly. The following medicines work to prevent attacks:
Doctors usually choose to prescribe cromolyn, or sometimes called cromolyn sodium, first as a preventive medication for children with asthma. Your child will need to take it twice or three times a day, and it comes available as a pill and in an inhaler for your child to breathe directly into her lungs. It takes a while, sometimes as long as six weeks, to really see results. But this medicine can prevent attacks, and helps many people to get through their days without one.
This drug is very much like cromolyn, only it cannot be inhaled, only taken in pill form. People with asthma who take theophylline have found they have fewer attacks during the night. However, some people have some bad side effects when they take this medicine. You will want to talk to your doctor about this medicine before it is prescribed for your child.
You may have heard the term "steroids" relating to drugs taken by athletes who want to build muscles or have better performance. These are different and do not build muscles, but reduce swelling in the lungs. Your child will probably be told by his doctor to take these steroids if cromolyn or theophylline are not effectively relieving his symptoms. Unlike cromolyn and theophylline, which have to be taken every day to prevent attacks, steroids are usually taken only every other day. Your child can take steroids in a tablet or liquid form, or they can be inhaled, like cromolyn. If your child is currently taking steroids, check with your doctor before stopping this medication.
Other medications are available that might help your child in preventing attacks. Antihistamines are sometimes helpful to children whose asthma attacks are brought on by allergies. Antibiotics can be used as well, since they can destroy infections in your child's body. Your doctor will advise you on what he feels will best treat your child's asthma. He will also let you know which medicines your child needs to avoid taking together. Some combinations of medicines can be harmful, and your doctor knows what drugs and in what amounts your child should take to keep attacks away.
Always remember to read labels on any over-the-counter medicine that you may want to give to your child. Some medications cannot be taken by persons with asthma, and the label will tell you whether or not that drug is safe. If you have any questions about the safety of an over-the-counter medication, do not give it to your child until you have talked with your doctor or pharmacist.
Is it possible to predict an asthma attack?
Your peak flow meter is your best tool in predicting when your child might have an attack. Another way to watch for an attacks is to learn to recognize the early warning signs. These include:
- your child is complaining of a headache
- your child's eyes are watering, or his head is stuffy
- your child tells you her heart is beating really fast
- you notice your child coughing or sneezing
- your child complains of an itchy or scratchy throat
- your child is short of breath and tells you his chest feels tight
- your child seems tired, angry, sad, or depressed
Each child is different, and yours is unique as well. If you notice other early warning signs that seem to always or often happen before your child has an asthma attack, note them and watch for them. When these signs show up, it is time to act and prevent that attack before it happens. Have your child use her peak flow meter, and be ready with rescue medicines.
Another way to predict your child's attacks is to write down when they happen, and the situation your child was in when he had the attack. Similar situations, locations, or events may trigger your child's asthma, and by recording her attacks, you can know which places and situations to keep your child away from.
What do I do when my child has an asthma attack? How do I treat it?
Once your child is having a full-fledged asthma attack, her preventive medicines will no longer work. It is necessary to use what is termed "rescue medication." These medicines work immediately to relax the muscles that are constricting the lungs to let your child breathe more easily.
The most common rescue medications are called bronchodilators, and they come in an inhaler. An inhaler is a small, hand-held device that your child simply puts between his lips, squeezes, and inhales the medicine that is pumped out. Because it is so easy to use, your child may want to use it often, even when it really isn't necessary. Your doctor will let you know how often your child can use his bronchodilator.
Have your child follow these instructions for using the inhaler:
- Shake the inhaler before removing the cap that covers the mouthpiece. Your child should hold the inhaler so that the mouthpiece is on bottom, and the medicine bottle is on top.
- Your child should put her thumb below the mouthpiece and her index and middle fingers on top of the medicine bottle.
- Have your child take a deep breath, and then let it all out, as much as he can.
- Have your child hold the mouthpiece between his lips and push down on the medicine bottle with one pump.
- As the medicine sprays out (called a "puff"), tell your child to breathe in as much of the medicine as she can, slowly and deeply, so that it goes well into the lungs.
- Have him hold his breath for a few seconds and then breathe out slowly, to let the medicine get evenly distributed in each lung.
- Have your child wait at least a minute before using the inhaler again. She may want to rinse her mouth since the medication has a bitter taste.
- Make sure your child keeps his inhaler clean, rinsing the mouthpiece with water after each use.
Bronchodilators are very effective in stopping attacks and usually work within two to three minutes. However, they must be used with caution. If your child is taking other medication, inform your doctor so that he'll know which medicines he can prescribe and which ones may be dangerous if mixed with your child's current drugs. Your doctor will let you know how many puffs your child should take for each dose. Also, tell your child to let you know if any of these side effects happen after she uses her inhaler:
- shaking or trembling
- tenseness or restlessness
- fast heartbeat
- queasiness or vomiting
- stomach pain
If any of these do happen, inform your doctor right away.
Sometimes, inhalers have spacers and holding chambers attached. Your child can use these to make his inhaler work better. A spacer connects to the inhaler and makes it easier for your child to get the medication into her lungs. Some spacers look like plastic masks that can fit right over your child's nose and mouth. Once he sprays the medication into the spacer, he can simply breathe in and out, using the same technique as listed in numbers 5 and 6 above. A holding chamber lets your child get all of the medication from each dose, and allows your child to breathe twice, not just once, for each puff, since the extra medicine in held in the chamber.
What is a nebulizer?
A nebulizer is used to treat asthma attacks very much like an inhaler, but it is a machine and works differently than your child's inhaler. A nebulizer sprays medicine in a mist into your child's lungs. Most of the time, nebulizers are used when your child is too young to properly use an inhaler, or having a severe enough attack not to have the strength or energy to use the inhaler. Your child simply places the mouthpiece between his lips and breathes in the mist supplied by the machine. Sometimes, a nebulizer may come with a face mask that fits over your child's nose and mouth, and this is best used on very young children. Encourage your child to breathe through her mouth to get the medicine deep into her lungs. The process takes about fifteen minutes. Make sure that you follow the manufacturer's directions for using the machine and your doctor's advice for using the medicine. Do not allow your child to drink the liquid medicine that goes into the nebulizer, as it is for inhaling only.
What if my child's asthma attack is severe?
You can try to prevent asthma attacks with medications, and you can administer the rescue medications during an actual attack. But sometimes your child will have a severe attack that may need the attention of her doctor.
Here are some signs to recognize that indicate your child's attack is severe:
- Your child is not able to speak easily between breaths
- Your child's pulse has gotten very fast (over 100 beats per minute)
- Your child is standing up, leaning forward, and his shoulders are arched
- Your child's nostrils are flared
- Your child's lips are beginning to look blue or gray
- Your child's chest is over-inflated, and the rib spaces are depressed
- When you have your child use her peak flow meter, the reading is less than half of her peak flow rate.
If your child is indeed having a severe attack, try having him bronchodilator. If the attack is not relieved in five minutes, call your doctor or take your child to the hospital. Remember to stay calm and do not upset your child any further. Always try to keep your child as calm as possible.
Once at the hospital, the staff will likely give your child medication using a nebulizer. If this is not successful in stopping the attack, they may give him an I.V., or intravenous fluids given directly into the blood veins. They may also begin a treatment of steroids to lessen the swelling in her lungs. Your child may have to remain at the hospital for a few days. Be sure to increase the dosage of preventive medication so that your child's lungs can heal quickly.
What about when my child is away from home, on vacation or at school?
Whenever your child is away from home, he should always have his inhaler. Usually, that is all he will need if he is just at school or going over to a friend's house for a few hours. If he goes somewhere overnight, or on a trip, he needs to have most of his equipment with him. Below is a good checklist of things your child should take with him on trips:
current preventive medication and "rescue medicines"
extra medication in case of emergency
pharmacy bottles for refills if necessary
a list of all current medicines
inhaler with bronchodilator medicine
nebulizer and medication
peak flow meter with chart
sleep items that have been treated for dust mites, such as a pillowcase or mattress pad
Your child should also have her doctor's phone number, the names and phone numbers of any asthma specialists that she goes to for treatment, and her medical insurance card, if you are insured. Your child should have these items at all times.
How can I get the most out of my child's visits to the doctor?
Your doctor is a very important part of your child's treatment. In fact, your doctor will plan with you the treatment that your child will need daily, during asthma attacks, and if an attack is severe. Your role in this planning is to give your doctor as much information as possible so that he can decide what the best treatment plan is for your child's case.
During the visit to your child's doctor, you can ask any questions that you have, and as they come to you in the weeks before your visit, be sure to write them down so you won't forget any of them.
Make sure to bring the peak flow meter chart with you and show it to your child's doctor. Tell him about any severe attacks, and your child's current medicine schedule. Also, let him know if your child has any allergies that may aggravate the asthma. The doctor may recommend allergy testing for your child.
When your doctor gives you a treatment plan for your child, be sure to follow it exactly. In case you may need to make notes during the visit, bring a pad and pencil with you.
Most important, never miss a visit to the doctor. Your child's health depends on it!
If your child has any of the following symptoms, call your doctor right away:
- your child keeps coughing during breathing
- your child is still wheezing after using his inhaler
- your child is coughing up a lot of mucus, or mucus that is greenish in color or bloody
- your child is having trouble seeing or thinking clearly
- your child is feeling overly weak
- your child is not able to exercise moderately all of a sudden
- your child has a fast heartbeat or a fever
- your child's chest hurts or feels very tight
- your child's peak flow meter readings are in the red zone
Where can I get more information about asthma?
There are many support groups available for persons who have asthma or care for those who have asthma. Below is a listing of groups and phone numbers you can call for more information.
The American Academy of Allergy, Asthma and Immunology
The American College of Allergy, Asthma and Immunology
The American Lung Association
A.A.F.A. - The Asthma and Allergy Foundation of America
One way for your child to have fun and also learn about asthma is at asthma camps. You can find out more about these camps by calling one of the numbers listed above.
Asthma pronounced "az-muh", it is a disease of the lungs that causes the bronchial tubes to become inflamed and constricted, not allowing enough air into the lungs. Asthma is a hereditary condition that is treatable but not curable.
Constrict to make tight or cramped. When bronchial tubes are constricted, very little air can pass through them.
Bronchial tubes the airway tubes that lead down the throat and into the lungs. Air passes through these tubes and into the lungs so that oxygen can be passed to the rest of the body. During an asthma attack, these tubes become constricted and air cannot pass through them easily.
Trigger to cause to happen, or something that causes a reaction, such as an asthma attack. For example, dust is a common trigger of asthma attacks because it often triggers them.
Dust mites very tiny insects that are found in dust. They are so small they can be breathed right into your lungs, and they often cause asthma attacks. One way to get rid of them is to get rid of the dust they live in.
Stress anything that causes strain and emotional upset, such as very tiring work or being unprepared for a meeting or deadline. Your body reacts to stress the same way it would react if you were being chased by a wild animal. Certain chemicals are released that speed up some of the body's functions, like the heartbeat and blood pressure. Stress can bring on asthma attacks in some people.
Allergies these are reactions that the body has to anything it may be sensitive to when it is exposed to it. Certain allergies, such as reactions to food or to pollen, can trigger asthma attacks. An allergen is the item that causes the allergy.
Peak flow meter a device to measure how quickly air can be breathed out of the lungs. By using a peak flow meter daily, and recording the results, an asthma sufferer can predict and possibly prevent attacks.
Anti-inflammatories drugs that reduce swelling or inflammation in the body. Cromolyn, theophylline, and steroids are types of anti-inflammatories used to prevent asthma.
Antihistamines drugs that prevent the body from reacting to certain allergens or hay fever by blocking histamines, which are made by the body and cause our eyes to water and our noses to itch, burn, and sneeze repeatedly. Some antihistamines are helpful in preventing asthma attacks.
Antibiotics drugs that destroy the growth of any microorganisms in the human body. Antibiotics are taken when an infection is present, to kill the germs that are causing the infection. Some antibiotics can help to prevent asthma attacks.
"Rescue medication" drugs that work right away to stop an asthma attack once it has started. Most rescue medicines are inhaled, or breathed directly into the lungs and take only minutes to take effect.
Bronchodilators medicine that comes in an inhaler and is breathed directly into the lungs to relieve an asthma attack. This is the most common type of rescue medication.
Inhaler a small hand-held device that holds a canister of medication (bronchodilator) and allows the medication to be pumped out and breathed in by the asthma sufferer.
Puff one "pump" of bronchodilator medication from an inhaler. Your child's doctor will let you know how many "puffs" he should take for each dose.
Spacer a device that attaches to an inhaler to make breathing in the medication easier for children.
Holding chamber a device that attaches to an inhaler and holds any extra medicine until it can be breathed into the lungs.
Nebulizer a machine that sprays a fine mist of medication into the lungs of an asthmatic. Liquid medicine is poured into the nebulizer, and over the course of ten or fifteen minutes, it is pumped out into the lungs.
I.V. an abbreviation for intravenous, meaning "into the veins." An I.V. is given when someone is dehydrated and cannot take liquids by mouth, or when medicine needs to be given but cannot be taken orally by the patient. I.V.'s are usually given by doctors or nurses at a hospital or emergency room.
Treatment plan a plan designed by your child's doctor that includes all medications and in what dosages your child should take, both for prevention and treatment of asthma attacks. Your child's doctor will work closely with you on instructions and information about your child's treatment.