Managing Asthma

The good news is that for most children, asthma can be well controlled - sometimes so well controlled that a child has only rare asthma flare-ups (commonly called an attack). For many families, the learning process is the hardest part of controlling asthma. Between diagnosis and good control, there's a lot to learn and a lot to do. A child might have flare-ups while learning to control asthma, but don't be surprised or discouraged. Asthma control can take a little time and energy to master, but it's worth the effort!

How long it takes to get asthma under control depends on the child's age, the severity of symptoms, how frequently flares occur, and how willing and able the family is to follow a doctor's prescribed treatment plan. Every child with asthma needs a doctor-prescribed individual asthma management plan to control symptoms and flare-ups. This plan usually has five parts.

Step 1: Identifying and Controlling Asthma Triggers

Children with asthma have different sets of triggers - those things that can irritate airways and lead to an asthma flare-up. Triggers can vary from season to season and as a child grows older. Some common triggers are:

• allergens, including microscopic dust mites present in house dust, carpets and pillows; animal dander and saliva; pollens and grasses; molds; foods; medications; and cockroaches.
• viral infections, including the common cold and the flu (influenza).
• irritants, including smoke, air fresheners, aerosols, paint fumes, hair spray, and perfumes
• exercise
• breathing in cold air
• weather changes

Identifying triggers and symptoms can take time and good detective work. But once patterns are discovered, some of the triggers can be avoided through environmental control measures.

Step 2: Anticipating and Preventing Asthma Flare-Ups

Many kids with asthma have increasing inflammation in their airways from everyday trigger exposure - but they just can't feel it. Their breathing may sound normal and wheeze-free when their airways are actually narrowing and becoming inflamed, making them prone to a flare-up.

Since just listening to a child's breathing (or asking the child how breathing feels) can't give you an accurate sense of what's really happening inside, a more objective way to measure breathing is needed. Breathing tests measure the volume and speed of air as it is expelled from the lungs. Asthma specialists make several measurements with a spirometer, a computerized machine that takes detailed measurements of breathing ability.

At home, a peak flow meter - a hand-held tool that measures breathing ability - can be used. When peak flow readings drop, it's a sign of increasing airway inflammation. The peak flow meter can detect even subtle airway inflammation and obstruction - even when a child feels fine. In some cases, it can detect drops in peak flow readings two to three days before a flare-up occurs, providing plenty of time to treat and prevent it.

During the first stages of treatment, the doctor usually will have a child take a series of peak flow readings for a period of time. The readings help to establish a child's baseline PEFR, or peak expiratory flow rate - his personal best during a time when he has the least symptoms. After establishing a baseline reading, peak flow readings should be taken at least once a day so daily readings may be compared with the baseline.