Managing Asthma

Identifying and Controlling Asthma Triggers

Triggers — things that can irritate airways and lead to an asthma flare-up — can vary from season to season and as kids get older. Common triggers include:

• 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
• 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.

Anticipating and Preventing 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 how the breathing feels) can't give an accurate sense of what's happening inside, a better way to measure breathing is needed. One way to measure breathing is by using an instrument called a spirometer, a computerized machine that measures the amount of air inhaled or exhaled and how much time each breath takes. This test is usually done in a doctor's office.

Anticipating Flare-Ups at Home

At home, a peak flow meter — a handheld 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 2 to 3 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 — a personal best during a time with few symptoms. After establishing a baseline, readings should be taken at least once a day so they can be compared with the baseline.

Another way to know when a flare-up is brewing is to look for early warning signs (EWS). EWS are little changes that signal medication adjustments might be needed (as directed in a child's individual asthma action plan) to prevent a flare-up. EWS can help to detect a flare-up hours or even a day before the appearance of obvious symptoms (such as wheezing and coughing). Kids can develop changes in appearance, mood, or breathing, or they'll complain of "feeling funny" in some way.

EWS are not always definite proof that a flare-up is on the way, but are signals to plan ahead, just in case. It can take some time to "tune in" to these little changes, but over time, recognizing them becomes easier.

Parents with very young kids who can't talk or use a peak flow meter often find early warning signs very helpful in predicting and preventing flare-ups. And EWS can be helpful for older kids and even teens because they can learn to sense little changes in themselves. If they're old enough, they can adjust medication themselves according to the asthma action plan; if not, they can ask for help.

Taking Medications as Prescribed

Developing an effective medication plan to control a child's asthma can take a little time and experimentation. There's no single remedy that works for every child with asthma. The different categories of asthma are treated differently, and some medication combinations work well for some kids but not for others.

The two main categories of asthma medications are rescue medications and controller medications.

Over-the-counter medications, home remedies, and herbal combinations are not substitutes for prescription asthma medication. First, they can be life-threatening to rely upon during a flare-up because they cannot reverse airway obstruction quickly and effectively (if at all). Second, they don't address the cause of many flare-ups: hidden airway inflammation. As a result, asthma is not controlled by these non-prescription medicines, and can even become worse with their use.

Controlling Flare-Ups With the Asthma Plan

Mastering these first steps of asthma control means a child will have fewer asthma symptoms and flare-ups. But any child with asthma can still have an occasional flare-up, particularly during the learning period (between diagnosis and control) or after exposure to a very strong or new trigger.

With the proper patient education, on-hand medications, and keen observation, families today can learn to control nearly every asthma flare-up by initiating treatment early, which will reduce ER visits and possibly eliminate hospital admissions.

The doctor provides a written, step-by-step plan (asthma action plan) outlining exactly what to do between flare-ups and how to recognize and manage them if they occur. The plan is different for each child. Over time, families learn to recognize when to start treatment early and when to call the doctor for help.

Learning More

It's a fact: those who learn the most about asthma are the most successful in controlling it. Fortunately, more is being discovered about asthma every day!

Many organizations can provide information, videos, books, educational video games, and pamphlets, and also can direct you to local support groups where families and kids can meet others going through the same frustrations and learning processes. Together, they share experiences, helpful strategies and tips, and coping skills.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: August 2011