The most effective way to manage a chronic condition like asthma is to keep it under control. We know that there is no cure for asthma, so the very best we can do as parents and health care professionals is to control it by preventing airway inflammation and minimizing triggers that can set off a flare.
When asthma is described as a chronic condition or illness, it means that it is ongoing, month to month, year to year. This doesn’t mean that asthma symptoms stay at a steady level of frequency or intensity. A key to understanding any chronic disease is recognizing that it changes over time. Chronic illnesses-for example, asthma, diabetes, inflammatory bowel disease, cystic fibrosis-behave like seesaws. There are ups and downs, good times when symptoms are quiet or even nonexistent, and other times when they become aggressive.
This uneven course often confuses parents and children alike because it’s difficult to understand and accept asthma’s changes. Some times your child may have many frequent symptoms that require a lot of medicine (may be more than you feel comfortable giving your child). At other times when you observe no symptoms, it may seem that your child needs no medicine at all.
How will you know if your child’s asthma is under the best control possible? Or when it’s fairly well controlled but not as much as it could be? Making these assessments isn’t easy or clear-cut. There’s no red warning light that’s either on or off. No alarm bells will ring to let you know that control is slipping. But you don’t have to grope in the dark either. There are guidelines for determining the degree of asthma control, even as the disease takes its typical waxing and waning course.
A panel of asthma experts at the National Institutes of Health reviewed all the research available about asthma and used this information to set standards for asthma care. The panel developed guidelines to inform health care providers about diagnosing asthma, deciding how severe it is, treating it, and educating patients and families about asthma.
In fact, these national guidelines spell out exactly how to tell whether or not asthma is under control. Much of this article is based on those national guidelines.
Ask about these NIH guidelines the next time you go for a medical visit. It is important to work closely with health care professionals to determine whether or not your child’s asthma is under control. If it is not, why? What needs to be done? You and your child’s physician or nurse practitioner should discuss and come to an agreement about how to work toward achieving control; or if your child’s asthma is already under control, then how to maintain it.
What Does “Under Control” Mean?
Three basic considerations help to determine how well controlled your child’s asthma is at any time during the course of the disease. If your child s asthma is under control, he or she should:
- Not be bothered day or night by symptoms, such as coughing, wheezing, shortness of breath, or chest tightness. But remember, even when a child does not show symptoms, it doesn’t mean the asthma has disappeared. A child can’t always feel when his breathing tubes are inflamed. You can’t see it in your child, but some degree of airway inflammation is always there.
- Be able to take part in all normal activities, such as lugging hefty book bags, going up and down stairs, taking gym class, and playing sports. If your child gets tired or can’t keep up with other youngsters his own age, something is wrong and his asthma is not under control.
Certainly some children just don’t like sports or have little talent for them, but all young people need regular exercise to be healthy, grow, and develop normally. When children stay away from physical activities, it may seem that they just aren’t interested, but this can be a mistaken interpretation. Younger children especially may appear disinterested, but they simply can’t (or won’t) tell you that they aren’t feeling up to par. Once these children get proper asthma treatment, they are able to enjoy playing. A result of bringing their asthma under control is that they become more physically active. - Be able to get a good night’s sleep. If children wake up because they’re bothered by symptoms or need to take medicine in the middle of the night, their asthma is not under control as much as it could be. If symptoms disturb them at night, they will not be well rested the next day and will either miss school completely or be less attentive in class. Uncontrolled asthma may not only cause children to miss a lot of school, but it can also affect your work schedule. If you are waking up at night to give medicine or check on your child’s breathing, you may be late or absent from work the next day.
How to Take Control
When most people think about controlling a disease, the first thing that comes to mind is medicine. How to keep asthma under control, keep these few facts in mind:
- Asthma medicines fall into two categories: long-term controller medicines and quick-relief medicines. Most, but not all, controller medicines treat airway inflammation.
- There are two ways to control airway inflammation. One is to make the airways less irritated so that they’re less likely to overreact and cause symptoms. Airway irritation can be reduced by taking antiinflammatory controller medicines properly.
- The second strategy for controlling airway inflammation is to stay away from triggers that cause symptoms or make asthma worse. Sometimes it’s easy to detect exactly which triggers irritate the airways and spark symptoms. At other times these triggers are more difficult to pinpoint.
Let’s look at the issue of secondhand smoke exposure, for example.
Secondhand smoke is an irritant that bothers everyone’s lungs, including the smoker and anyone else who’s exposed to the smoke, whether or not they have asthma. When a child with asthma lives in a home with a smoker, the smoker may be fooled into believing that the smoke doesn’t bother the child because he doesn’t cough or wheeze when the adult is smoking. As an irritant, however, the smoke may increase the level of airway inflammation that the child can’t feel. But this doesn’t mean that the smoke is not causing a problem. If we observe how children react, once the smoker at least goes outside or quits smoking, we find that their asthma comes under better control and they may need less medicine.
What’s Not Normal?
Adam is teenager who manages his asthma quite well most of the year. But he seems to have the most problems in the fall, usually during the last week in September around his birthday. Just about every September, Adam “celebrates” his birthday in the hospital. He and his family have come to accept this annual ritual as routine.
Some people with asthma believe that being treated in the emergency room or being hospitalized is a normal part of having asthma. But it shouldn’t be so. If a child comes to the emergency room or is hospitalized, his asthma is not under control.
If your child’s asthma gets out of control and he starts to have symptoms, it is important to think about what’s going on. Can you identify what has triggered your child’s symptoms? Once you have identified the trigger, you will need to work out a way to make sure your child stays away from that trigger as much as possible. And when those triggers do set off an asthma attack, you’ll need a plan to bring it under control.
[ Read: Top 5 Effective Home Remedies To Cure Asthma ]
Lung Function
A breathing test called spirometry monitors lung function, or how well children breathe. To take this test, they breathe into a machine that may be hooked up to a computer that prints a report of the results in numbers and on a graph. According to the NIH guidelines, the tests should be repeated several times: first, when a child is diagnosed with asthma; after starting medicine to see how well it’s working; and again at least every one to two years. The test is also recommended when a child has persistent wheezing.
Spirometry is recommended for anyone who has asthma. But because the test requires a fair degree of coordination and cooperation, not every child can successfully perform the test. Children under age four or five, as well as some older children, are not capable of performing the test voluntarily. Many primary care physicians and all specialists or hospitals have equipment and personnel that are needed to perform spirometry. With children over twelve years of age, this testing is straightforward and similar to adult testing. With younger children, health care workers who are experienced in obtaining good spirometry results from a young age group should perform the test.
Spirometry is a very useful tool for determining whether or not a child’s asthma is under control. She may act and feel fine and have no symptoms, but if her spirometry results are below normal for a child of the same sex and size, or if previous testing has shown better results, then something is going on. Her asthma is not under control.
If your child’s test results are below normal, it is crucial to discuss the results withyour child’s doctor or nurse practitioner to find out why and figure out what needs to be done to bring the asthma under control again. When a child’s asthma is under control, the spirometry results should be normal or even above normal for that individual child.
Bothersome Side Effects
All medicines (including those that require a prescription, over-the-counter medicines, and herbs/nutritional supplements) can cause side effects. Each time a new medicine is prescribed for your child, you should be aware of possible side effects. But the NIH guidelines suggest that children undergoing asthma treatments should be able to tolerate all their medicines with minimal or no side effects.
Doctors or nurse practitioners should talk with you about what to do if any side effects do occur. If they don’t bring up the subject, ask about potential side effects. Sometimes parents don’t ask but only read the package insert. When you read about possible symptoms or problems in an insert, you may be overwhelmed, but the Food and Drug Administration (FDA) requires that all possible side effects must be included in that insert even those that are extremely rare. Keep in mind that some side effects can be harmful, but many are harmless and just bothersome. It’s best to discuss possible side effects directly with a physician or nurse before your child begins taking the medicine.
If your child does experience a troubling side effect whether she takes a medicine every day or just for quick relief it is very possible that the medicine isn’t being used properly. Again, check this out with your physician or nurse practitioner. Children who don’t take medicines at the right time and in the correct way won’t be able to meet the goal of keeping asthma under control. It is essential to let your child’s pediatrician or nurse practitioner know that she is experiencing a side effect. They will help you determine if it was a significant side effect and what should be done about it. Many asthma medicines are currently on the market, so if one causes a problem, the doctor may substitute another.
Do not stop a medicine suddenly without notifying your doctor.
Stopping medicine abruptly interrupts treatment and puts children like Michael at risk to develop more problems, ranging from mild symptoms to a serious flare. Always call your health care professional and explain the problem so that another medicine can be tried or another cause of the side effect can be identified.
Taking Medicine The Right Time, The Right Way
Medicines won’t control asthma unless they are taken at the right time and in the right way.
Two-year-old Ryan needs two medicines, a daily controller medicine and a quick relief kind for symptoms. He takes both medicines through a nebulizer, a machine that mixes medicine and air into a mist that’s inhaled through a face mask or mouthpiece. But Ryan is a typically active toddler who doesn’t like to sit still or wear a face mask. His frustrated parents feel badly when they have to hold him down to give him his daily nebulizer treatment, so they have given up the face mask and blow the mist of medicine in his face as best they can. They wonder if Ryan is getting any of the medicine. They have also become more concerned because his day care teacher reports that Ryan is wheezing during playtime.
When his parents take him in for a sick visit, they learn that virtually no medicine has been getting deep down into Ryan’s lungs, which is why he is not doing well. The doctor and parents discuss strategies for getting him to wear the mask by making it a game, distracting him by reading a book, or giving him his treatment while he is asleep.
Older children present other challenges.
Thirteen-year-old Shakira has difficult-to-control asthma and is on numerous medicines. When her parents notice that she has symptoms, they ask her if she is taking her medicines. She assures them that she is. Meanwhile Shakira’s doctor has been trying to figure out why she is not doing well. Shakira eventually admits that she often forgets to take her morning dose when she’s rushing for school, but she hasn’t told her parents because she worries they’ll be angry with her.
When you take the time to have an honest conversation with teenagers, you find out that they have many reasons for not taking their medicines the way they should. Some of their reasons include: “I’m busy. I forget. I don’t like the way the medicine makes me feel.” But they often don’t tell anyone because they’re embarrassed about having asthma or about seeming different from other teens. Two other typical reasons: if they don’t have symptoms, they don’t understand the need for ongoing controller medicine; or they don’t realize that it’s important to take care of their lungs now so they’ll be healthy years from now.
Children usually don’t put asthma treatment, at the top of their priority lists. They’d rather be out with their friends or playing a game. They’ll remember their medicine when symptoms start to bother them, but it is difficult for them to remember to take it every day especially when they are feelingfine.
Even when children are old enough to administer their own medicine, parents need to be aware of the correct techniques and timetables in order to supervise the way older children take their medicine. You don’t want to feel as if you’re a prison guard who must watch them each and every time. But let them know you believe the treatment is important by keeping a close eye to make sure that it is being taken correctly.You can support them in positive ways, such as praising them for remembering to take their medicine and trying not to sound accusatory when they forget.
Running On Empty
Even the most effective medicines can’t control asthma ifthey run out. To keep your child’s asthma under control, keep track of all medicines, know when they need to be refilled, and refill them before the container is empty.
Sara is a four-year-old with asthma. About three weeks after starting an inhaled medicine called Flovent her asthma came under control. She stopped coughing at night, and she got over her last cold in less than a week. Two months later her symptoms returned with a vengeance, even though Sara’s mother was giving her the medicine every day. It turned out that her mom used the same canister of Flovent for three months long after the canister was empty. At Sara’s follow up appointment, Mom learned that the canister contains only enough medicine for one month.
When children skip medicine or use an empty inhaler, they run the risk of losing control of their asthma. These issues might seem like small details, but they are not uncommon. It is essential to be aware of them because they can make all the difference between controlling asthma or allowing it to spin out of control.
Education and Communication
The NIH guidelines set standards for health care professionals to educate patients about controlling asthma. Just as you expect your child’s caregivers to provide prescriptions for medicine, you should also expect them to inform you (and your child if he’s old enough to understand) about asthma. This information should come in two forms: general information about the disease and specific information tailored to your child. Although you can learn about asthma from organizations like the American Lung Association or Allergy & Asthma Network: Mothers of Asthmatics, on the Internet, remember that only your child’s physician or nurse practitioner can provide you with education that is individualized to meet your child’s specific needs.
The national guidelines offer these key educational concepts, which your health care professional should review with you:
Basic facts about asthma: You should understand what the lungs do and what is wrong with the airways and lungs in someone with asthma. The airways are inflamed, irritated, and oversensitive on a chronic or ongoing basis. The airways overreact, and the muscles encircling them go into spasms that results in symptoms.
Roles of medicines: You should know the two categories of asthma medicines: (1) long-term controller medicines to prevent symptoms and attacks, and (2) quick-relief medicines to relieve symptoms and treat attacks.
In addition to this general information, it is essential to know the exact names (both brand names and generic names) of all your child’s medicines, their strengths, what category they are (controller or quick-relief), how and when to take them, as well as how and when to refill them.
Skills: Whether your child is old enough to take her own medicines, you need to know how to administer each type correctly. Older children who are able to take their own medicine will need to practice and master the proper techniques, too.
Another important skill in keeping asthma under control is observation. When your child starts to cough and wheeze, you know that her asthma is acting up. You can monitor the state of her asthma by observing signs like her tolerance for activity, sleep patterns, and other symptoms. Some parents like to keep a written diary of these observations.
But these obvious signs don’t always give the full picture because airway inflammation starts to increase before symptoms even appear. Sometimes the symptoms are mild even though the airways are actually quite clogged from mucus and excess swelling. So observation isn’t the only skill you’ll need.
To help determine how open your child’s lungs are, you may want to ask your doctor or nurse practitioner whether a peak flow meter is right for your child. A peak flow meter is a small, inexpensive device that measures how fast air moves out of your child’s lungs when she exhales. It takes a little practice to learn how to use a peak flow meter properly and what to do when it indicates a problem.
Triggers and environment: Parents need to understand the significance of identifying their child’s asthma triggers and taking action to get rid of them or avoid them. To some parents, this may seem overwhelming at first because they assume they’ll need to make major, expensive changes in their home. But that is rarely the case.Your child’s asthma caregivers can help you prioritize which strategies can reduce exposure to triggers like dust, dander, smoke, and pollen.
Written asthma management plan: Every single child (and adult) with asthma should have a written treatment plan with specific instructions about how and when to take medicines, as well as how and when to increase medicine for symptoms and attacks. The plan should also spell out exactly what to do if the plan doesn’t seem to help or if your chid becomes worse.
The written plan should guide you in recognizing signs that your child’s asthma is getting out of control. Once your child starts to experience symptoms, try to identify the trigger and increase medicines as directed by your child’s plan. The sooner you start extra treatments for symptoms and attacks, the more likely you are to get things under control quickly. The longer you wait to start, the more likely it is that your child’s asthma could get out of control and result in a sick visit, emergency room treatment, or overnight stay in the hospital.
The written plan should cover all possibilities from what to do for common symptoms to an emergency situation. The plan should bewritten clearly and be readily available on the refrigerator door or kitchen bulletin board. Tell baby sitters and relatives where to find it when you aren’t home, and be sure a responsible person at your child’s school or day care center has a copy. A written plan not only provides vital information tailored to your child, but it also will help you feel that you have control in managing your child’s asthma.
All of the education guidelines mentioned above are useful only if you and your child’s doctor or nurse practitioner communicate about them. Ask questions at any time, not just when the plan is new or when your child has an unfamiliar symptom or side effect from medicine. Communicate with your child’s health care professionals about all issues relating to her asthma. For example, if your insurance or prescription plan doesn’t cover one of your child’s medicines, let the doctor or nurse know so another medicine can be substituted or the insurance company contacted.
Satisfied Customers
Another important goal of therapy, according to the national guidelines, is one that is most often overlooked: you and your child should be satisfied with your asthma care. Has your child’s doctor or nurse practitioner asked if you are satisfied with your child’s care? If the question hasn’t been asked, bring it up the next time you have an appointment. Open, two-way communication should include a discussion of the goals of asthma therapy and clear expectations of what control means for your child not for all children in general, but for your individual child. For this to succeed, parents and professionals should be working as a team. You should feel comfortable asking questions, even ones that might seem “stupid.” There are no stupid questions when it comes to your child’s health.
When parents don’t ask questions, many times a busy doctor or nurse will assume that parents understand what is going on and agree with the treatment plan. To ensure the best possible care for your child, you need to take responsibility by playing an active role.
Common Sense
Remember: the best strategy for keeping asthma under control is to use common sense. Asthma cannot be cured, but control is a realistic, achievable goal. Parents need to use common sense in their relationship and communication with health care professionals. As a parent, you know your child best. You need to work with your child’s physician or nurse practitioner to make sure that they learn whatever they need to know to match the treatment to your individual child and make it fit your family’s lifestyle.
