Things you may not know about your child's asthma

Written by Heather Staples, 4th year medical student at Florida State University College of Medicine.

Have you ever left your doctor’s office, filled a prescription, gotten home and realized you have no idea what this medication is that you’re holding in your hand?

This is not an uncommon feeling among parents of children with asthma. Multiple drugs with different dosing schedules…it can be confusing! And why do they need them when they aren’t coughing, wheezing or looking sick?

Let’s see if we can figure this out…

What is asthma anyway?

Nearly one out of 10 children have asthma, so it is very common! It is the top reason for school absences in the U.S. and accounts for half a million emergency room visits each year for children.

You can’t do a blood test and know your child has asthma. You can’t look in their ears or their mouth and say, “Yes!  I see asthma!” The diagnosis of asthma is made from the history of information you give your child’s pediatrician, a physical exam of your child, and often, how they respond to medications.

Asthma affects your child’s airway in three ways: inflammation (swelling inside their airways), bronchoconstriction (squeezing of the muscle around the airway) and mucus production that plugs up the airway openings.  All of these work together to cause coughing, wheezing and shortness of breath.

How is it that my child has asthma when I never hear them wheeze and gasp for air?  Isn’t that what happens with an asthma attack?

Every child’s asthma looks different, even between siblings in the same family. Some children will never wheeze once and still have asthma. Some kids only cough. And there is a wide spectrum of symptoms: one child may cough a little longer when he gets a cold while another may have a full-blown asthma attack like you see in the movies. Another may cough at night, and yet another may have coughing or a little extra difficulty breathing on the soccer field. But each of those children has asthma and needs to be adequately controlled.

Why does my child have asthma then?  And why does it seem to be worse at some times more than others?

There is a genetic component to asthma- parents with asthma are more likely to have children with asthma. Children who were born prematurely also have an increased risk of developing asthma because their lungs weren’t fully mature at birth. But there are also a lot of other components that factor into the development of asthma.

The most important thing, though, is to understand what aggravates your child’s asthma. Each child has ‘triggers’ that can increase their asthma symptoms. For some children, these triggers are environmental allergies. Other children are triggered by colds, exercise, cold weather, dust, dust mites…just to name a few. Understanding what worsens your child’s asthma and removing those triggers as much as possible can help keep their asthma symptoms under control.

Will my child have asthma forever?  Does this mean they can’t play sports?

Many children with asthma will eventually “grow out of ” their symptoms. When asthma is diagnosed during childhood, the likelihood of seeing a decrease in symptoms over time is much more likely than if the diagnosis is made during adulthood. In addition, a child who wheezes before they are 3 years old is less likely to wheeze after age 3. So some early wheezers who need breathing treatments may not need them at all by the time they go to kindergarten!

When children are adequately controlled with their asthma, there are typically no restrictions on physical activity. But not taking care of their asthma could limit them!  If they are struggling to catch their breath or coughing all through their basketball game, that is definitely a limitation. Keeping their asthma well treated can usually prevent this.

When should my child see an asthma specialist?

You should always discuss this with your child’s primary care physician. Services offered in the asthma specialty clinic at Arnold Palmer Hospital would be lung function testing, hands-on asthma education, thorough evaluation to rule out illnesses other than asthma contributing to the child’s symptoms.

What about this pile of inhalers I have on my kitchen counter?  Or this nebulizer with multiple solutions?  What are they for and when do I use them?

The best thing to do is to follow the directions given to you by your child’s doctor. They know your child’s medical condition best and have the most knowledge about what dosing scheduling your child needs.

But, the more you understand about your child’s medications and how to use them, the better off your child will be.

Here are some important things to know:

Know the difference between a rescue medication and a controller medication

A rescue medication, in its generic form is either albuterol or levalbuterol. There are many brand names: Ventolin, ProAir, Proventil, Xopenex. It provides short-term relief by opening your child’s airways, which is crucial when your child has difficulty breathing.

The other medication commonly used is an inhaled corticosteroid. It’s called a “controller” medication because it gives more long-term control over asthma symptoms and progression of the disease. There are many brands, such as Flovent, Qvar, Alvesco, Pulmicort, etc.

One of the common mistakes parents make is neglecting to give the controller medication, and they only treat the symptoms with their rescue inhaler. Many don’t realize that although they can’t always see the effects of the controller medication right away, giving the controller medication regularly can prevent many asthma attacks!

Know how to use the medication properly

Asthma medications often differ from other medications by the way they are delivered. Most likely your doctor has prescribed either a nebulizer machine or a spacer device (Aerochamber and other brands). The nebulizer uses liquid medications to produce a mist that your child breathes in. The spacer device uses the traditional inhalers and provides an easier and more reliable method of delivery, directly into the airways instead of the tongue or the back of the throat.

It is very important, though, that you are using these devices correctly to ensure that your child is getting maximum benefit from their medication. When you bring your child in for a doctor’s visit, bring your child’s inhaler and spacer. Let your physician observe how you use the medication to make sure you’re doing it correctly.

Consistency is key

So what does all this mean? Asthma is a common childhood diagnosis, and it can be managed if parents and children are consistent with the treatment. It is so important to listen to your pediatrician and follow the directions for inhaler use.  Just like with antibiotics, you don’t want to stop using the medication just because you are feeling better. Make sure you continue to take the inhalers and other medications for the entire time your doctor prescribes.

By doing so, you give your child a better chance at healthy lungs and a more active and healthy childhood!

For more information on asthma, check out these websites:

American Lung Association:  www.lung.org

Mothers of Asthmatics:  www.aanma.org