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Medical Conditions > Airway, Breathing, and Lung Conditions

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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 . 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 flare-ups 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 asthma action plan to control symptoms and flare-ups. This plan usually has five parts.

Step 1: Identifying and Controlling Asthma Triggers

Triggers are 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.

Another way to know when a flare-up is brewing is to look for early warning signs (EWS). EWS are little changes in a child that signal medication adjustments may 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 flare-up 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 they 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 children 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 children and even teens because they can learn to sense little changes in themselves. If they are old enough, they can adjust medication by themselves according to the asthma action plan, and if not, they can ask for help.

Step 3: 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 children but not for others.

There are two main categories of asthma medications: rescue medications and controller medications . Asthma medications treat both symptoms and causes, so they effectively control asthma for nearly every child. 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: the hidden inflammation smoldering in a child's airways. As a result, asthma is not controlled by these non-prescription cold medicines, and may even become worse with their use.

Step 4: Controlling Flare-Ups By Following the Doctor's Written, Step-by-Step Plan

Mastering the first three 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 mean less emergency room visits and fewer admissions, if any, to the hospital.

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 flare-ups when 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.

Step 5: Learning More About Asthma, New Medications, and Treatments

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! There are several organizations you can contact for information, videos, books, educational video games, and pamphlets (click on the Additional Resources tab at right for a partial listing). They can often 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: May 2007