How to Manage a Child's Asthma

Having asthma is not a death sentence. When given proper guidance and medication, asthmatic children can (and often do) lead healthy, fulfilling lives. Here’s how.

Management of asthma is two-pronged: reducing the triggers that can attack the lungs from the outside and using medications to reduce symptoms from the inside.

normal">Avoiding Triggers
Doctors identify six major triggers that aggravate asthma:

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1. Allergens – These are substances that cause an immune response. Some allergies are obvious: a child wheezes and coughs around certain animals or when exposed to high levels of pollen, dust or mold. Children are often referred to a board-certified allergist who will try to identify and treat the allergy.

The primary line of defense is removing known allergens from the child’s environment, which can seem an overwhelming task. After receiving five pages of do’s and don’ts from her daughter’s allergist, Nancy Sander couldn’t imagine how she could afford to do everything. “I sat in the car and cried,” she remembers. “Then I started tackling it one piece at a time. Anything I did removed things from my daughter’s ‘allergy bucket.’”

normal">2. Irritants – These are airborne substances that cause coughing, wheezing, runny nose or watering eyes. They often act like allergens, but aren’t related to the immune system.

Parents can avoid the most common irritants by forbidding all cigarette smoking in the house, avoiding aerosol sprays and making the home as odor-neutral as possible. Outdoors, parents may have to restrict exercise or use medications on days when ozone levels, diesel fumes or other forms of air pollution are high.

3. Weather – Breathing cold air, especially if it’s dry, is the primary weather-related trigger. Some children wear ski masks or scarves loosely covering the nose or mouth. Asthma rates often rise in the spring and early summer and again in the fall when pollen counts are high. Windy weather scatters more allergens, while rainy weather cleans them out of the air. Continual dampness promotes mold concentrations. There is no one kind of climate that’s best for all people with asthma.

4. Exercise – Running can trigger an episode in 80 percent of children with asthma, according to the American Lung Association. Many children use inhaled medications before exercising and, with proper control, can participate successfully in sports. Swimming seems to cause the fewest symptoms. Exercise may need to be curtailed when levels of pollen or air pollution are high or when the air is cold and dry.

5. Infections – Infections, especially viral respiratory ones, cause swelling and mucus secretion in everyone, adding to the underlying symptoms of asthma. Children with mild asthma may only show symptoms during and after infections. Prevention methods include frequent hand washing and keeping the child away from large crowds and infected people. Chronic sinusitis is the most common bacterial infection that triggers asthma. Doctors will usually treat it with antibiotics.

6. Emotions and stress – Rapid breathing when a child is yelling, crying or laughing hard can trigger asthma in the same way running does. Stress has been shown to undermine the immune system, which especially impacts a person with asthma. “It’s the underestimated trigger,” says Greg Redding, M.D., North American coordinator for the International Study of Asthma and Allergy in Children.

Managing with Medication
The American Lung Association, the National Institutes of Health and the National Heart, Lung and Blood Institute blame undermedication for increasing rates of hospitalization and preventable asthma deaths.

“Some parents say, ‘I don’t want my child to be dependent on medication,’ but then we put our children at risk and teach them to go into denial about their symptoms,” says Nancy Sander, founder of Allergy & Asthma Network Mothers of Asthmatics. “It’s a wrong belief. It’s like saying that wearing glasses for poor eyesight makes the eyes dependent on them.”

Doctors prescribe two basic kinds of medicine:

  • short-term, “rescue medications” to open airways during an attack.

  • long-term, “controller medications” to alleviate underlying inflammation or constriction.

Most asthma medications are inhaled by spraying them into the mouth, or occasionally the nose, to deliver them straight to the lungs through the use of a metered dose inhaler or a nebulizer. Systemic asthma medications are taken orally and travel all through the blood and body. Children vary in which medications work best for them, and in how many side effects they experience.

“There are more and more options for managing asthma now,” Sander notes. However, she says, parents often make the mistake of underusing the medicines, especially preventative ones, if they don’t seem to be working right away or if their child seems to be doing better. Conversely, they may overuse medications in the belief that more is better, risking long-term side effects.

It’s a mistake to treat medications like a “magic wand,” Sander adds. Some parents forget about eliminating triggers just because the child is on medication. “That would be like mopping up water, while letting the spigot keep running,” she says.

“The challenge is for people to take asthma seriously,” she concludes. “Our attitude should be, ‘I have it for the rest of my life, but I have control over it for the rest of my life.’”