infants & toddlers
 
Asthma, You and Your Child:
Recognizing triggers, monitoring symptoms, & getting treatment

Asthma is a chronic lung disease that affects about 5 million children in the United States. As parents, you can play a pivotal role in the diagnosis and management of your child's asthma. To do this, you must have some knowledge of the disease and a good working relationship with your child's health care provider. This combination and an individualized treatment plan, can give you the tools you need to practice self-management and help control your child's asthma.

Recognizing Asthma
Asthma is characterized by airway narrowing, swelling and hyper-responsiveness ("twitchy airways"). Common symptoms include: cough, wheeze (high-pitched whistling sound), breathing fast, labored breathing, shortness of breath, significantly longer time to breathe out than breathe in, "tight" feeling in chest, congestion, irritability and lethargy. Not every child will have all these symptoms and some may have others. To prevent a full-blown attack, you must recognize your child's early warning signs. Recognizing early warning signs is especially important during the infant/toddler years when the child is unable to verbalize what he is feeling.

Monitoring Asthma
One way to monitor your child's asthma is to keep a symptom diary. A symptom diary is a log of your child's symptoms, a list of factors ("triggers") that preceded and possibly contributed to the symptoms, the actions taken to resolve the symptoms and your child's response to the action taken. Another way to monitor your child's asthma is with the use of a peak flow meter (PFM). A PFM is a hand held device used to measure the maximum rate at which air can be forced out of your child's lungs in one blow (peak expiratory flow rate or PEFR). It is a measurement of airway obstruction commonly used in children five years of age and older. Both the symptom and peak flow diary should be shared with your child's health care provider, so that an individualized treatment plan can be developed for both daily and emergency management of your child's asthma.

Treating Asthma
The treatment plan should include medical and non-medical therapies. The non-medical therapies consist of practicing trigger avoidance and environmental control measures. A trigger is something that can bring on an asthma attack when your child is exposed to it. Common triggers include: colds; exercise; weather changes; irritants such as smoke, perfumes and paints, and allergens such as pollen, dust-mites, molds and pets. Medications and foods can also be triggers, but are less common in children.

In addition to controlling factors that contribute to asthma symptoms, some children will also require medications. Long-term-control medications, i.e. anti-inflammatories, are used daily to prevent, reverse and control asthma symptoms. There are two types of anti-inflammatories; steroidal and non-steroidal. Anti-inflammatories have also been referred to as "preventive" or "quiet" medicines because they are used every day to help with the quiet part (airway swelling) of asthma.

Quick-relief medications provide immediate relief of asthma symptoms. Bronchodilators are the major category in this class. They have often been referred to as "rescue" or "noisy" medicines because they are used to control the noisy part (airway narrowing) and (hyper-responsiveness) of asthma.

Asthma medications are available in several forms. They include: oral, nebulized, metered-dose inhalers (used with spacing/holding devices), and dry-powder inhalers. All but the dry-powder inhalers can be used as early as infancy. When possible, the inhaled forms are preferred because they are delivered directly to the lungs where they are needed allowing for fewer side effects. In order for the medications to be effective, they must be delivered properly. Therefore, it is imperative that you are educated on proper administration techniques.

Monitoring your child's asthma and communicating with his health care provider can have a positive impact on your child's asthma care and quality of life.

Resources:

American Lung Association of CT: 800.586.4872.

Mothers of Asthmatics: 800.878.4403.

American Academy of Allergy, Asthma & Immunology: 800.822.2762.

Tina Tolomeo, RN, MSN, is the nurse coordinator for the Section of Pediatric Respiratory Medicine at Yale and the asthma educator for the Pediatric Asthma Care Team at the Yale Pediatric Asthma Clinic, 203.785.4081.

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