Asthma, Child, with Action Plan

Asthma is a disease of the respiratory system. It causes swelling and narrowing of the air tubes inside the lungs. When this happens there can be coughing, wheezing (a whistling sound when you breathe), chest tightness, and difficulty breathing. The narrowing comes from swelling and muscle spasm of the air tubes. Asthma is a common illness of childhood. Knowing more about your child's illness can help you handle it better. It cannot be cured, but medications can help control it.

CAUSES

Asthma is a complex chronic inflammatory (swelling) disorder of the airways. This is often triggered by allergies, viral lung infections, or irritants in the air. Allergic reactions can cause your child to wheeze immediately when exposed to allergens or many hours later. Continued inflammation may lead to scarring of the airways. This means that over time the lungs will not get better because the scarring is permanent. Asthma is likely caused by inherited factors and certain environmental exposures.

Common triggers for asthma include:

  • Allergies (animals, pollen, food, and molds) can trigger attacks.

  • Infection (usually viral) commonly triggers attacks. Antibiotics are not helpful for viral infections and usually do not help with asthmatic attacks.

  • Exercise Proper pre-exercise medications allow most children to participate in sports.

  • Irritants (pollution, cigarette smoke, strong odors, aerosol sprays, paint fumes, etc.) all may trigger an asthmatic attack. SMOKING SHOULD NOT BE ALLOWED IN HOMES OF CHILDREN WITH ASTHMA. Children should not be around smokers.

  • Weather changes. There is not one best climate for children with asthma. Winds increase molds and pollens in the air, rain refreshes the air by washing irritants out, and cold air may cause inflammation.

  • Stress and emotional upset. Emotional problems do not cause asthma but can trigger an attack. Anxiety, frustration, and anger may produce attacks. These emotions may also be produced by attacks.

SYMPTOMS

Wheezing and excessive nighttime or early morning coughing are common signs of asthma. Frequent or severe coughing with a simple cold is often a sign of asthma. Chest tightness and shortness of breath are other symptoms. Exercise limitation may also be a symptom of asthma. These can lead to irritability in a younger child. Asthma often starts at an early age. The early symptoms of asthma may go unnoticed for long periods of time.

DIAGNOSIS

The diagnosis (learning the cause) of asthma is made by review of your child's medical history, a physical exam, and possibly from other tests. Pulmonary (lung) function studies may help with the diagnosis.

TREATMENT

Although asthma cannot be cured, the majority of children with asthma can be controlled with treatment. Besides avoidance of triggers of your child's asthma, medications are often required. Two medication classes are utilized for asthma treatment: "controller" (reduces inflammation and symptoms) and "rescue" (relieves asthma symptoms during acute attacks) medications. Many children require daily medicines to control their asthma. The most effective long-term controller medicines for asthma are inhaled corticosteroids (blocks inflammation). Other long-term control medicines include leukotriene receptor antagonists (blocks a pathway of inflammation), long-acting beta2-agonists (relaxes the muscles of the airways for at least 12 hours) with an inhaled corticosteroid, cromolyn sodium or nedocromil (alters certain inflammatory cells ability to release chemicals that cause inflammation), immunomodulators (alters the immune system to prevent asthma symptoms) or theophylline (relaxes muscles in the airways). All children also require a short-acting beta2-agonists (medications that quickly relax the muscles around the airways) to relieve asthma symptoms during an acute attack. All caregivers should understand what to do during an acute attack. Inhaled medications are effective when used properly. Read the instructions on how to use your child's medications correctly and speak to their physician if you have questions. Follow up with your doctor on a regular basis to make sure your child's asthma is well-controlled. If your child's asthma is not well-controlled, if your child has been hospitalized for asthma, or if multiple medications and/or medium to high doses of inhaled corticosteroid steroids are needed to control your child's asthma request a referral to an asthma specialist.

HOME CARE INSTRUCTIONS

  • It is important to understand how to treat an asthma attack. If any child with asthma seems to be getting worse and is unresponsive to treatment, seek immediate medical care.

  • Avoid things that make your child's asthma worse. Depending on your child's asthma triggers some control measures that can be undertaken include:

  • Changing your heating/air conditioning filter at least once a month.

  • Placing a filter or cheesecloth over your heating/air conditioning vents.

  • Limiting your use of fire places and wood stoves.

  • If you must smoke, smoke outside and away from the child. Change your clothes after smoking. Do not smoke in a car with someone with breathing problems.

  • Get rid of pests (roaches) and their droppings.

  • If you see mold on a plant, throw it away.

  • Clean your floors and dust every week. Use unscented cleaning products. Vacuuming when the child is not home. Use a vacuum cleaner with a HEPA filter if possible.

  • If you are remodeling, change your floors to wood or vinyl.

  • Use allergy-proof pillows, mattress covers, and box spring covers.

  • Wash bed sheets and blankets every week in hot water and dry in a dryer.

  • Use a blanket that is made of polyester or cotton with a tight nap.

  • Limit stuffed animals to one or two and wash them monthly with hot water and dry in a dryer.

  • Clean bathrooms and kitchens with bleach and repaint with mold-resistant paint. Keep child with asthma out of the room while cleaning.

  • Wash hands frequently.

  • Talk to your caregiver about an action plan for managing your child's asthma attacks at home. This includes the use of a peak flow meter that measures the severity of the attack and medications that can help stop the attack. An action plan can help minimize or stop the attack without having to seek medical care.

  • Always have a plan prepared for seeking medical attention. This should include instructing your child's caregiver, access to local emergency care, and calling 911 in case of a severe attack.

SEEK MEDICAL CARE IF:

  • There is worsening cough, wheezing, or shortness of breath not responding to usual "rescue" medications.

  • There are problems related to the medicine you are giving your child (such as a rash, itching, swelling, or trouble breathing).

  • Your child's peak flow is less than half of the usual amount.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your child develops severe chest pain.

  • Your child has a rapid pulse, difficulty breathing, or can not talk.

  • There is a bluish color to the lips or fingernails.

  • Your child has difficulty walking.

ASTHMA ACTION PLAN, CHILD

Patient Name: __________________________________________________ Date: ________

Follow-up appointment with physician:

  • Physician Name: ____________________

  • Telephone: ____________________

  • Follow-up recommendation: ____________________

POSSIBLE TRIGGERS

Tobacco smoke, dust mites, molds, pets, cockroaches, strong odors and sprays (burning wood in fireplace, incense, scented candles, perfume, paints, cleaning products), exercise, pollen, cold air, or the flu.

WHEN WELL: ASTHMA IS UNDER CONTROL

Symptoms: Almost none; no cough or wheezing, sleeps through the night, breathing is good, can work or play without coughing or wheezing.

Use these medicine(s) EVERY DAY:

  • Controller and Dose: ____________________

  • Controller and Dose: ____________________

  • Before exercise, use reliever medicine: ____________________

Call your physician if using reliever more than 2-3 times per week.

WHEN NOT WELL: ASTHMA IS GETTING WORSE

Symptoms: Waking from sleep, worsening at the first sign of a cold, cough, mild wheeze, tight chest, coughing at night, symptoms which interfere with exercise, exposure to known triggers (such as weather or allergies).

Add the following medicine to those used daily:

  • Reliever medicine and Dose: ____________________

Call your physician if using reliever more than 2-3 times per week.

IF SYMPTOMS GET WORSE: ASTHMA IS SEVERE - GET HELP NOW!

Symptoms: Breathing is hard and fast, nose opens wide, ribs show, blue lips, trouble walking and talking, reliever medication (bronchodilator) not helping in 15-20 minutes, neck muscles used to breathe, if you or your child are frightened.

  • Call 911.

  • Reliever/rescue medicine:

  • Start a nebulizer treatment or give puffs from a metered dose inhaler with a spacer.

  • Repeat this every 5-10 minutes until help arrives.

Bring your medications/devices with you to your follow-up visit.

SCHOOL PERMISSION SLIP

Date: ________

Student may use rescue medication (bronchodilator) at school.

Parent Signature: __________________________ Physician Signature: ____________________________

Form courtesy of Arnold Palmer Hospital for Children, Orlando, Florida.