Saturday, May 22, 2010

So my kid has asthma- what do I do now?

Asthma can be a scary disease. Your kid isn't breathing well and there's all these medications- what do I do? When do I need help? How bad is bad?

The answers to these questions vary from person to person and from kid to kid. I have written about asthma before but I didn't really address how to know if your kid needs help.

This is a link to my earlier post describing what asthma is-

I see a lot of kids in the emergency department who have been told they have asthma. Making the actual diagnosis is challenging at times in young children. This is because small children often wheeze when they have a viral illness. This is due to their small airways and does not mean they have asthma. A lot of pediatricians will not make the actual diagnosis of asthma and will call it "reactive airway disease." It doesn't really matter what it's called as long as it's controlled.

Kids with mild intermittent asthma symptoms are kids who only have symptoms less than 2 times per week. There is usually a trigger- such as a viral illness, cold air, stress, allergy exposure. The symptoms are relieved by a rescue inhaler sucuh as albuterol. Make sure your child is using the inhaler correctly- if you have questions about this then talk to your health care provider.

Kids with mild persistent asthma symptoms have symptoms more than 2 times per week but not daily. They may need a daily medication to control their symptoms, usually an inhaled steroid such as flovent or pulmicort.

Kids with moderate persistent asthma symptoms have symptoms on most days. They usually need a daily medication in a higher dose in addition to their rescue inhaler.

Kids with severe asthma have symptoms daily and have severely limited activity.

The key to managing your kid's asthma is to have a plan. Know your child's triggers and help him to avoid them. If your kid gets asthma symptoms with cat exposure, consider getting rid of the cat. If your kid gets symptoms in the spring with pollen and trees, be prepared. Everyone with asthma has triggers and you need to know what triggers your child to have symptoms.

Remember this- albuterol inhaler is for RESCUE only. If your kid is needing the inhaler more than 2 times per week then their symptoms are not under control and they need daily asthma medication. I often see kids who use their albuterol every 4 hours all the time because the parent didn't understand that it was an AS NEEDED medication.

You should talk to your child's health care provider about an asthma action plan. This is a plan that lays out what to do if he has certain symptoms, when to seek help, what to look for, etc. This should be used as a guide to help you know when your child is in trouble.

Here is an example action plan:

Billy, age 7.

Asthma triggers: illness, cats, exercise

Daily medication: none

As needed medication: albuterol inhaler 2 puffs every 4 hours

Billy needs Albuterol inhaler right before gym class at school. If he develops chest tightness, shortness of breath, wheezing during gym then he needs to see the school nurse.
The nurse will administer another dose of albuterol. If symptoms persist after the second dose of albuterol, his parents need to be called and he should have further medical evaluation.

Billy should not have a cat. If he goes to his cousin's house where there is a cat, he needs to bring his albuterol and use it if he has shortness of breath, wheezing or chest tightness.

When Billy gets a cold, his symptoms are likely to be worse because of his asthma. At the first sign of an upper respiratory infection he needs to start Flovent 110 mcg 2 puffs every 12 hours. He should use his albuterol inhaler every 4 hours as needed for chest tightness, wheezing or shortness of breath.

If Billy's symptoms are persisting despite his flovent and albuterol, he needs medical evaluation.

If he develops color changes, severe shortness of breath, breathing fast, sucking in his chest with each breath, or severe wheezing then he needs emergency evaluation.

You can find out more about asthma action plans here:

The key is to ask your health care provider what to look for, when to start and increase medication and when to seek help. This will vary from kid to kid.
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1 comment:

  1. I like your blog a lot. Its informative and full of information. Thank you for sharing.