Because every child's asthma condition is different, treatment plans also vary. "Your doctor should tailor an asthma care plan to meet your child's specific needs," says Stan Szefler, M.D., head of pediatric clinical pharmacology at National Jewish Health in Denver. Depending on the severity of your child's illness, treatment may be needed sporadically to restore normal breathing, or daily to prevent breathing problems. Doctors often recommend a combination of the following treatment options along with certain lifestyle modifications.
Long-Term (or "Control") Medications
Anti-inflammatory medications reduce swelling and mucus production in the airways, making them less sensitive to triggers. These need to be taken daily to control and prevent symptoms, but a child needs quick-acting, short-term meds for an actual asthma attack. Often long-term medications control asthma so well that it might seem that a child is no longer sick. "This indicates that the condition is being properly managed. You should never stop treatment without consulting with your doctor," Dr. Szefler says. Long-term medications come in different forms, including steroid pills and syrups, leukotriene modifiers (pills or liquids), and anti-IgE injections for prevention of allergic reactions. The most effective long-term asthma medication--corticosteroids--are inhaled daily via metered-dose inhalers or dry powder inhalers.
Short-Term (or "Rescue") Medications
A child in the midst of an asthma attack needs the quick relief that comes from a short-term inhaled rescue medication that goes directly to the lungs to open up the airways. Short-acting beta-agonists can relax the smooth muscles around the airways for several hours. This medicine is often used to treat sudden and severe asthma symptoms, as well as exercise-induced asthma. Another short-term medication, an anticholinergic, blocks the nerve reflexes that control the smooth muscle around the airways. Because it can take up to 20 minutes for this medicine to take effect, anticholinergics are usually used after an inhaled beta-agonist to achieve longer-lasting relief. Devices that deliver these short-term medications directly into the airways include metered-dose inhalers (a pressurized canister that releases a mist of medicine); dry powder inhalers (disks or canisters that deliver medicine in powder form); and nebulizers (air-compressor machines that are most helpful for toddlers and preschoolers who can't yet use inhalers).
Peak Flow Meter
This is sometimes used as part of an asthma care program to assess how well a child's lungs are working. The device measures how fast your child can blow out air after a big inhalation, known as peak expiratory flow. In the past, peak flow meters were used daily to monitor breathing. "But kids don't like to do it every day and studies show their use doesn't make a huge difference in asthma management," Dr. Szefler says. Still, your child may need to use a peak flow meter for short periods of time to assess how well a change in treatment is working or to help familiarize him with signs of breathing trouble. "Some children can't recognize decreased lung function," Dr. Szefler says. Because peak flow numbers can decrease hours or even days before asthma symptoms appear, using the monitor gives kids and parents time to take preventive action. By age 5, most kids are able to use a peak flow meter correctly.
Asthma Action Plan
Your doctor can provide an asthma action plan to give you and your child's caregivers and teachers information about when and how to use daily medications, emergency meds, and tools such as peak flow meters. The plan typically covers what to do when your child experiences symptoms, instructions about when and how to take medications, and guidelines for when you might need to increase treatments or call the doctor. The written plan should also include where to find emergency care sites and phone numbers for emergency services. You should review this action plan with your child's doctor at least once a year or anytime that treatment changes.
Medications are a must for kids who experience asthma symptoms. But living healthfully by following these steps also makes a difference.
Feed mini-meals. A child with asthma can feel short of breath when her stomach gets full. Offering smaller, more frequent meals can help.
Encourage exercise. Asthmatic kids can and should still get the 60 minutes of daily physical activity that the Centers for Disease Control and Prevention recommends. "A child can pretreat with a short-term inhaler before exercising," Dr. Szefler says.
Avoid triggers. Allergens--such as dust mites, pollen, mold and pet dander--can worsen asthma. If you have a cat or dog, keep it out of your child's room and off of the furniture. Protect against dust mites by encasing your child's mattress, box springs, and pillows in allergen-proof covers. Keep allergic kids inside as much as possible on when pollen counts are high.
Nix the smoking. Exposure to secondhand smoke can increase a child's risk of developing respiratory infections and bring on more frequent and severe asthma attacks. In fact, secondhand smoke is responsible for up to 26,000 new cases of childhood asthma every year. If you smoke, try to quit. At the very least, do not smoke or allow others to light up around your child or inside your home and car.
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