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| Main > Preschool > Common Problems
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Asthma
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| Asthma or reactive airway disease (RAD) is a common problem in infants and children. The most common symptoms include coughing, wheezing and difficulty breathing. Inflammation and tightness in the breathing tubes of the lungs cause these symptoms.
Asthma does seem to run in certain families and is more common in children that also have allergic rhinitis or eczema. It is also more common in children that are exposed to second hand smoke, air pollution and pets.
Asthma is a chronic disease, but many children do outgrow it as they grow older. With the proper medications, your child should be able to run and play without any limitations.
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Asthma Medications
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| The medications that are used to control the symptoms of asthma include bronchodilators and anti-inflammatories (including steroids). Do not use over the counter medicines to control your wheezing. |
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Bronchodilators
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| These are medicines that help to relieve asthma symptoms, such as coughing, wheezing or difficulty breathing by relaxing tight breathing tubes in the lung. They are available in different forms, including syrup, tablet, MDI and solution for use with a nebulizer. Names for bronchodilators include: Albuterol, Ventolin, and Proventil.
Bronchodilators are generally used on and as needed basis. When your child with asthma is having trouble with coughing, wheezing or difficulty breathing you can begin to use them every four to six hours (except for the syrup form which is only used three times a day) or follow your asthma treatment plan.
If your child only has coughing or wheezing after physical activities, then he may have exercise induced asthma. For this problem, it is best to use a bronchodilator 20-30 minutes before activities that make him wheeze. Also, avoid intense activities done in cold, dry air (swimming is a good sport for children with EIA).
Let your pediatrician know if you are using a bronchodilator regularly, such as more than once every one to two weeks, so that a preventative medicine can be started.
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Preventing Asthma
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| Asthma attacks can be triggered by many things, including irritants (smoke or strong odors), allergens (dust mites, molds, etc.), exercise, upper respiratory infections, and changes in the weather. The best treatments are to avoid the things that trigger your child's asthma attacks (keep a diary), follow the environmental controls described below, and use any preventative medications that we have prescribed for your child everyday. |
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Environmental Controls
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These steps are aimed at controlling the most common allergens that can trigger children's asthma attacks.
- Get rid of dust collectors, including heavy drapes, carpeting, & stuffed animals.
- Use an airtight, allergy-proof plastic cover on all mattresses and pillows.
- Wash all bedding and stuffed animals in hot water every 7-14 days.
- If you must keep pets in the house, at least keep them out of your child's bedroom.
- Avoid exposing your child to molds by keeping them away from damp basements or water-damaged areas of the house.
- Keep indoor humidity low, since dust mites and mold increase in high humidity.
- Provide a smoke-free environment for your child (it is not enough to smoke outside).
- Vacuum frequently, but only when your child is not at home.
- Avoid the use of ceiling fans.
- Cover air vents with filters.
- For seasonal symptoms, keep windows closed in the car and home to avoid exposure to pollens.
- Consider using a HEPA filter to control airborne allergens.
- Take any allergy medicines that have been prescribed on a daily basis, since uncontrolled allergies can make asthma worse.
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Anti-inflammatory Medicines
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| These are medicines that are used to help prevent your child from having an asthma attack. To be effective, they must be used every day, even when your child is not having any asthma symptoms. These medicines will not help relieve any of the symptoms of an asthma attack, such as coughing, wheezing or difficulty breathing.
The preventative medicines for asthma include Intal (or Cromolyn), which should be used 3-4 times each day. It is available as a nebulizer solution (usual dose is 2ml or one ampule 3-4 times a day) or as an inhaler (usual dose is 2 puffs 3-4 times a day).
Other preventative medicines are the steroid inhalers, which include Flovent, Azmacort, Vanceril DS, Aerobid, and Pulmicort. In general, the usual starting dose for these steroid inhalers is 2 puffs twice a day. Always use a spacer with your steroid MDI and be sure to rinse your child's mouth out with water after using it. Also, if you are also going to use a bronchodilator medicine, you should use it first and then use your steroid inhaler.
Serevent, is another preventive medicine and it is a long acting form of the bronchodilators. It is available as a MDI (usual dose is 2 puffs twice a day) or as a Diskus (usual dose is 1 inhalation twice a day). Unlike the other bronchodilators, Serevent is for prevention only and not for an asthma attack.
Singulair is a newer anti-inflammatory medicine that is available as a tablet and chewable pill that is taken once a day. We may use this medicine alone or in addition to one of the above medicines.
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Peak Flows
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| A peak flow meter is an important tool that can help us to determine how your child's asthma is doing. Your child's peak flow represents how much air he can get out of his lungs. You should determine your child's personal best peak flow by having him use his peak flow meter 2-3 times on a day when his asthma is under very good control.
Most children are able to use a peak flow meter once they are five to six years old. You can discuss with your pediatrician if your child with asthma should have a peak flow meter at home.
Knowing your child's peak flows will help us to determine what to do when your child is having an asthma attack and you should check your child's peak flow whenever he is having problems breathing.
It is best to check your child's peak flows twice a day and keep a diary of them. For many children, their peak flows will begin to drop just before they are going to have an asthma attack, so if you are checking peak flows every day you may catch an asthma attack early.
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Using a Peak Flow Meter
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- Move the pointer to zero.
- Stand and take the deepest breath that you can.
- Put the mouthpiece of the peak flow meter in your mouth and seal your lips around it.
- Blow out as hard and fast as you can.
- Read the meter.
- Repeat these steps 3 times and record the best out of the 3 tries.
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Using a Metered Dose Inhaler
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Most children are able to use a MDI when they are 4-6 years old. Younger children may also be able to use a MDI with a spacer and mask.
- Shake the inhaler.
- Breathe out normally.
- Hold the inhaler in your mouth (closed mouth technique) or right in front of your open mouth (open mouth technique). If using a spacer and a mask, place the inhaler in the spacer and place the mask firmly over your child's mouth.
- Press down on the inhaler once to release the medicine at the same time that you start to breathe in slowly (or wait until your infant takes a breath if using a spacer and mask).
- Breathe in slowly for 3-5 seconds and then hold your breath for 10 seconds.
- Breathe out comfortably.
- Wait about 1 minute before taking additional puffs.
- To find out how much medicine is left in your inhaler, place the canister (without the mouthpiece) in a container of water. It will sink if it is full and float if empty. Do not do this with Intal or Proventil HFA.
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Using a Nebulizer
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Here are tips for using your nebulizer correctly.
- Always use clean equipment.
- Assemble the air source, nebulizer and tubing per the manufacturers instructions.
- Measure the medications and place them in the nebulizer (remember that ml and cc are the same). Measure your child's dose of Albuterol with 2cc of Broncho Saline or with an ampule of Intal if it has also been prescribed.
- Turn on the nebulizer and hold it close to your child's nose and mouth (or you can use a mask and strap it in place).
- Older children can use a mouthpiece that is held in their mouth with their lips closed, as long as they only breathe through their mouth.
- Turn off the nebulizer and clean your equipment when the treatment is finished.
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Important Reminders
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- Always call your pediatrician to refill your medications before you run out and always your asthma medicines available.
- Call your pediatrician if you are not improving or if you are getting worse on your current regimen.
- Do not stop taking your preventative medicines unless instructed to do so by your pediatrician.
- Follow-up appointments are usually every two to three months, or sooner depending on the severity of your child's asthma.
- With the right management, your child's asthma should not limit his activities.
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