Asthma Treatment Requires Action Plans

Known to many by its trademark wheeze, asthma is a chronic disease of the airways in the lungs. When a person with asthma comes into contact with something that bothers his lungs, the airways get tight and clogged, making it difficult to breathe.

With asthma rates increasing among children - especially in inner cities - doctors are anxious to find clues as to why we are seeing such an increase in the number of cases. Most important, they are anxious to teach parents and children how to manage the disease.

There are 16 million asthma sufferers in the United States. Five million of them are children. Asthma is the leading cause of chronic illness in children and the number one cause of school absenteeism. In recent years, deaths among children with asthma have doubled.

Asthma and allergies can run in families, but children can develop asthma without a positive family history. And while some children's asthma gets much better - or even disappears - as they grow older, careful, daily asthma management and treatment are crucial for both children and adults.

"Asthma treatment is based on each individual's asthma severity as outlined in the National Asthma Education and Prevention Program guidelines," says Dr. Marianna Sockrider, head of the Consultative Clinic program at the Children's Asthma Center.

The mildest form of asthma is intermittent and is characterized by less than two attacks per week. Children with more frequent asthma symptoms and lung function changes have persistent asthma, which can range from mild to severe.

Asthma in young children is not easy for parents to identify, especially since it can look and feel like a cold or respiratory infection. Common asthma symptoms include coughing, wheezing, chest tightness or pressure and shortness of breath. Things that can trigger asthma include irritants - like tobacco smoke, strong odors or perfumes, pollutants, and chemicals, and allergens - like pollen, dust mites, mold, animal danders and some foods. Other factors that can trigger asthma include colds or viral respiratory infections, weather changes, exercise and playing hard, and emotions such as heavy crying or laughing.

"Parents should not diagnose and self-treat a child they think might have asthma," says Dr. Sockrider. A primary care pediatrician can usually diagnose most cases of asthma; a more severe case might warrant the attention of a specialist. A pediatrician will do a physical exam and take a detailed patient and family history. A spirometry test is the most effective method for determining how well the lungs are functioning and can be performed on children who are older than 6.

After the child's pediatrician diagnoses asthma, an individualized asthma action plan is developed. The action plan includes written guidelines for both the parents and the child and outlines what steps to take for routine asthma management, how to recognize asthma triggers and what actions to take when a flare-up occurs. Following the asthma action plan carefully is crucial. Parents and children learn the importance of managing asthma on a daily basis, even when symptoms are not severe.

Mild intermittent asthma is generally treated with use of a bronchodilator. Bronchodilators such as albuterol are rescue medicines that work quickly to relax the smooth muscle around the bronchial tubes, allowing them to open up. Persistent asthma sufferers often need to add an anti-inflammatory medication. Anti-inflammatories are maintenance medicines that, when taken regularly, reduce swelling inside the airways making it easier to breathe.

Since allergies and asthma often go hand in hand, the pediatrician may recommend an allergy evaluation and skin testing for allergen sensitivities. A child who suffers from allergic rhinitis (inflammation of the nasal passages) and asthma may benefit from immunotherapy with allergy shots.

Most asthma sufferers complain of more flare-ups in the winter. In Houston, however, where allergies are a year-round problem, a child can suffer any - and every - day of the year.

And it's not just the pollen and the ragweed and other allergens we associate with being outdoors that cause the problems. In fact, studies indicate that Americans spend 93 percent of their time indoors and one-third of that time in the bedroom. "Indoor allergens can often be difficult to control," notes Dr. Sockrider. "So environmental control measures such as air filters and mattress covers may need to be included in the asthma action plan."

Dr. Sockrider stresses that while asthma cannot yet be cured, it can be controlled. "As long as children and parents understand what triggers asthma symptoms and then work to manage those symptoms at home and school with proper medications and environmental controls when necessary, there's no reason a child with asthma cannot lead a full, normal life,'' she says.

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©2006 Texas Medical Center

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