Asthma occurs commonly in children. One out of ten children in the United States has asthma. It is one of the main reasons that children are admitted to the hospital and miss school. Unfortunately, despite an increased understanding of asthma by the medical profession, the number of children who die of asthma is increasing. We want our patients with asthma to be well educated about their disease and to be managed well so that complications do not occur. With proper management, children with asthma can live normal healthy lives.

Asthma is one of several conditions which are caused by allergies. Allergic conditions include asthma, eczema, allergic rhinitis, allergic conjunctivitis and eosinophilic esophagitis (a form of gastroesophageal reflux disease). We give these conditions the name: atopic diseases.

Asthma is a chronic disease of the small passageways of the lungs that carry air to the lungs. It is in these small air passageways or “airways”, that the problems of asthma occur. During an attack of asthma, groups of chemicals are released by cells of the immune system which are in the airways. These chemicals cause several problematic changes to the airway itself. First, the lining of the airways becomes swollen, irritated and inflamed, resulting in constriction in the size of the airways. Next, the mucous glands along the airways produce more mucus (phlegm). This causes a cough as the child tries to clear this. Lastly, the muscles surrounding the airways tighten, constricting them. This results in increased work necessary to move air.

All these factors cause constriction of the size and resultant blockage of the airways. It makes it more difficult to move air in and out of the lungs. This obstruction to airflow is the main problem with asthma. The obstruction to airflow causes labored breathing, feelings of chest tightness and shortness of breath. Some children who experience an asthma attack may describe it as chest pain.

The first sign of an asthma attack is usually a cough, as the child tries to clear the mucous which is produced. Other symptoms follow shortly, including wheezing (a high pitched sound of air being forced through swollen, constricted airways), fast breathing and retractions (depressions of the skin over the chest). With continued worsening, the child may develop severe breathing difficulty. It is important to treat an asthma attack early, before severe symptoms appear.

Prevention: If your child has been diagnosed with asthma, prevention of asthma attacks is the best way to manage the problem. Because asthma is a chronic, potentially dangerous condition, it requires input of time, energy and money on your part to keep your child in a safe, healthy state and out of the hospital. We recommend regular office visits at least every six months for our kids with asthma to develop, implement and continue a preventative plan to manage and prevent asthma attacks. The goal of our treatment of asthma is to prevent lung scarring with its attendant long term complications.

We classify asthma into four categories which recognize persistent symptoms and severity.  Treatment is based on this classification of asthma persistence and severity. These are:

Mild Intermittent Asthma

  • Symptoms of cough, wheeze, chest tightness or difficulty breathing less than twice a week
  • Flare ups are brief, but intensity may vary
  • Nighttime symptoms occur less than twice a month
  • No symptoms are present between flare-ups

Mild Persistent Asthma

  • Symptoms of cough, wheeze, chest tightness or difficulty breathing three to six times a week
  • Flare ups may affect activity level
  • Nighttime symptoms occur three to four times a month

Moderate Persistent Asthma

  • Symptoms of cough, wheeze, chest tightness or difficulty breathing occur daily
  • Flare ups may affect activity level
  • Nighttime symptoms 5 or more times a month

Severe Persistent Asthma

  • Symptoms of cough, wheeze, chest tightness or difficulty breathing are continual
  • Nighttime symptoms occur frequently
  • Activity level is affected

Asthma Action Plan

Compliance with an asthma preventative plan that is developed for your child is essential to keep your child healthy and out of the hospital. The following can be helpful in preventing asthma:

1. Avoidance:  Once a child develops sensitive, over-reactive airways, there are many factors which can trigger an asthma attack. These “triggers” should be identified in your child and strictly avoided. Failure to avoid a trigger for your child’s asthma can cause an attack of breathing difficulty.

a.  To avoid an attack of asthma you should do the following to avoid asthma triggers:

  • There should be no exposure to cigarette smoke or fireplace smoke whatsoever.
  • Avoid strong odors and sprays. This includes perfumes, cleaning agents, etc.
  • Avoid exposure to house dust and dust mites.
  • Avoid exposure to dogs, cats, rabbits and other animals as much as possible.
  • Avoid exposure to people with colds and flu.
  • Avoid exposure to molds.
  • If your child wheezes with exercise, consult us about how to prevent this.
  • Avoid other triggers for your child as you identify them. An allergist can help you identify these.

b.  To mitigate triggers you should do the following:

  • Vacuum and dust frequently. Remove dust catching rugs.
  • Remove stuffed animals from the child’s bed.
  • Place plastic covers on the mattresses and pillows in your child’s bedroom.
  • If your child is allergic to dust mites consult us about dust mite control.

Sometimes work up by an allergist is indicated to help identify and treat the role that different allergens may be playing in your child’s asthma. Consult us for a referral to an allergist should this become necessary.

2. Immunizations: Make sure that your child has received the Chicken pox vaccine (Varivax). This is a routine vaccine that we normally give children at one year and four years of age. The reason for this is that cortisone medications are routinely given to stop asthma attacks. Chicken pox can be made much worse, if a child is on cortisone type medication when chicken pox develops. In addition, your child should also get a yearly Flu Shot. Sometimes, we recommend one of the pneumococcal vaccines called Pneumovax or Prevnar if your child has had recurrent pneumonia.

3. Medications:  In addition to the above asthma preventative measures that are needed for all children with asthma, children with persistent asthma need daily medicines to control their symptoms.  These medications are called “controller” medications.

4. Specialty Allergy care:  Some children with persistent asthma may also need an allergy workup by an allergist. Please consult us about this if your child has had several episodes of wheezing or a particularly severe episode of wheezing requiring hospitalization.

Asthma Attack Management: Should your child develop an attack of asthma with breathing difficulty, you should institute your asthma attack management plan. These plans are developed during a visit to our office concerning asthma for use when an attack of asthma occurs in your child. Typically, a quick relief medication, which is also called a rescue inhaler, is prescribed for your child for these situations. If you are in a situation in which your child is having an attack of asthma with no medication to treat it, you should contact us immediately or go to an emergency room. Repeated trips to the emergency room may indicate that the preventative plan is not effective enough and requires modification.  Our asthma attack management plans include three situations:

GREEN ZONE: Your child is doing well

  • No cough, wheeze, chest tightness or shortness of breath during the day or night
  • Your child can do usual activities
  • WHAT TO DO: Take preventative medications as usual

YELLOW ZONE: Your child’s asthma is getting worse

  • Your child may be experiencing cough, wheezing, chest tightness or shortness of breath, or waking at night due to asthma
  • Your child can do some but not all usual activities
  • WHAT TO DO: Take preventative medications as usual AND take your quick relief medication

RED ZONE: Medical Alert! Emergency. Your child is not breathing well.

  • Your child is very short of breath with wheezing, retractions and difficulty breathing.
  • Quick-relief medicines have not helped,
  • Your child cannot do usual activities

OR Symptoms are same or get worse after 24 hours in Yellow Zone

  • WHAT TO DO: Take preventative medications as usual AND take your quick relief medications.
  • If no better after quick relief medications, go to the Emergency Room or our office.

DANGER SIGNS: Call 911 or go to the Emergency Room immediately if:

  • Your child has trouble walking and talking due to shortness of breath
  • Lips or fingernails are blue
Reviewed 3/16/17 by Dr. Byrum