What's the treatment for childhood asthma?
The goals of asthma therapy are to prevent your child from having chronic and troublesome symptoms, to maintain your child's lung function as close to normal as possible, to allow your child to maintain normal physical activity levels (including exercise), to prevent recurrent asthma attacks and to reduce the need for emergency department visits or hospitalizations,
and to provide medicines to your child that give the best results with the fewest side effects.
Children use the same types of medications for asthma as adults do. The amount and type of medication your child will need depends on the severity of the asthma. For mild intermittent cases, your doctor may prescribe only a bronchodilator — a medication that helps breathing by relaxing the tight ring of muscle around the airways — for quick relief as soon as symptoms begin. More frequent or persistent cases will require daily medication to reduce the swelling of the linings of the airways and to prevent attacks.
It is important to be alert to the child's symptoms, and start or increase treatment at the first sign of worsening asthma. In course of time, each child learns his or her particular triggers, and learns also to avoid them. The child must herself learn to identify the early signs of an acute attack. Many attacks can be stopped by starting treatment quickly. A peak flow meter is a great help in the home monitoring of asthma. It can warn of an impending attack even before symptoms start. Children over the age of four years are usually able to use one.
Children with mild asthma (infrequent attacks) may use relief medication as needed. Those with persistent asthma should take control medications on a regular basis to prevent symptoms from occuring. A severe asthma attack requires a medical evaluation and may require hospitalization, oxygen, and intravenous medications. Although these are the same medications used to treat adults, there are different inhalers and dosages especially for children. In fact, children often use a nebulizer to take their medicine rather than an inhaler, because it can be difficult for them to use an inhaler properly.
Families play a very important role in the control of asthma by helping get rid of the indoor triggers that worsen asthma. For example, it is extremely important to eliminate tobacco smoke from the home. This is the single most important thing that a family can do to help a child with asthma. Just having people smoke "not in the house" is not enough, as family members and visitors can bring residual smoke in on their clothes and in their hair.
Keeping low levels of humidity and fixing leaks can reduce growth of organisms such as molds. Exposure to cockroaches can be reduced by cleaning and by keeping food in containers and out of bedrooms. Bedding can be covered with "allergy proof" polyurethane-coated casings to reduce exposure to dust mites. Detergents and cleaning agents in the home should be unscented.
All of these efforts can make a significant difference to the child with asthma, even though it may not be obvious right away. Your allergist can assist you with a plan for reducing the asthma triggers in your home.
A peak flow meter, a simple device to measure lung volume, can be used at home to help you "see an attack coming" and take the appropriate action, sometimes even before any symptoms appear. If you are not monitoring asthma on a regular basis, an attack can take you by surprise. Peak flow measurements can help show when medication is needed, or other action needs to be taken. Peak flow values of 50-80% of the child's personal best indicate a moderate asthma attack, while values below 50% indicate a severe attack.
Many children under age 5 can't use a peak flow meter well enough to make the numbers useful, so their asthma must be managed by an adult who needs to watch carefully for the asthma signs. The age 5 "cutoff" is somewhat arbitrary, however, and can be adjusted based on the abilities of the individual child. It's a good idea to start using peak flow meters before age 5 to get the child used to them, but not to actually rely on them too much for monitoring the child's condition.
There is no fool-proof method to prevent asthma attacks. The best way to minimize the number of attacks is to follow the asthma plan that you develop with your doctor and to eliminate triggers (especially cigarette smoke) as discussed above. When families take control of their home environment, asthma symptoms and exacerbations can be significantly decreased.
When a child begins to get symptoms, a severe attack can be prevented by a quick response. An asthma action plan can tell a family exactly what to do when symptoms start to increase. Following an asthma action plan can prevent severe exacerbations that otherwise might result in hospitalization.