Summer will be over before you know it, and, with the arrival of fall, doctors will be treating more cases of asthma in the emergency rooms. Asthma affects an estimated 300 million individuals worldwide and its prevalence in children is increasing.
Asthma is a chronic inflammatory disorder of the airways in which airflow is obstructed that can be completely or partially reversed, with or without therapy. Most children with asthma develop symptoms before the age of 5. Asthma will differ with each child and symptoms may get better or worse at certain times of the year. In some children, asthma symptoms will improve with age. Common symptoms of asthma include coughing, wheezing, trouble breathing, chest pain and recurrent bronchitis. There is no cure for asthma, but you can keep symptoms at a minimum by having an asthma action plan.
Dr. Peter O’Keefe, a board-certified pediatrician at Village Pediatrics on Long Island, explains why more children with asthma have flare-ups in the fall.
"When the kids are out in the field in the fall, playing sports late in the evening, they are inhaling that cooler air and get an exercise-induced bronchospasm," he says. "What we try to do now in August, when ragweed and all of the other allergens kick in—we start to incorporate some preventative things before school starts. We have an asthma plan."
O’Keefe uses an asthma action plan with red, yellow and green levels designed to help the patient.
"When a child first comes down with asthma, the parents are overwhelmed by all of the medicines," he says. "This plan allows the child to know what to do. When you start to have symptoms of coughing or wheezing, you may start with some Albuterol. When they are having some of the symptoms, they can look at the plan and say, ‘This is how I feel,’ and follow the instructions on what to do. If you are in the red area, you are obviously doing much worse and you are calling 911 or the doctor, but you have a plan for what to do until help arrives."
One way to test for asthma is by using a peak flow meter, an instrument into which the child breathes to measure how much air he or she is able to expel in a short period of time, usually a few seconds.
Certain triggers, such as weather changes, seasonal allergies, cigarette smoke, perfumes, pets, chemicals, paints, dust mites, molds or cold air, can start an asthma attack in a child. Infants with asthma may feed slowly or experience shortness of breath during feeding. Toddlers may become fatigued easily and cough more when exercising. For children under 5, asthma attacks can be triggered or worsened when they have colds or respiratory infections. For some children, severe asthma attacks can be lifethreatening and require emergency room treatment.
Asthma emergency symptoms include:
• Gasping for air
• Breathing so hard the abdomen is sucked under the ribs
• Difficulty speaking If your child experiences any of these symptoms, get to an emergency room immediately.
O’Keefe stresses the importance of understanding asthma, but lets families know, "This is not the end of the world— you just have to be in control of your disease. These are the cards you have been dealt and these are the things you can do.
"For all of these kids who have asthma, the most important thing for them is that they can be kids and do what they want to do."
One of the examples Dr. O’Keefe uses when talking to patients who have been diagnosed with asthma is the story of Jerome Bettis.
"He played for the Pittsburgh Steelers and went on to win the Super Bowl three years ago," he said. "He has had a lifelong disease with asthma."
With all patients who have asthma, the key is patient and parent education and understanding how to use medications and devices. Discuss a management plan with your doctor and write and discuss in detail a rescue plan for an acute episode. A plan should include instructions for identifying signs of an acute asthma attack, using rescue medications, monitoring and when to contact your doctor.