For the parent of a child with asthma, life can feel like a constant crisis. But experts say it doesn't have to be that way.
Fifteen million Americans suffer asthma. About 4.4 million of those patients are children, according to the U.S. Department of Health and Human Services. From 1980 to 1996, the number of Americans with asthma more than doubled, to almost 15 million, and childhood asthma rose even more rapidly. From 1980 to 1994, asthma cases increased 160 percent among children younger than 5, the department says.
More than 5,000 Americans children and adults die of asthma each year, and half a million are hospitalized. Yet despite the recent explosion of asthma cases, officials with the National Heart, Lung and Blood Institute, the American Lung Association and other public-health agencies describe asthma as a reversible disease that, if properly treated, should almost never lead to death, hospitalization or even lifestyle limitations.
People "should be controlling asthma, not having asthma control them," says Dr. Linda Ford, president of the Asthma and Allergy Center in Papillion, Nebraska, and past president of the American Lung Association.
That means your child shouldn't wake at night wheezing or coughing, shouldn't require trips to the emergency room, and shouldn't have to sit out physical education class or sports practice for fear of provoking asthma, Ford says.
"Almost all children with asthma can have a normal life," says Gail Shapiro, a Seattle allergy and immunology specialist and president of the American Academy of Allergy, Asthma and Immunology. "That includes normal play, normal sleep, normal school attendance."
You can make that ideal a reality by knowing what kind of treatment your child should have and making sure she gets it, experts say.
Asthma Medication
The key to controlling chronic asthma is maintenance medication -- particularly inhaled steroids, asthma experts say.
The regular use of low-dose inhaled steroids is associated with a decreased risk of death from asthma, an article in the August 2000 New England Journal of Medicine reported.
Australian researchers found that the use of inhaled steroids can slash the risk of asthma death by 90 percent, according to a study conducted by Monash University, Southbank, and Monash Medical School at the Alfred Hospital in Melbourne, Australia. The study was published in the January 2001 American Journal of Respiratory and Critical Care Medicine.
Inhaled steroids reduce the risk of acute asthma attacks by decreasing inflammation of the airways, Ford says.
Yet out of 1,000 children with asthma surveyed in a national health and nutrition study, only one-quarter of those with moderate to severe asthma were taking regular doses of maintenance medications, researchers concluded, writing of their findings in the January 2000 issue of Pediatrics.
Only one-third of kids with the most severe asthma took medication regularly. Children 5 or younger, poor and minority children, and those living in the inner city were most likely to receive inadequate medication, the study reported.
Parents may be wary of placing their children on daily medication, or may doubt whether the drugs are effective, the study surmised. They may also have a hard time getting very young children to take their drugs.
Even primary care doctors are often reluctant to prescribe inhaled steroids, Ford says, out of concern that the drugs may cause bone loss or decrease growth in children. However, the New England Journal of Medicine article reported that low doses of corticosteroids cause little or no such side effects.
"The doses we use for asthma have not shown a decrease in growth in children or an increase in osteoporosis in children or adults," Ford says. Even children on lifelong regimens of high-dose inhaled steroids generally grow to within an inch of their expected adult height, she says.
What to Expect From Your Child's Doctor
Knowing what you have the right to expect from your doctor will help you get the best possible care for your child.
Your doctor should take a thorough history of your child's asthma, analyzing his medical history and environment, says Dr. Phillip Korenblat, an asthma specialist and professor of clinical medicine at the Washington University School of Medicine in St. Louis, Missouri.
This should pinpoint substances like dust, pollen or animal dander that may trigger allergic reactions, and activities or situations that bring on asthma. Once you and your doctor have figured out what makes your child's asthma worse, you can work out ways to avoid those triggers, Korenblat says.
If your child is old enough for lung function tests, your doctor should perform those as well, Korenblat says. Children are usually able to respond to directions and perform the tests at age 3 to 5, he says.
You'll need to know the severity of your child's asthma, Ford says. It might be intermittent asthma, in which the patient is basically stable but suffers occasional asthma attacks, or persistent asthma, in which the patient has chronic breathing problems. Persistent asthma is further broken down into mild, moderate or severe asthma, Ford says.
Daily medication is a must for persistent asthmatics, experts say. If the doctor doesn't prescribe maintenance medication for your child, you should find out why.
Your doctor should show you how to monitor your child's symptoms and measure his or her air flow with a peak flow meter, and should draw up an action plan to help you respond when your child's symptoms get worse.
Written action plans decrease the risk of asthma death by 70 percent, the American Journal of Respiratory and Critical Care Medicine article reported.
Helping Your Child Deal With Asthma
A diagnosis of asthma can be scary for your child. She might be afraid of dying, embarrassed about being different, or confused by a new regimen of treatment and medication.
Encourage children to express those fears and concerns, then work on ways to alleviate them.
"You can help [them] increase their self-esteem and feel better about their chronic condition by letting them know they can take charge" of their treatment, says Melissa Korenblat-Hanin, a licensed clinical social worker and asthma specialist in St. Louis. Korenblat-Hanin, who is Korenblat's daughter, served as coordinator of education and social services at the asthma center of Washington University School of Medicine in St. Louis.
If your child doesn't like the taste of the medication, ask your doctor for alternatives that are more palatable. Younger kids may cooperate with medication administered through nebulizer treatments if they get to watch a special video or read a favorite story during the treatment, she suggests. If your child has trouble using an inhaler, ask your doctor about special apparatus that may help him or her to inhale the medication.
If your child is embarrassed about taking medication, work out a schedule that will allow him or her to do it privately at home, instead of at school, Korenblat-Hanin says.
Let your child know that taking asthma medication is a way to avoid feeling different, and will allow him or her to lead the same lifestyle and join the same activities as other kids. Although some children -- and even their parents -- may neglect or forget medication when the child is feeling well, it's important to see it as an ongoing defense against asthma.
Korenblat-Hanin said she sometimes explains maintenance medication to very young children using analogies of cartoon superheroes -- describing the medication as a guardian that stays with them to keep asthma at bay.
"From the get-go, you need to convey to the parent and the child that the maintenance medication is what's going to keep [the child] feeling better," she says "The way to take charge and take control is to always have the medication in you, to keep the inflammation from occurring."
Deborah Sullivan Brennan is an Idyllwild, California-based writer specializing in health and environmental issues. She is a regular contributor to the Los Angeles Times and to several health Web sites, including Apria.com.
