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Family Health Online / Pharmacy at Safeway
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Family Health Magazine - CHILDHOOD

Asthma and Your Child
Steps to keep asthma under control

Common asthma triggers

  • virus infections
  • smoke
  • cold weather
  • pollen
  • exertion or exercise
  • dust or mould
  • dog or cat dander
  • strong odours
  • emotional stress

Asthma is a chronic condition affecting children as well as adults. It cannot be cured, only controlled. To understand what a severe asthma attack feels like, breathe in very deeply and hold for a second. Now, try to take another breath. This unpleasant sensation occurs when a trigger causes airways to the lungs narrow. Symptoms of asthma are wheezing, coughing, chest tightness, short​ness of breath and mucous production.

Avoiding Asthma Triggers

ALLERGIC ASTHMA TRIGGERS

Children with allergies may be sensitive to certain foods or substances. Breathing in or eating these substances could cause an asthma attack.

Pollen - Trees, grass, ragweed

  • avoid freshly cut lawn and being out in wind in pollen season
  • keep doors and windows closed in pollen season and
    use central air conditioning if available

Dust Mites - Carpets, furniture, mattress, dirty filters, feather pillows, stuffed toys

  • vacuum regularly (avoid sweeping) • wash sheets in hot water
  • use zippered synthetic dust-proof covering for mattress and pillows
  • damp dust regularly • change furnace filters monthly • use foam pillows

Mould - Damp areas, such as sinks, bathroom, laundry areas, plants, garbage cans or humidifiers

  • clean regularly • air room when possible
  • reduce house plants • clean humidifiers if used
  • keep humidity in house low (40-50 per cent) to avoid growth of moulds and dust mites

Animals - Household pets, such as cats or dogs

  • pets should be removed from the home
  • if pets cannot be removed altogether, keep them out of the bedroom
  • wash pets once a week to reduce dander

Foods & Additives - Certain foods such as nuts, shellfish, eggs, milk or chocolate, additives or food colouring, sulphites in dried or preserved fruits, beer, wine or salads, monosodium glutamate (MSG)

  • don’t eat or drink foods that you know are triggers
  • be alert and read labels on products
  • ask if triggers have been added to restaurant foods and salad bars

NON-ALLERGIC ASTHMA TRIGGERS
& IRRITANTS

Smoke, fumes and irritants - Cigarette smoke, fumes from bleach, paint, wood stoves, perfume or chemicals, high humidity or cold air

  • stop smoking and avoid smoky areas and wood burning fireplaces
  • have plenty of fresh air in sitting and work areas
  • avoid strong-smelling detergents • use a mask where possible
  • wear a thick scarf over nose and mouth in cold weather

Exercise - Various sports and activities

  • use relief inhaler 15 minutes before exercise
  • stay active and keep exercising • exercise indoors in cool weather
  • warm up before exercise and cool down afterward

Emotion - Excitement, laughing, crying, fear, anxiety or stress

  • use relaxation techniques when possible
  • take slow deep breaths and breathe out through the mouth (pursed lip breathing)

Infection - Colds or chest infection

  • monitor peak flows to see if asthma is getting worse
  • refer to action plan
  • talk to your doctor about getting a yearly flu shot

Medications - ASA, certain blood pressure pills (B-blockers), certain eye drops (beta blockers), anti-inflammatory (NSAIDS)

  • tell your doctor and pharmacist about
    all medications your child is taking, so additional or different medications can be given safely
  • consider a Medic Alert bracelet

Steps to keep asthma under control

Asthma is a chronic condition affecting children as well as adults. It cannot be cured, only controlled. To understand what a severe asthma attack feels like, breathe in very deeply and hold for a second. Now, try to take another breath. This unpleasant sensation occurs when a trigger causes airways to the lungs narrow. Symptoms of asthma are wheezing, coughing, chest tightness, short​ness of breath and mucous production.

Although struggling for air can be very frightening, asthma is not caused by anxiety. Never brush it off as ‘just nerves.’ Those who do not understand the condition may think someone with asthma is just puffing to get attention or avoid activity. However, asthma is very real and must be taken seriously.

Asthma is often inherited, affecting both adults and children. If both parents have asthma, the child’s risk of developing it is even higher. Mothers who smoke are more likely to have children with asthma. Although a diagnosis is rarely made before age one, roughly 10 per cent of children have asthma.

diagram - reduced air flow in asthma

In Canada and across the world, more and more people are being diagnosed with asthma. Each decade, the number rises by 50 percent. Although we do not understand exactly why, increasing urban dwelling may be related. Modern medical treatment and medication have allowed the death rate from asthma in Canada to slowly drop since 1990. Still, around 20 children and 500 adults die of asthma each year. Whether you care for a child with asthma or have it yourself, the following information on managing the condition can help.

How asthma affects the lungs

diagram - bronchospasmPeople with asthma have airways that are very sensitive to one or more triggers. Exposure makes airways begin to spasm, becoming red, swollen and narrow. Mucous is produced and gathers in the airways.

Next, small muscles around the airways go into spasm. As they become active, they shorten and tighten around the tubes in the lung. This narrows the airways and reduces airflow, much like wrapping your hand around a soft garden hose and squeezing to reduce the flow of water. During an asthma attack, both inflammation and resulting airway spasm cut the air flow. This causes shortness of breath, coughing, and often wheezing through the narrowed airway tubes.

Diagnosing asthma in a child

The pulmonary (lung) function tests ordinarily used to diagnose asthma are usually impractical before six years of age. Instead, doctors use a good history, physical examination and follow-up of the child. Lab tests are usually done only to rule out other conditions that might cause similar symptoms. Response to bronchodilator medication can help confirm the diagnosis of asthma.

For some children, unrestricted play is just a dream. Others with asthma are able to control it so effectively that they are able to participate in world class sporting competitions.

Caring for a child experiencing an asthma attack

  • Have the child stop any physical activity.
  • Reassure the child that everything will be okay and that you will help.
  • Have the child use the (blue) puffer [usually salbutamol (Ventolin™ or bricanyl)].
  • If the attack does not subside after two puffs and it is not your child, call the parents.
  • If the child is struggling for air and not settling down after using the puffer, call an ambulance or go to the nearest hospital emergency department. Use the salbutamol or bricanyl inhaler as often as needed until help arrives.
  • Do not send the child home unattended and do not leave the child alone.

Preventing an attack

As with most illnesses, the best treatment is prevention. Think about what irritates your child’s airways and triggers an attack. Then, reduce exposure to triggers (see sidebar).

  • Keep your home as allergen-proof as possible. Do not allow smoking in the house.
  • Most children spend at least a third of their lives sleeping, so the bedroom is particularly important. Vacuum and dust it often. Remove large carpets and rugs, and replace them with easily cleaned surfaces such as linoleum.
  • If your child has a house dust mite allergy, use zippered mattress and pillow covers. Make sure bedding, rugs and curtains are all made of washable materials, such as cotton, nylon and polyfil. Every week, wash bedding in hot water and dry it in a hot dryer. Avoid having wool, animal skins and plants in the bedroom.
  • Many children are allergic to animal dander. If your child is truly allergic to a cat or dog, the only remedy is removing the pet from the home.
  • Be aware of materials used in your child’s stuffed animals. Kapok and straw fillings may cause trouble.
  • Special air-conditioner filters may help at times, as spores from some moulds and particles of house dust are so small they slip through conventional filters. Controlling moulds is more difficult than controlling pollens, since some moulds grow indoors.

Exercise-induced asthma

Some children only have symptoms of asthma when they exercise. They seem to experience more problems when exercising in cold dry air. Coughing after exercising may be the only symptom. Children may not mention breathing difficulties, but avoid physical activity because they cannot keep up with their friends. Stop-and-go sports such as baseball and volleyball may cause fewer problems than hockey and soccer. Water sports in an indoor pool and exercise in an indoor gym cause the least trouble because the air is warm and moist.

To prevent symptoms of exercise-induced asthma, make sure your child:

  • stays in good physical condition.
  • does warm-up exercises before starting any vigorous sport, and cools down slowly for at least ten minutes after exercising - don’t stop suddenly.
  • wears a face mask when exercising in cold weather, to help warm air before it enters the lungs.
  • breathes through the nose as much as possible, to warm and moisten air before it reaches the lungs.
  • talk to your doctor about using rescue medication (Salbutamol) 15 to 20 minutes before exercising.
  • avoid having your child exercise outdoors on days when pollution or pollen counts are high–exercise indoors instead.

Take the 30 second asthma test to find out if your child’s asthma is under control.

If you answer yes to one or more questions, talk to your doctor about how you can better manage your asthma.

Do you cough, wheeze or have a tight chest because of your asthma four or more days a week?
Yes No
Does coughing, wheezing, or chest tightness wake you at night once or more a week?
Yes No
Do you stop exercising because of your asthma?
Yes No
Have you missed school because of your asthma in the past
three months?
Yes No
Do you use your rescue medication four or more times a week? (except one dose per day for exercise) Yes No

All about asthma medications

Asthma medications fall into two major groups: relievers (rescue) medications (bronchodilators) and preventor medications (anti-inflammatories). If you have any questions about your child’s asthma medication, or concerns about how your child feels while taking it, talk to your doctor or pharmacist.

Reliever (rescue) medications

Rescue medications (fast-acting bronchodilators) quickly relieve symptoms (see table below). They bring rapid relief by relaxing bronchial muscles. Only use a brochodilator when needed:

  • for quick relief during an asthma attack (it should bring relief within five to 10 minutes)
  • for relief of symptoms such as cough, chest tightness, wheezing and shortness of breath
  • 15 minutes before exercising, if prescribed by your doctor.

If your child is using rescue medication more than three times a week, other than once a day with exercise, the airways are likely swollen and need treatment. Follow your action plan or tell your doctor. You may need to increase asthma prevention medication or add another medication until the asthma is under control.

Trembling, nervousness, flushing, and increased heart rate are all common side effects of rescue medication.

Preventer medications

Inhaled corticosteroids

If your child has asthma, your doctor is likely to prescribe an inhaled corticosteroid to keep it under control. These medications reduce swelling, redness and mucous in the airways. Inhaled corticosteroids are taken daily even if there are no symptoms to prevent swelling and mucous in the airways.

Inhaled corticosteroids do not have the same side effects as the performance enhancing anabolic steroids some athletes take illegally. Nevertheless, their use requires regular check-up as recommended by a family doctor. Oral yeast infections, hoarseness and sore throat are the most frequent problems. Remedy this by rinsing the mouth out with water after each dose.

Other asthma medications

Corticosteroid pills

For asthma attacks corticosteroids are sometimes taken systemically (by mouth or injection). Doctors often prescribe these pills for a short time to get swelling and mucous under control quickly. For prescriptions lasting three to seven days, side effects may include increased appetite, mood changes, water retention, and, in children, hyperactivity. When used for a few days, side effects are expected to be minimal compared to the benefits.

Long–acting bronchodilators

Long-acting bronchodilators help keep airways open and muscles relaxed, preventing asthma attacks for up to 12 hours. They are always prescribed with inhaled corticosteroids and should not be taken alone. Long acting bronchodilators may be used in children four years and older. Combination products containing inhaled corticosteroid and a long acting bronchodilator are available for children who need to be on both medications. Combinations make it easier to take medication on a regular basis.

Leukotriene receptor antagonists

Leukotriene receptor antagonists help reduce inflammation or swelling in the airways and keep airway muscles relaxed. Montelukast (Singulair) comes in pill form and is taken once daily. It can be used in children as young as two.

Zafirlukast (Accolate) is an oral tablet taken twice daily and used by children over 12. Leukotriene receptor antagonists are usually added to existing inhaled corticosteroid therapy when optimal asthma control has not been reached. They can be used in patients who cannot or will not take inhaled corticosteroids.

Theophylline

Theophylline is a bronchodilator in pill form. Today it is seldom used. It works directly on the airway muscle to relax it, making it easier to breathe. Theophylline has many side effects and needs to be closely monitored.

Antibody Neutralizers (Xolair)

Antibody neutralizers are used when moderate to severe asthma is triggered by allergies and inhaled steroids do not help. Xolair works by decreasing the amount of the antibody (the substance in the body that makes airways swell with an allergic reaction).

Asthma medication devices and how to use them

metered-dose inhalerMetered dose inhalers (puffers)

Asthma medications are often given through a metered dose inhaler (MDI). This system delivers a fine medication mist directly to the airway. A metered-dose inhaler can be used with an open or closed mouth technique. The preferred method for children is the closed–mouth version.

Helping your child to use a metered-dose inhaler

  • Remove the cap from the inhaler.
  • Shake well.
  • Have your child breathe normally and slowly through the mouth, then breathe out.
  • Seal lips around mouthpiece.
  • As your child begins to breathe in, push down on the cartridge once. Your child should continue to breathe in slowly and deeply through the mouth until finished taking in that breath.
  • Tell your child to hold the breath for five to ten seconds, and then breathe out slowly.
  • Replace the cap.
  • If an additional inhalation is prescribed, wait 60 seconds before giving another dose.

Caring for a metered-dose inhaler

Once a week, remove the medication canister from the plastic casing and wash the casing in warm, soapy water. When the casing is dry, replace the medication canister and put the cap on the mouthpiece. Ensure the hole is clear.

spacerSpacers

A spacer device is an add-on that attaches to the mouthpiece of a metered-dose inhaler. Acting as a holding chamber for aerosol medication, a spacer makes it easier to take the medication.

It reduces the amount of medication deposited in the throat and increases the amount that reaches the lungs. A spacer is recommended for use with all metered dose inhalers.

Spacers are available with either a mouthpiece or a face mask. Spacers with face masks are used for young children. As soon as your child is able to use a spacer with a mouthpiece, make the switch. With face masks, as much as two-thirds of the drug may not be deposited in the lungs.

turbuhalerTurbuhaler

The turbuhaler is a multidose powder inhaler. Since the particle size and volume of powder is so small, your child may not taste or feel anything while inhaling it. Children three years and older can be taught to use a turbuhaler.

Helping your child to use a turbuhaler

  • Unscrew and remove the cap.
  • Hold the turbuhaler in an upright position and turn the coloured base as far as possible in one direction, then turn back until a click is heard.
  • Have your child breathe out away from the turbuhaler.
  • Place the mouthpiece between the teeth and ask your child to close the lips around it.
  • Tell your child to breathe in quickly and deeply through the mouth. Remove turbuhaler from mouth. Your child should hold the breath for ten seconds, then breathe out.
  • Repeat the process for the prescribed number of inhalations.

Caring for the turbuhaler

Clean mouthpiece using a dry tissue or cloth, gently wiping away any particles which have collected inside the mouthpiece. Never wash the turbuhaler. Check the dose window counter - once a red mark appears in the window, there are approximately 20 doses left. Some turbuhalers use numbers to indicate doses left. Note that the sound heard when shaking a Turbuhaler is not the medication but an agent that keeps the medication dry. Hearing the sound does not mean that there is still medication in the container.

asthma discusDiskus

A diskus is a multi-dose (60) dry powder inhaler. Children as young as age three may be able to use a diskus.

Helping your child to use a diskus

  • To open, hold the outer case in one hand and put the thumb of the other hand on the thumb grip.
  • Push the thumb grip as far as it will go until a click is heard.
  • Slide the lever away as far as it will go until you hear another click.
  • Have your child exhale completely.
  • Put the mouthpiece of the diskus to your child’s lips. Ask your child to inhale quickly and deeply through the inhaler.
  • Remove the inhaler.
  • Tell your child to hold the breath for about 10 seconds, and then to breathe out slowly.
  • Close the diskus by sliding the thumb grip as far as it will go until a click is heard. The lever is automatically reset for the next dose.

Caring for the diskus inhaler

Store the device in a dry place, and close it when not in use. Never wash a diskus inhaler. Use a dry tissue or cloth to clean the mouth piece.

Nebulizers

Nebulizers are usually reserved for hospital in-patients or out-patients who cannot use other inhalation devices. The amount of drug breathed in is the same as for metered-dose inhalers with spacers or breath-activated powdered inhalers. The same degree of bronchodilation occurs as with a properly used inhaler. As a result, it makes more sense for most people with asthma to use an inhaler.

Written Action Plan

An asthma action plan is a written set of instructions developed with your doctor or asthma educator. It explains what medication your child should take regularly when feeling well. It also discusses how to increase the medication if breathing problems occur. An asthma action plan can be used with or without a peak flow meter to help manage asthma.

ASTHMA ACTION PLAN FOR: ______________________________

Uncontrolled Asthma

  • cough, wheeze, chest tightness, shortness of breath appear less than four days per week
  • waking at night with asthma symptoms – happens less than one night per week
  • able to do usual activities and not missing school or work
    • needing rescue medication less than four times per week (may use one dose per day for exercise)

PEAKFLOW ______________________ TO_____________________ (80% – 100% of personal best)

MEDICATION: (Avoid triggers):


Uncontrolled Asthma

  • coughing, wheezing, chest tightness, shortness of breath appear more than four days per week
  • waking at night with asthma symptoms – happens more than one night per week
  • not able to take part in usual activities, missing work or school
  • needing reliever more than four times a week

PEAKFLOW _____________________ TO ______________________ (60% - 79% of personal best)

MEDICATION: (Avoid triggers)


ASTHMA ALERT!!!

Signs of Severe Asthma

- Call 911 or go to nearest hospital One or more signs may be present:
  • Very short of breath
  • Coughing frequently
  • Not responding to reliever
  • Cannot speak easily
  • Looks ill, listless, colour poor
  • PEAKFLOW less than 60% personal best
USE RELIEVER MEDICATION AS OFTEN AS NECESSARY UNTIL YOU ARRIVE AT THE NEAREST HOSPITAL EMERGENCY DEPARTMENT Physician’s Signature:

Date:

Using a Peak Flow Meter

A peak flow meter measures how fast air is blown out of the lungs. It can help you and your doctor determine peak lung capacity to get a sense of the pattern of your child’s asthma. Take readings one or two times a day, as recommended by your doctor. Record the reading in a diary and take it with you each time you visit the doctor. The reading can be used to find your child’s personal best. A peak flow meter is used in conjunction with a written action plan.

To use the peak flow meter properly

  • Set the scale to zero.
  • Always take the reading in the same position, preferably standing up.
    If your child is unable to stand, find another comfortable position.
  • Breathe in deeply.
  • Place the meter in mouth and close lips around the mouthpiece.
  • Do not cough or let the tongue block the mouth of the meter.
  • Blow out as hard and as fast as possible.
  • Check the value on the scale and write it down.
  • Take two more readings.
  • Record the highest of the three numbers in the peak flow diary.
  • Be sure to check in the early morning when asthma tends to be worse.

Every week in Canada, people die from asthma. Many are children. However, asthma can be controlled and treatment is better than ever. Take asthma seriously, learn about it and work closely with your doctor to keep the illness under control. If you need more information, contact your family doctor.

MEDICATION

BRAND NAME

ACTION

SIDE EFFECTS

RELIEVER (RESCUE) MEDICATION – used during an asthma attack, if your breathing gets bad, or before exercising
Inhaled bronchodilators (airway openers) Bricanyl™ (terbutaline sulfate), Ventolin™ , ‘Airomir’ (salbutamol), Oxeze (Formoterol), Symbicort (Budesonide + formoterol) Quick relief within five minutes, relaxing tight muscles around airways Shakiness, fast heart rate when first taken
PREVENTER MEDICATION - used every day to prevent swelling and mucus in the airways even if you have no symptoms
Inhaled corticosteroids Pulmicort™ (budesonide), Flovent (fluticasone), Qvar (Beclomethasone), Alvesco(Ciclesonide), Symbicort (Budesonide + Formoterol), Advair (Fluticasone + Salmeterol) Works over time to prevent swelling, mucous build-up and reduce inflammation in airways Hoarseness, mouth and throat infection (thrush) – after use, rinse out mouth and spit to avoid this effect. Alvesco does not have this side effect. May use with a spacing device (except Pulmicort™).
OTHER MEDICATIONS
Corticosteroid pills Prednisone, Prednisolone (PediaPred), Dexamethasone (Decadron) Take effect over 4 to 6 hours to reduce swelling, inflammation and mucus secretions in airways; emergency control of asthma symptoms and severe asthma Only use for 5 -7 days for asthma attack; may cause mood changes, water retention and increased blood sugar
Long-acting bronchodilators Oxeze (Formoterol) Serevent (Salmeterol):must be used with an inhaled corticosteroid and come in combination: Symbicort (Formoterol + Budesonide) Advair (Fluticasone + Salmeterol) Work over a 12 hour period to keep airways opened and muscles relaxed preventing asthma attacks Tremors and palpitations
Leukotriene receptor antagonists Accolate® (Zafirlukast)
Singulair® (Montelukost)
Slow action: prevent swelling and mucous build-up which cause narrowing of the airways, reduces twitchiness of airways, dosage adjusted according to age Stomach upset, tiredness
Theophylline (seldom used) Uniphyl™ (theophylline)
Theolaire (theophylline)
Short or long lasting (8 to 12 hours) to open airways; not for quick relief, as it does not take effect immediately Never increase the dose on your own, as it can be toxic if too much is taken. Take after meals or with food. Do not chew or crush tablets. May experience upset stomach, shakiness, headache, restlessness or sleep disturbance.
Antibody Neutralizers Xolair (Omalizumab) Lowers amount of antibody causing allergic reaction For use in children over age 12
FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2015, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6    [CH_FHc08]
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