What is asthma?

Asthma is a respiratory disease that affects the airways (breathing tubes that carry air in and out of the lungs). The lining inside the airway walls is inflamed and swollen. The inflammation of the airway walls is continuous, or chronic. Even when a child is having no asthma symptoms, there is almost always some inflammation (swelling) in the airways. During an asthma “flare” (episode of breathing problems) the following changes occur:

  • Increased swelling and inflammation of the airway lining
  • Muscles tighten around the airways (called bronchospasm)
  • More mucus is produced (which can clog airways)

All of these things cause the airway to narrow. This causes breathing problems: it is very hard to move air in and out of a narrowed airway.

Common Symptoms

Symptoms can be difficult to recognize in very young children. Some symptoms that may be associated with asthma include:

  • Cough, that takes a long time to go away after a cold
  • Bad cough with cold, coughing “spells” that waken child at night
  • Wheezing (whistling or squeaking sound with breathing), coughing, or trouble breathing with exercise
  • Infants may have trouble feeding and grunt during sucking
  • Coughing (often worse at night,  early in the morning, or with exercise)
  • Chest tightness (like something squeezing the chest)
  • Difficulty breathing (may feel like can’t get enough in and out of chest)

Many people have been taught that someone with asthma has “big” breathing problems nearly all the time. This is not true!

Some children may have no asthma symptoms for long time periods, then they may have a serious asthma “flare”. Other children may have symptoms on a more ongoing basis. Symptoms can vary from one asthma “flare” to another. Some flares may be serious, even life threatening, while others may be more mild.

Call the doctor right away when asthma begins to cause problems. Early treatment can help prevent a serious, life threatening asthma episode.

What are common triggers of asthma symptoms?

Colds, and other respiratory viruses are one of the main things that cause asthma “flares” in children. Other things that may trigger asthma problems include:

Allergens

  • Pollens
  • Molds (indoor and outdoor)
  • Animal dander
  • House dust mites

Irritants

  • Cigarette smoke
  • Air Pollution
  • Cold air and weather changes
  • Strong odors (from painting, cooking, cleaning products)
  • Scented products

Avoidance of things that trigger asthma problems will help keep asthma under better control.

Medicines

Usually two kinds of medicines are needed to treat asthma. These medicines have been shown to be very safe and effective for children.

Albuterol (quick relief or rescue medicine)

This medicine works quickly and is used “as needed” for breathing problems. This medicine provides temporary relief of breathing problems by relaxing tight muscles around the breathing tubes. Albuterol is the medicine used the most (Proventil® and Ventolin® are common brand names for albuterol).

Long term control (maintenance) medicine:

  • Treats the inflammation of the airways
  • Helps control asthma and prevent problems
  • Must be taken every day (to keep the inflammation under control)
  • Includes inhaled medications such as Flovent, Qvar, and Advair, as well as oral medications such as Singulair.

Asthma Control

When asthma is under good control, the child should have minimal or no problems breathing. Signs of good asthma control include:

  • No coughing
  • No breathing difficulty (wheezing, chest tightness)
  • No waking at night with breathing problems
  • Normal activity levels (including play, sports, other activities)
  • No missed school days because of asthma problems

Asthma Action Plan

Every child with asthma needs a written asthma action plan. This management plan tells which medicines to take when the child is doing well. In addition it outlines how to increase medicines when problems start, and when to call the pediatrician. Using this plan as soon as problems start can help prevent the asthma flare from getting out of control. An asthma action plan can be made during an office visit for asthma.
Talk to your pediatrician about how to prevent asthma symptoms with exercise. Usually the child will need to take some albuterol before exercise. If asthma is under control, children should be able to exercise and participate in all activities.

Update on new HFA Inhalers

Metered dose inhalers (MDIs) have been changed from a CFC propellant (used in the old inhalers) to the newer HFA propellant. HFA inhalers operate a little differently from the old CFC inhalers. HFA inhalers have a finer mist with smaller particles. You will probably feel and taste less of the medicine. The smaller particles are easier to inhale and can move better and deeper into your airways (compared to CFC).

Cleaning the inhaler: (to be done once a week)

The medication is more sticky when contained in a new HFA inhaler, and can clog the exit hole. Read and follow cleaning instructions on the insert with your HFA inhaler.

  • Take the metal canister out of the plastic case
  • Wash the plastic case, running warm water through the case (top to bottom)
  • Shake off excess water.
  • Air dry.
  • Put the plastic case and metal canister back together after completely dry.

Never immerse the metal canister in water!

Priming the inhaler: (spraying into room, away from your face)

Priming is important to ensure accurate dosing and should always be done before using a new inhaler. The exact instructions vary with the different brands of albuterol. Also, if a Ventolin inhaler is dropped, it needs priming again.

ProAir HFA (albuterol):

  • Before first dose: 3 sprays
  • After 2 weeks of no use: 3 sprays

Proventil HFA (albuterol)

  • Before first dose: 4 sprays
  • After 2 weeks of no use: 4 sprays

Ventolin HFA (albuterol)

  • Before first dose: 4 sprays
  • After 2 weeks of no use: 4 sprays
  • When dropped: 4 sprays
  • After washing: 1 spray

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