Asthma Managing the Wheezing

Managing the Wheezing

Cases of childhood asthma are on the rise, which can be pretty frightening for parents. But the rise in asthma has been accompanied by much research on the subject, and today many doctors can recognize the early symptoms of asthma and help children with this condition.

It's not always easy for parents to recognize that a child has asthma. ''About half of those with asthma never wheeze,'' says Ted Kniker, M.D., professor of pediatrics, microbiology and internal medicine in the Division of Pulmonology, Allergy and Critical Care Medicine in the Department of Pediatrics at the University of Texas Health Science Center in San Antonio. ''Coughing is the most common symptom, and especially coughing at night. Your child may also complain of tightness in the chest and a general feeling of tiredness, particularly after exercise.''

What happens during an asthma flare-up? The airflow becomes reduced as the airways become inflamed and swell. Muscle contractions and thick mucus further impair breathing. A number of things can trigger asthma: pollen, a viral respiratory infection, pollution, dust, animal dander, mold or even exercise.

If you think your child may have asthma, take him to the doctor as soon as possible. If asthma is diagnosed, your physician may prescribe a medication to prevent the inflammation of airways and a bronchodilator, a drug to be used during flare-ups to help open tightened airways. These medications are administered by devices called inhalers and nebulizers. Your physician may also prescribe regular use of a peak flow meter, a hollow tube with a built-in numbered gauge that measures how much air is getting to the airways.

Here are tips from the experts to help you manage your child's asthma.

Make it part of a routine. Daily peak flow meter readings eliminate the guesswork when you're trying to estimate how well your child is breathing. Have your child use the peak flow meter at a specified time every day, such as right after he gets up. If the reading is lower than usual--indicating that less air is getting through the airways--check with your doctor to see if extra medication can be given to head off a full-blown flare-up, says Thomas Irons, M.D., professor of pediatrics and senior associate dean at East Carolina University School of Medicine in Greenville, North Carolina.

Practice peak-flow blowing. To produce an accurate reading on a peak flow meter, your child needs to take a deep breath of air, close her lips around the mouthpiece and then blow as fast and as hard as she can. This may take some practice. To help your child develop her blowing technique, place a cotton swab inside one end of a straw, suggests Nancy Sander, president and founder of the Allergy and Asthma Network/Mothers of Asthmatics in Fairfax, Virginia, and author of A Parent's Guide to Asthma. ''Make a game of it. Have your child take a deep breath, then place the other end of the straw in her mouth and tell her to blow out as hard and as fast as she can. The object is to make that cotton swab pop out of the straw and sail across the room. That gives your child a sense of the amount of effort needed to use the peak flow meter,'' says Sander.

Keep an asthma diary. ''Keep a record of symptoms and what triggered them, daily peak flow meter readings and medications,'' says Gary Rachelefsky, M.D., clinical professor of pediatrics and associate director of the allergy and immunology training program at the University of California, Los Angeles, and director of the Allergy Research Foundation in West Los Angeles. This information may help you avoid things that trigger symptoms and will help your doctor adjust your child's medication as needed.

Be knowledgeable about your child's medications. ''That includes the benefits and side effects,'' says Sander. Ask your pharmacist to include the package inserts with any medications you are getting. Ask your doctor or pharmacist any additional questions you may have about the medications, and write down the information so there's no confusion later.

Call a conference. Everyone involved with a child with asthma--from parents to day-care workers to school personnel--needs to appreciate the seriousness of this condition and know the details of your child's treatment, says Dr. Kniker. Arrange where your child's asthma medication will be kept during school hours and what plans are to be followed if symptoms develop.

Supervise practice sessions. Your physician may recommend a metered-dose inhaler for an older child to take asthma medications--but these devices are tricky to use and require practice. ''It takes a bit of coordination and timing to use them properly,'' says Dr. Kniker. ''Kids can start to use it adequately by the time they are 7, but not until they're 10 or 12 do most of them do it well.'' Many children find a metered-dose inhaler more comfortable to use with the help of a ''spacer.'' This collects the cloud of medication, which makes inhaling easier. If your child is just beginning to use an inhaler, watch closely to make sure he is following the doctor's instructions. Later on, check up from time to time to make sure he's following the correct procedure.

Encourage visualization. Sometimes kids breathe the medication from their inhalers too quickly or not deeply enough, depositing most of the medicine in their mouth and throat. To help your child use the inhaler properly, help her understand what the medicine is going to do and visualize where it should go, says Sander. ''Explain to your child that her lungs are injured, and you want the medicine to go where the injury is, which is deep down in the lungs. And then show her how to breathe in slowly by having her say--in her mind--a silly phrase or line of a rhyme as she takes her breath in. Then she should hold her breath as long as possible to let the medicine go as deeply as possible.'' This will help her prolong the breathing in.

Reach out for support. The Allergy and Asthma Network/Mothers of Asthmatics offers a monthly newsletter, The MA Report, which provides coping strategies, medical update information, tips and moral support for families affected by asthma and allergies, says Sander. For more information, send a business-size envelope with two first-class stamps to the Allergy and Asthma Network, 3554 Chain Bridge Road, Suite 200, Fairfax, Virginia 22030-2709.

Allergy-proof your home. Over 90 percent of children under age 16 who have asthma also have allergies, according to the National Institute of Allergy and Infectious Diseases in Bethesda, Maryland. ''That means that if your child with asthma is diagnosed as allergic to cats, dust mites or whatever, you need to allergy-proof your house,'' says Dr. Kniker. Encase your child's mattress, box spring and pillows with plastic covers, for example, and consider removing carpets from your child's bedroom. Ideally, cats and other pets to which the child is allergic should be removed from the house. If not, the pet should be washed regularly to reduce allergen shedding and should be kept out of the child's bedroom. (See page 203 for more allergy-proofing tips.)

Make your house a smoke-free zone. Smoke from tobacco, fireplaces and wood-burning stoves can trigger an asthma flare-up, says Dr. Kniker. No one should be allowed to smoke in a house where a child with asthma lives. And if your house has a wood-burning stove, it would be best to install some other kind of heating system.

Teach breathing from the belly. Breathing slowly in and out for ten times twice a day can help your child learn to use a metered-dose inhaler. And knowing how to breathe deeply and slowly can help calm him during an asthma attack, says Dr. Irons. But the kind of breathing makes a difference. Help your child practice diaphragmatic breathing--which means holding the upper chest still while taking a deep breath by moving the abdomen.

To do this, have your child lie on the floor and put a book flat on his belly, suggests Dr. Irons. Tell him to make the book move up and down as he breathes. ''Have him purse his lips and breathe in as deeply as possible. Then show him how to tighten his lips and let the air out very slowly.''

Make breathing exercises fun. To build lung power and exercise the airways, your child can take up a musical instrument or help you blow up balloons, says Sander. For both, the child should be encouraged to do diaphragmatic breathing rather than ''chest breathing.''

Keep extra inhalers around. In case of an asthma emergency, you want to have medication immediately available, says Sander. ''Always have one more inhaler than you think you'll need. Keep the extra taped to an inside cupboard door in the kitchen.'' But don't store a metered-dose inhaler over a hot stove and don't keep it in the glove compartment of a car in the summer, because heat can break down the valves in the canister, allowing small amounts of medication to escape. Extreme heat can also cause metered-dose inhalers to explode. These medicines are generally good for about two years, so keep a check on the expiration date, says Sander.

Consider medicine before exercise. ''If your child has exercise-induced asthma, he can prevent an attack by simply taking a dose of prescribed medicine from an inhaler a few minutes before he begins exercise or sports activity,'' says Dr. Kniker.

Determining the correct pre-exercise dose will require some trial and error, which should always be done in consultation with your doctor. ''Most kids need two puffs on their inhaler for adequate protection,'' says Dr. Kniker. ''Sometimes the child may have to repeat whatever dose she used within an hour or so. The weather may also affect the amount needed. Warm weather is easier on asthma than cold days.''

Keep calm during flare-ups. When an attack does occur, remain calm and speak in soothing tones. ''An asthma attack is distressing to parents,'' says Dr. Irons, ''but it will help the child to stay calm if you don't lose your cool.'' If your child is excited or coughing or crying, your nervousness or panic will make the wheezing worse.

Talk your child through it. During an asthma attack, talk to your child calmly, says Sander. ''Tell him, 'I'm here and I'm going to help you. First we're going to use your inhaler. Now let's use it together. Now the medicine is inside you, and very soon you will start to feel better. So now, let's relax while the medicine does the work. Hey, wasn't that a great vacation we took last summer?' '' Talking about fun times you've had together as a family helps divert his feelings of panic as the attack subsides, she explains. If your child's asthma episode does not respond to medicines as your doctor has instructed, seek immediate medical attention.

Reach for a tape or book. ''A child who starts to panic during an asthma flare-up can often be calmed with a favorite tape--either video or audio,'' says Dr. Rachelefsky. ''Concentrating on the music or show takes their minds off the attack.'' Reading a favorite storybook aloud can also help.