Step 1: Get Good Care
How to find the right doctor and develop an asthma action plan.
Step 2: Follow Advice Carefully
The importance of following the asthma plan.
Step 4: When to Find a Specialist
When to seek the opinion of a specialist. For example, an allergist.
Step 5: If You're Too Stressed, Seek Help
Who to talk with about your concerns.
Find the right doctor: Work with a doctor who you feel has sincere interest in you/your child and family.
It is easiest to diagnose asthma in children age6 year and older. This is done using a pulmonary-function test in the office. The test observes an improvement in lung function after the child inhales a bronchodilator, a medicine that relaxes the muscle around the airways. To diagnose asthma in young children who are not able to perform the lung-function test, the doctor may prescribe asthma medicine. He/she will then ask you to see if there is a decrease in asthma symptoms such as coughing, wheezing, and shortness of breath.
Your doctor should know: Best asthma medication
Tell the difference of asthma from other lung diseases (pneumonia)
Know medical conditions that aggravate asthma (sinusitis,reflux)
Use peak flow monitoring to manage asthma
You and your doctor should develop an asthma action plan specific to you/your child for when he/she is sick. The plan should include instructions of what medicines to take depending on the peak-flow values or symptoms. By following the plan, you can prevent the asthma from getting worse. Instructions will include the how to use bronchodilators and inhaled corticosteroid. It may also include how to use oral corticosteroid medicine, which can reverse an asthma attack.
It is best not to use an inhaled corticosteroid daily if you/your child does not need it. Singulair is a nonsteroidal anti-inflammatory medicine... Individuals with moderate-to-severe asthma may need an inhaled corticosteroid. This is good treatment if the other medicines are not effective.
Your action plan should also include the doctor’s phone number. It should also include instructions to go to the emergency room if you are unable to reach the doctor when peak-flow values are too low or symptoms too severe.
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At this point, you/your child’s doctor:
It is important to follow the advice your doctor has given you.
Research has shown that 30 to 50% of patients do not follow advice from the doctor. There are many reasons for this:
These are just some of the most common reasons.
Medication that reduces inflammation in the airways is an important part of treatment. We will talk about the other 2 treatments that relate to allergies in Step 4.
You/your child depends on you to get the medicine they need. If you are not sure that the diagnosis of asthma is correct, you should talk to your doctor about this. If you are still not convinced, you should go for another opinion. Let the doctor know if you do not agree with the type or amount of medicine.
Let the doctor know if there are any side effects from the medicine. He or she will ask you to stop the medicine for a few days. The doctor may ask you to either try the same medicine again or a different one.
If you were not pleased with part of the care given discuss it with the office manager. For example, you were not happy with the amount of time waiting in the office. If they do not respond to your need, think about switching to a new doctor.
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Everyone who oversees the asthma medicine your child takes, needs to be on the same team and follow the same plan.
All children react differently to taking their medicines.
Some infants are easier than others in giving medicines and nebulizer treatments.
For infants, it is important for you to relax and be consistent and insistent. The child will develop the routine that you create.
For older children, it is helpful for the parent to give positive reinforcement for taking the medicine. Positive reinforcement involves giving a child attention or something extra, for good behavior. For example, a reward might be renting a video or a new toy.
Reinforcement may not always be effective. Some children may not always follow their parents’ requests. Here are some tips to help:
Success will come if you are consistent and persistent.
If your spouse doesn’t think that the medicine for your child is a good idea and will not give it to your child, let your doctor know. A family conference should be scheduled to discuss this and other issues that affect your child.
When searching for a daycare for your child, look for a program that will make sure your child gets his/her asthma medicine. Ask if any of the children take asthma medicine. If so, ask when you can visit and watch them give the medicine. If they do not do it the right way, you might want to look elsewhere.
Also, since children pass viruses back and forth, try to place your child in a program with the least number of children.
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Asthma can be managed if you are following the right plan for you/your child. As mentioned in Step 2, medicine is one of 3 treatment options. The other 2 options are allergen avoidance and allergy shots/drops. In mild cases of asthma, anti-inflammatory medicine can control inflammation, prevent asthma symptoms and maintain normal lung function. Allergic individuals who live around allergens may need an increased amount of asthma medicine to control symptoms. This may include inhaled corticosteroid medicine, which has negative side effects on growth of children at higher doses.
To reduce the need for asthma medicine and/or better control symptoms, ask your doctor for a referral to an allergist.
The allergist is an asthma specialist. He/she is trained in finding out if you/your child is allergic to dust mites, cats, dogs, guinea pigs, molds, pollens, cockroaches, foods, etc. This is usually done by allergy skin testing. It can also be done by a blood test. The allergist takes a detailed history of allergen and irritant fume exposure (smoke, perfumes, etc.). Based on the test results, the allergist will give you information on what allergens and irritants to avoid.
This specialist will also be looking for factors that could be aggravating or masking themselves as asthma (pneumonia, cystic fibrosis) as mentioned in Step 1. He or she will review the information with you, and maybe start another medicine plan.
Those who live in an allergic environment or are not able to avoid allergens may get allergy desensitization treatment. In the past allergy injection treatment was the only form of immunotherapy. . This can take anywhere from 3 to 12 months to have a positive effect. Shots are given every week for about a year, then every 2 weeks for a year, and every 3 to 4 weeks for another year. Recently a new form of immunotherapy has been developed where the patient takes the injectable medicine by mouth every day. The FDA is close to approving this treatment.
After an allergy consultation, many families remove the allergens from their home environment. By doing so they reduce the amount of medicine you/child needs to take
One may be allergic to a family pet. In most situations, having the pet stay out of the bedroom, washing the pet a lot, placing a HEPA filter in the bedroom, and vacuuming the house often will improve the problems for those with asthma. If these strategies work, you do not have to remove the pet.
If an allergist is not available the doctor may ask you/your child to see a pulmonologist. This doctor is a lung specialist who treats asthma. He or she is an asthma expert who will perform a similar evaluation as the allergist. The difference between an allergist and a pulmonologist is that a pulmonologist does not focus on allergy diagnosis He/she also does not treat with allergy shots/drops.
If your child has colds a lot and recurrent ear and sinus infections that aggravate his or her asthma, the doctor may ask you to go to an otorhinolaryngologist. This is an Ear, Nose, and Throat (E.N.T.) doctor. The E.N.T. will check whether an operation is needed to clear up an infection that will not clear after many antibiotics. At that point, surgery may be needed. Some E.N.T. surgeons also do allergy testing and treat the upper airway with allergy shots/drops.
You may be asked to see a gastroenterologist for treatment of gastroesophogeal reflux. This is a stomach and intestine specialist who treats the flow of food, liquid, and gastric juices from the stomach that can cause asthma symptoms. Often techniques such as elevating the angle of the bed, thickening feedings, and taking medicine to decrease acid, can control and prevent asthma. Sometimes, surgery is needed to prevent asthma symptoms.
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Having a sick child is very stressful. Your child is not comfortable. He/she cannot do all of the activities. You and others are making sure that your child is taking his/her medicine. You are trying to decrease exposure to things that were positive on the allergy tests. You may be faced with having to remove your child’s favorite buddy, his/her pet dog. Your other child is angry with you because he/she feels that you are spending more time with his/her "sick" sibling. Your spouse is wondering when the 2 of you are ever going to have a night out. He or she is also wondering when you are going to return to sleeping in your bed, and not in your child’s, afraid that he will stop breathing. Your supervisor is losing patience and is less sympathetic with your frequent trips to the doctor and your decreased productivity. And your in-laws are questioning your capabilities as a parent and spouse. If you are feeling like this, you should consider finding someone to talk to.
The first instruction will look familiar: get good care. If you have good care and you are following advice carefully, your child’s symptoms should decrease.
Once an effective treatment plan has been made, it would be a good idea to talk to the doctor about your concerns. They should tell you that what you and your family are experiencing is common in most families with a chronic disease. The advice should include sticking with the treatment plan. If the child continues to have symptoms, return to the office for a re-evaluation. Tension and stress should subside when symptoms are decreased. If they don’t, the doctor may suggest to go to a support group, or see a mental health counselor.
A support group is a way to get information from others who "have been there and done that." They can give great advice on how to deal with your problems. Asthma and Allergy Foundation of America has educational support groups that meet often and offers a helpful newsletter and other resources.
Seeking mental help is right if your concerns persist despite counseling by your doctor and support group. [ back to top ]
Parents raising infants and young children with asthma know that when their child gets upset and cries, coughing and wheezing may follow. Some parents do not want to discipline their child because they do not want to make the asthma worse or the child to have an attack. Many concerned parents will try to stop the temper tantrum to prevent an asthma attack. They may give into the child to prevent asthma symptoms. If this parent-child behavior continues, the child can get the upper hand. This leads to stress for the parent and other members of the family. The child can then threaten to have an asthma attack if he/she doesn’t get their way.
Older children and teens can also bring on wheezing by yelling or shouting. This causes asthma symptoms the same way that exercise causes asthma. If you know that you will be having a talk with your child where there could be yelling or crying, give your child an inhalation treatment of a beta-2 agonist such as albuterol. This should prevent the crying and yelling-related coughing and wheezing so you can talk with your child without worrying about an asthma attack. You should speak to your child’s doctor to see if this is the right strategy for you and your child. [ back to top ]