Dr. Seth Craig
Allergy & Asthma Center of Fredericksburg www.AllergyAsthmaDoctors.Com
The primary goal of asthma treatment is to allow the child with asthma to have a good quality of life and to be able to participate in all normal activities including social and sports activities, to feel well, to attend school or daycare regularly, and to have undisturbed sleep. The first step is to have a comprehensive evaluation by an allergist to determine the child’s type of asthma, its severity, its triggers, its effect on the child’s life and the effect on the family life; to evaluate the child’s environment, and to educate the family on the environmental changes needed and the medications needed to allow the child to live as normal a life as possible. Asthma is a highly variable condition: it comes and goes, can be severe at times and at other times it may not show any signs at all. Some children will outgrow asthma and some will not depending on genetic risk factors and environmental triggers. For instance if one or both parents have asthma there is an increased risk that the asthma in the child’s asthma will be more persistent.
Environmental factors such as airborne irritants including strong fragrances and chemicals, aerosols, and tobacco smoke worsen asthma symptoms. If the child has allergies to house dust, animal dander, pollen, or mold, these will aggravate the symptoms as well.
Asthma needs constant monitoring to maintain good control. You should have visits to your doctor every one to six months depending on the severity and degree of asthma control that has been achieved. These visits will help determine the dosage of controller medications need to be taken on a daily basis. You will also be taught how to monitor symptoms at home and how to adjust the medications depending on the child’s asthma symptoms such as cough, wheezing, shortness-of-breath, the ability of the child to run and participate in activities, and whether the child has cough or breathing difficulties which disturb the child’s sleep (or the family members sleep). You will need to know the difference between controller (preventive maintenance) medication such as Advair, Symbicort, Flovent, QVAR, and Singulair, and quick-relief (emergency) medications such s albuterol, ProAir, Proventil, Ventolin, Xopenex, and Maxaire. The asthma treatment guidelines from the National Institute of Health are very useful. (www.nhlbi.nih.gov – click on Lung Diseases – and then click on Asthma Action Plan for a standard form on which to list the medications and when they are to be used.
The Asthma Control Plan is mainly based on symptoms. A peak flow Meter is sometimes helpful in assessing the level of lung function when the person has difficulty in perceiving the severity of the asthma from the present symptoms. In general if a person has asthma symptoms more than twice a week or awakens with asthma more than on night per month, or if asthma limits the child’s activities, then the preventive (controller) medication should be started or increased.
Asthma education is a continuous process. The more you learn and put into practice, the more the child will benefit. Ask your allergist questions at each visit. Visit reliable websites such as those of the major allergy organizations : www.acaai.org, www.aaaai.org. Consider an asthma day camp or summer asthma residential camp to help children learn there are other children who have asthma and how they deal with it. Several of these camps in Virginia are sponsored by the American Lung Association: www.lungusa.org/virginia. (Click on “Asthma & Children” in the drop-down menu under “Asthma” and then click on “Asthma Camps” and you will be guided to find an asthma camp near you. The American Lung Association also has some Stop Smoking programs.
In summary, asthma is a complex and variable disorder which must be actively controlled to allow a child to have a normal good quality of life.