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• Asthma

• Wheezing: a high-pitched whistling or musical sound while breathing out
• Recurrent attacks of wheezing, coughing, chest tightness, and difficulty in breathing
• Often associated with sneezing and a runny nose
• Usually no fever
• Also called reactive airway disease ( RAD )
• This diagnosis must be confirmed by a physician

Asthma is an inherited type of "twitchy" lung. The airways go into spasm and become narrow when allergic or irritating substances enter them. Viral respiratory infections (colds) trigger most attacks, especially in younger children. If the asthma is due to pollens, it flares up only during a particular season. Asthma often occurs in children who have other allergic reactions such as eczema or hay fever. While emotional stress can occasionally trigger an attack, emotional problems are not the cause of asthma. Some common triggers are listed under the section titled "How can asthma attacks be prevented?"

Asthma attacks may be frightening, but they are treatable. When medicines are taken as directed, the symptoms completely clear up and there are no permanent lung changes. Asthma can be a long-lasting disease, but more than half of young people who have asthma outgrow it during adolescence.

Asthma is a chronic disease that requires close follow-up by a physician who coordinates your child's treatment program.

Spacers
Metered-dose inhalers work much better when they are used with a spacer (or chamber). The spacer (chamber) traps the asthma medicine and gives your child time to breathe it in. Children less than 6 years old can't coordinate all the steps required for using an inhaler. They must use a spacer because it provides for better delivery of the medicine to the lungs. Older children and adults should also consider using a spacer because it provides for better delivery of the medicine to the lungs.

Asthma Nebulizer treatments
Children younger than 4 year old can't use inhalers with a spacer. They need nebulized medicine treatment, using a machine.

Oral steroids or other asthma medicine
Although inhaled medicines work best for asthma, some children also need to take medicines by mouth.

Continuous asthma medicine
Most children with asthma need medicines only during asthma attacks. Children with the following symptoms usually need to take asthma medicines every day to allow them to engage in normal activities:

• 3 or more attacks of wheezing per week
• asthma flare ups lasting several days
• the need for emergency room care despite proper use of inhaler
• asthma triggered by pollens (use daily asthma medicines during the entire pollen season).

If you have any doubt about whether or not your child is wheezing, have your child start taking his asthma medicine. The later medicines are begun, the longer it takes to stop the wheezing. Once treatment with the medicines is begun, keep your child on the medicine until he has not wheezed or coughed for 48 hours. (Stay on the medicine at least 7 days.)

Many children wheeze soon after they get coughs and colds. Start the asthma inhaler or oral medicine at the first sign of any coughing or wheezing. The best "cough medicine" for a person with asthma is an asthma medicine, not a cough syrup. Always keep the medicine handy and take it with you on trips. If your supply runs low, get a refill.

Peak flow meters
The most reliable way to detect the start of an asthma attack is by using a peak flow meter, which can measure the air flow out of the lungs. Peak flow meters (PFM) measure how fast your child can move air out of the lungs. Every child asthmatic over age 6 should use a PFM. These measurements will tell you when to increase medications (flow rate less than 80% of baseline) and when to see a doctor immediately (less than 50%).

Fluid Intake
Fluids keep the normal lung mucus from becoming sticky. Encourage your child to drink one glass of fluid every 2 hours during waking hours. Clear fluids such as water are best. Sipping warm fluids may improve your child's wheezing.

Exercise-induced asthma
Most people with asthma also get 15- to 30-minute attacks of coughing and wheezing when they exercise strenuously. Running, especially in cold air, is the main trigger. This problem should not interfere with participation in most sports nor require a gym excuse. The symptoms can be prevented by using an inhaler 10 minutes before exercise. Teenagers with asthma usually have no problems with swimming or sports not requiring rapid breathing.

Hay fever
For hay fever symptoms, it's OK to give antihistamines. Poor control of hay fever can make asthma attacks worse. Recent research has shown that while antihistamines can dry the airway, they don't make asthma worse.

Going to school
Asthma is not contagious. Your child should go to school during mild asthma attacks but avoid gym on these days. Arrange to have the asthma medicines available at school. If your child uses an inhaler, he should be permitted to keep it with him so he can use it whenever he needs it.If your child can't go to school because of asthma, he should see a physician that same day for additional treatment.

Try to discover and avoid the substances that trigger your child's asthma attacks. Second-hand tobacco smoke is the biggest offender. If someone in your household smokes, your child will have more asthma attacks, take more medication, and need more emergency room visits. Try to keep pets outside or at least out of your child's room. Indoor pets need a weekly bath to remove allergic particles. Learn how to dust proof your child's bedroom. Change the filters on your hot-air heating system or air conditioner monthly. For allergies to molds or carpet dust mites, try to keep the house humidity less than 50%. Consider using a dehumidifier. If your child wheezes after any contact with grass, pollen, weeds, or animals, there may be pollen or animal dander remaining in the hair and clothing that keeps the wheezing going. Your child should shower, wash his or her hair, and put on clean clothes.

IMMEDIATELY IF:

• The wheezing is severe.
• The breathing is difficult or tight.
• The wheezing is not improved after the second dose of asthma medicines.
• The peak flow rate is less than 50% of normal.
• Your child starts acting very sick

During regular hours if:

• The wheezing is not completely cleared in 5 days.
• You have other questions or concerns.