Understand Your Child's Asthma Action Plan

When your child has an asthma flare, it's natural to worry that they're in serious trouble or wonder if they just need a tweak to their medicine. That's where an action plan can help. It lays out the symptoms you should watch for and the steps to take to get their breathing under control.

Step 1: Identifying and Controlling Asthma Triggers

Children with asthma have different sets of triggers. Triggers are the factors that irritate the airways and cause asthma symptoms. Triggers can change seasonally and as a child grows older. Some common triggers are cigarette smoke, allergens like dust, dust mites, and pet dander, viral infections, irritants like strong perfumes, exercise -- which is often the most common asthma trigger -- breathing cold air, and weather changes.

Identifying triggers and symptoms can take time. Keep a record of when symptoms happen and how long they last.

Once you spot patterns, you can avoid some of the triggers. Talk with your doctor about starting environmental control measures that will limit those allergens and irritants. Remember that allergies develop over time with continued exposure to allergens, so a child's asthma triggers may change.

Others who provide care for your child, such as babysitters, day care providers, or teachers, must be informed about your child's asthma treatment plan. Many schools have programs for their staff to learn about asthma and recognize severe symptoms.

Here are some suggested environmental control measures for different allergens and irritants:

Indoor controls

To control dust mites:

• Use only polyester-filled pillows and comforters (never feather or down). Use mite-proof covers (available at allergy supply stores) over pillows and mattresses. Keep covers clean by vacuuming or wiping them down once a week.
• Wash your child's sheets and blankets once a week in very hot water (130 degrees or higher) to kill dust mites.
• Keep upholstered furniture, window mini-blinds, and carpeting out of a child's bedroom and playroom because they can collect dust and dust mites (especially carpets). Use washable throw rugs and curtains and wash them in hot water weekly. Vinyl window shades that can be wiped down can also be used.
• Dust and vacuum weekly. If possible, use a vacuum specially designed to collect and trap dust mites (with a HEPA filter).
• Reduce the number of dust-collecting house plants, books, knickknacks, and non-washable stuffed animals in your home.
• Avoid humidifiers when possible. Moist air promotes dust mite infestation and mold growth.

To control pollens and molds:

• Ventilate bathrooms, basements, and other damp places where mold can grow.
• Consider keeping a light on in closets and using a dehumidifier in basements to remove air moisture.
• Use air conditioning because it removes excess air moisture, filters out pollens from the outside, and provides air circulation throughout your home. Filters should be changed per the manufacturer's recommendations.
• Avoid wallpaper and carpets in bathrooms because mold can grow under them.
• Use bleach to kill mold in bathrooms.
• Keep windows and doors shut during pollen season.

To control irritants:

• Do not smoke (or allow others to smoke) at home, even when a child is not present.
• Do not burn wood fires in fireplaces or wood stoves.
• Avoid strong odors from paint, perfume, hair spray, disinfectants, chemical cleaners, air fresheners, and glues.

To control animal dander:

• If your child is allergic to a pet, you may have to consider finding a new home for the animal or keeping the pet outside at all times. Even if your child isn't allergic to the animal now, they can become allergic with continued exposure.
• It may (but does not always) help to wash the animal at least once a week to remove excess dander and collected pollens.
• Never allow the pet into the allergic child's bedroom.
• If you don't already own a pet and your child has asthma, consult your child's doctor if you're considering getting one.

Outdoor controls

• When mold or pollen counts are high, give your child medications recommended by your doctor (usually an antihistamine like Zyrtec or Claritin) before going outdoors.
• After playing outdoors, the child should bathe and change clothes.
• Drive with the car windows shut and air conditioning on during mold and pollen seasons.
• Don't let a child mow the grass or rake leaves.

In some cases, the doctor may recommend immunotherapy, a way of slowly improving your child’s tolerance of allergens that bother them when control measures and medications aren’t working. Talk with your child's doctor about these options.

Step 2: Anticipating and Preventing Asthma Flare-Ups

Patients with asthma have long-term or chronic inflammation of their airways. Inflamed airways tend to constrict (or narrow) whenever they are exposed to a trigger (such as infection or an allergen). Some children with asthma may have increased inflammation in the lungs and airways every day without knowing it. Their breathing may sound normal and wheeze-free when their airways are actually narrowing and becoming inflamed, making them prone to a flare-up. To better assess a child's breathing and determine risk for an asthma attack (or flare- up), breathing tests may be helpful, but in your home, health care professionals are more likely now to use a simple color-coded system (see below) to help you assess what kind of treatment your child needs.

Step 3: Taking Medications as Prescribed

Developing an effective medication plan to control a child's asthma can take time and trial and error. Different drugs work more or less effectively for different kinds of asthma, and some drug combinations work well for some children but not for others.

There are two main categories of asthma medications: quick-relief medications (rescue medications) and long-term preventive drugs (controller medications). Asthma drugs treat both symptoms and causes, so they effectively control asthma for nearly every child. Over-the-counter drugs, home remedies, and herbal combinations are not substitutes for prescription asthma medication because they cannot reverse airway obstruction and they do not address the cause of many asthma flares. As a result, asthma is not controlled by these nonprescription drugs, and it may even become worse with their usage.

Step 4: Controlling Flare-Ups by Following Your Asthma Action Plan

When you follow the first three steps of asthma control, your child will have fewer asthma symptoms and flare-ups. Remember that any child with asthma can still have an occasional asthma attack, particularly during the learning period between diagnosis and control or after exposure to a very strong or new trigger. With proper patient education, having the right medications on hand, and keen observation, families can learn to control most minor asthma flare-ups by starting treatment early, which will mean less emergency room visits and fewer admissions, if any, to the hospital.

In the past, doctors had kids breathe into a tube called a peak flow meter to measure how much air they put out. These days, many doctors instead ask you to watch your child's behavior and look for specific signs to see which zone they're in.

The Action Plan Zones

Your child's doctor will help you create a plan that's right for them. Most use a simple system that's set up like a traffic light: green for "go," yellow for "caution," and red for "stop -- danger!" See how your child fits into each color zone, and you'll know how to respond.

The green zone

This is where you want your child to be. You'll know they're in the green zone when they:

• Are breathing easy
• Aren't coughing or wheezing
• Can do their regular activities
• Sleep through the night without coughing

If you can say "yes" to those four items, they're doing well. No need to hold them back from their usual routine. Let them enjoy school activities and playtime, too.

Even when they’re doing well, keep up their regular medication. Your doctor may call it "controller" medicine because it keeps their asthma in check over the long haul. Make sure you follow the instructions for the dose and when to take it.

The yellow zone

Think of this category as a big yellow "caution" sign. You'll know your child belongs here when they:

• Coughs
• Looks like they're short of breath
• Wheezes
• Has some trouble doing their usual activities
• Has a tight feeling in their chest
• Wakes up at night with breathing problems

If they have some or all of those, make sure they're taking their regular treatment plus any additional medications their doctor recommends. They might prescribe some that give quick relief when your child has symptoms, called rescue medicines.

What should you do if the medications don't help? It depends on your plan. Your doctor may tell you to repeat the doses or call their office. Either way, keep in mind that your goal is to get your child back in the green zone.

The red zone

This zone means DANGER. Call your doctor right away if your child's in this zone. Your plan may ask them to take their rescue meds. If you think the symptoms are severe, don't hesitate to call 911.

Here's what to watch for:

• They’re breathing hard and fast.
• Their nostrils are open wide.
• They have trouble walking.
• They're not talking well.
• Their ribs are showing.

Your doctor should provide a written step-by-step plan outlining exactly what to do on a daily basis to prevent a flare-up, what to do if your child has a flare- up and what actions to take before exercise to prevent a flare up. The plan is different for each child. Over time, families learn to recognize when to start treatment early and when to call the doctor for help.

Keep the Plan Handy

Keep it where everyone in the house can see it. Also give a copy to everyone who cares for your child, including:

• Teachers or day-care workers
• School nurses
• Babysitters
• Coaches
• Camp counselors
• Other family members

Make Sure It's Up to Date

Review the plan with your child's doctor at least once every 6 months. If they are often in the yellow zone, check that they take their medicine the right way and use their inhaler correctly. They may need to get to a higher dose to get their asthma under control.

If your doctor switches your child to a new medicine or increases the dose, note it on the plan. Then, hand out a new copy to everyone who needs it.

Your action plan won't "cure" your child's asthma, but it can make a huge difference in how well they keep it under control. These simple rules can give you peace of mind when breathing problems flare.

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