Long-term control of asthma all in one guide
If avoidance procedures are successful (e.g., if your child is only allergic to cats and is no longer exposed to them) the asthma will be “cured” until exposure occurs again. Little or no medication may be required. This happy outcome will occur only if your child is allergic to just one or two easily avoided things.
Medications are required
- to bring, and keep, asthma under control.
- to treat flare-ups of asthma.
- to prevent asthma attacks triggered by exercise or allergens.
The specific medications and dosage needed to control an attack depend on the severity of the asthma. Severity is largely measured by how much the asthma symptoms interfere with a child’s life and the amount of prevented medication (e.g., inhaled steroids) needed to control the asthma. This is different from the acute attack that can occur in even mild asthmatics (severity level 1) under circumstances such as an exposure to a large amount of allergens, irritant chemicals, or a severe viral chest cold.
Defining Severity Levels
Severity Level I: Well-controlled asthma
The child is free of symptoms; bronchodilators are needed three, or fewer, times a week; and lung function is normal.
Severity Level 2: Symptoms are present from time to time on most days, but these are relieved by bronchodilators, which are required four or more times per week. The peak flow as measured at home is 10 to 20% below predicted or best achievable values. Peak flow is 15 to 25% lower in the morning than in the evening.
Severity Level 3: Asthma symptoms occur frequently, interfere with exercise or sleep, and may cause wheezing and chest tightness. The bronchodilator is needed daily, and peak flow readings are 20 to 40% below the predicted or best achievable result. The variability in peak flow readings from morning to-night is 25% or more.
Severity Level 4: Asthma symptoms are present almost continuously. They do not completely disappear even after bronchodilator inhalation. The peak flow reading is 40 to 50% below normal (or best previously achievable). In most children, increased symptoms, especially at night, and the need for bronchodilator puffs are the clearest indications of deterioration. In others, airway narrowing can become severe quickly, even before the child realizes that an attack is in progress. If your child can detect increasing symptoms, adjustments in medications are best related to symptoms and the need for increased bronchodilator puffs of long-term control of asthma
If your child is over age 3 to 4, and deterioration is difficult to determine at an early stage, It may be wise to adjust the level of treatment to regularly measured peak flow. Use a peak Bow meter with clearly indicated color coded zones that Indicate severity (see page 60. Eddy intervention can usually ward off serious attacks.
Monitoring therapy Guidelines of Long-term control of asthma
When asthma is first diagnosed, or at any time the asthma is not under control, diary cards that list symptoms, medications taken, and peak flow values provide an excellent method for following how well your child’s asthma is being controlled. By noting any major allergen exposures or triggers on the diary card, you can help your doctor help your child. The diary card used at the Asthma Center for Children, at the Brenner Children’s Hospital in Winston-Salem, North Carolina, is included in this book, and you can photocopy it for your child’s use.
Children older than 3 to 5 years, who need daily asthma medications, should use a peak flow meter and take measurements first thing in the morning and at bed time. The test is easy to perform — your child takes the biggest possible breath in through the mouth and, then he or she exhales through the mouth only as quickly and completely as possible into the peak flow meter (like blowing out birthday candles). The best of three successive attempts should be recorded on the asthma diary card.Contact your doctor if the peak flow is steadily falling, even if symptoms do not increase. Newer peak flow meters help you to adjust the medication according to deterioration in peak flow, because they are clearly marked with green, yellow, and red zones. These zones are related to the best achievable values, so that your doctor can provide written instructions as to what to do should the peak flow fall. Early morning flow rates are usually the lowest of the day. The variation between morning and afternoon results is called diurnal variability, and it is normally less than 10 to 15%.
Our goal is to achieve GREAT asthma control that is good asthma control on a minimum amount of medication. To achieve this, if your child is suffering a flare-up of asthma at the time treatment is started, you must first achieve good control by means of whatever medication is needed (including oral steroids).