Feature Archive

Managing Asthma

WebMD Feature

May 8, 2000 -- Nothing can be more frightening than feeling as if you can't breathe. And that is exactly what happens during a severe asthma attack. While a sudden, unexplained attack often leads to a trip to the emergency room -- where asthma is then diagnosed -- persistent symptoms, such as coughing and wheezing, should tip off a parent or doctor to test for the disease.

If a child is very young when a diagnosis is made, he or she may be too young to understand what is happening -- much less remember to use their inhalers once diagnosed -- so parents need to pay attention to a daily treatment regimen to prevent attacks, as well as be on the lookout for signs of a sudden flare-up.

There are two main types of asthma medication: one for preventing attacks, another for on-the-spot treatment when the disease flares up.

Anti-inflammatory inhalers are used frequently to prevent asthma attacks. These are usually based on steroid compounds, and current research indicates that steroids offer the best long-term treatment, although there are non-steroid medications available as well. Most people under treatment use inhalers every day, often more than once, in order to inhibit swelling of the airway tissues. It is important to follow the exact management plan defined by the doctor.

For sudden episodes that can be brought on by a host of environmental triggers, doctors recommend also keeping bronchodilators on hand to rapidly open the airways. These are considered rescue medications, and using them frequently may indicate the need to modify a patient's anti-inflammatory medication or consider a higher dosage.

Even with proper use of preventive inhalers, there are a host of things that can lead to a sudden shortness of breath, says Gary Rachelefsky, MD, a clinical professor of pediatrics at the University of California at Los Angeles and past president of the American Academy of Allergy, Asthma, and Immunology. He says people with asthma can be hypersensitive to toxins such as cigarette smoke and smog and are often allergic to a wide variety of common particles found in dust, pet fur, mold, and cockroaches. Cold, damp weather, or exercise may also bring on an asthma episode.

Tools to Have on Hand

In addition to medications, a peak flow meter is a must-have. This tool measures the volume of air passing into the lungs, which allows parents to track the success of the asthma management plan and to determine whether to use rescue medications. Parents should also have a device called a nebulizer; resembling an oxygen mask, it can deliver bronchodilators to the airways during a flare-up in higher volume than an inhaler.

For a severe attack, Rachelefsky says to be on the lookout for blue-tinted lips, which indicate a lack of oxygen in the body. Very rapid breathing, in the 70-breaths-per-minute range, coupled with a lack of energy, or weak crying in very young children, may require an immediate trip to the emergency room. Don't take chances: more than 5,000 people die every year from asthma, according to the CDC, so it's best to err on the side of caution.

Will Wade is a San Francisco-based writer. He has a 4-year-old daughter and was the co-founder of a monthly parenting magazine. His work has appeared in POV Magazine and The San Francisco Examiner.

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