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Asthma In Kids Can Be Controlled

Expert says ways to manage it are at fingertips, but often not used

MONDAY, Aug. 12, 2002 (HealthDayNews) -- Parents and health-care professionals have the tools they need to control most cases of childhood asthma, but one nursing expert says those tools often go unused.

In the August issue of the American Journal of Nursing, registered nurse Carolyn Gallagher says many asthmatic youngsters aren't being diagnosed or treated properly.

"Most kids with asthma can have a completely normal life," Gallagher says. "A child doesn't need to miss school or play because of asthma."

According to Gallagher, asthmatic children should expect to have no or only minor symptoms; be able to sleep through the night without symptoms; not miss school because of asthma; be able to participate fully in peer and sport activities; and not have to visit the emergency room or hospital because of their asthma.

The first step, she says, is getting the correct diagnosis. Wheezing and shortness of breath are classic symptoms of asthma, but Gallagher says sometimes the only symptom might be a persistent nighttime cough.

"Asthma is not necessarily an obvious struggle with breathing. It can be as simple as coughing and not having endurance to run for a long time," she adds.

Parents need to keep a diary of their child's symptoms to help their doctor correctly assess the problem.

The next step is assessing the severity of the asthma. Depending on the child's symptoms and the results of a test -- known as spirometry -- that measures lung function, your child's asthma will be classified as mild, moderate or severe. Within those categories, it will be either persistent or intermittent.

After getting a diagnosis, the most important step is coming up with an asthma management plan. A written plan provides parents with guidelines to follow. For example, it should include details such as what symptoms call for the use of a bronchodilator or "rescue" medication. It should include a place for parents to track symptoms and responses to medications, so parents and health-care professionals can see what's working and what isn't.

Unfortunately, "half of physicians don't use a written asthma management plan," says Gallagher, who adds that many doctors also aren't conducting necessary follow-up visits with their asthma patients. She recommends seeing a doctor at least quarterly to assess a child's asthma plan.

Steroid inhalers are one of the biggest advances in asthma treatment, and when used preventively they can reduce the severity of symptoms. Yet, according to Gallagher's article, some physicians hesitate to prescribe these medications because of concern they might slow a child's growth. However, she says, studies have shown these medications are safe in children older than 1 year, and they don't "deter growth significantly."

Dr. Marianne Frieri, director of allergy and immunology at Nassau University Medical Center in East Meadow, N.Y., says Gallagher brings up a lot of good points in her article and agrees that asthma is often missed or undertreated. She cautions, however, that asthma can be overtreated as well.

"It's true that a lot of times primary-care pediatricians, because they're so busy dealing with acute problems, may not use the tools," Frieri says.

She recommends seeing an asthma specialist, and adds that nurses are very important in helping to educate parents and children.

One aspect Gallagher didn't address in detail in her article that is very important for parents is trigger management, Frieri adds. Asthma flares are caused by triggers, and these vary from child to child, but some common ones are mold, dust, pet dander and cockroach excrement. Limiting your child's exposure to these triggers will help keep the asthma under control, Frieri says.

What To Do

For more information on managing childhood asthma, visit these pages from KidsHealth and the American Academy of Allergy, Asthma and Immunology. Your children might want to read this article for kids on asthma, also from KidsHealth.

SOURCES: Carolyn Gallagher, R.N., freelance writer and researcher, Miami; Marianne Frieri, M.D., director, allergy and immunology, Nassau University Medical Center, East Meadow, N.Y., and professor, medicine, State University of New York, Stony Brook, N.Y.; August 2002 American Journal of Nursing
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