Trying to relieve symptoms when a child is wheezing and gasping for air can be stressful. Having a written plan on what to do and when to do it reduces panic and helps make your response to an asthma attack or episode more effective for both caregiver and child.
Think of asthma action plans as written maps that help you determine the best tools to use when breathing gets difficult for children or adults with asthma.
In the case of 6-year-old Sean Welch of St. Louis, whose allergic asthma affects him year-round, all it takes is 20 minutes of playing outside to bring about an episode. Especially in the spring, when trees, grass, pollen, mold join other environmental triggers and pollutants fill the air.
For persons with asthma that is triggered by outdoor allergens, an immediate clean up when you come inside is an early line of defense.
“After he goes outside, we want to make sure he showers afterwards to wash the pollen off,” Harvey said. “And keep the windows closed.”
An asthma action plan was developed for Sean when he was diagnosed at age 4.
“This has been a good guide for me and everybody involved – my family, friends, the school – I keep enough medicine up there, so everybody is involved,” said Shawn Welch, Sean’s mother.
Along with an asthma action plan, additional tools are needed in an asthma management arsenal. Having prescribed medication on hand at all times, of course is one of them. An aero chamber, which also called a spacer, is another. The spacer connects to the rescue inhaler on one end and sends the full puff of medication into you mouth through the other side. A third item is a peak flow meter. It is a portable handheld device that measures how well air is moving out of the lungs. To use it, the person with asthma takes in a deep breath and blows into the meter. Using the meter regularly is one way to keep track on whether asthma symptoms are worsening or getting better. You can get these devices from the doctor.
“Everybody’s peak flow is different, so we decide what is your ‘personal best,’” said Dr. Felicia Harvey, a pediatrician at Betty Jean Kerr People’s Health Center in North St. Louis County.
The key symptoms to look for when a person is not breathing at their personal best are found along the side of the asthma action plan.
“If they can’t talk, they can’t play – those are signs that you need to get help quickly,” Harvey added.
Most asthma action plans are divided into zones similar to a traffic signal. Green means the person is breathing well, with no coughing or wheezing and can work and play and sleep through the night. The peak flow meter should read more than 80 percent of his/her personal best, at a level written out by the health care provider.
The yellow zone means breathing is experiencing some difficulty. The quick relief or rescue medicine is being used more than twice a week – in which case the physician should be contacted; there is some coughing, wheezing or chest tightness; along with problems at work or play and the symptoms wake you up at night.
For breathing treatments for the child at home, Harvey said most parents have for their child with asthma either an albuterol inhaler or in liquid form to be used in a machine called a nebulizer.
“The medication albuterol is a bronchodilator – it helps the tubes leading to the lungs, it helps them open up,” Harvey explained. “Normally we say every four to six hours, but when they are in the yellow zone or the red zone, you do as many as you need up to three times in one hour.”
The red zone is a serious medical alert, when emergency health care is needed. There is lots of trouble breathing; the person with asthma cannot work or play; he/she is getting worse instead of better and the medicine is not helping.
“I look at his chest too,” Welch said. “If it goes in and out.”
“She’s looking for retractions,” the doctor said. “If he is having troubling breathing, this goes in and out.”
Dr. Harvey was pointing to the circular indentation at the bottom of the throat at the top of the chest.
“It sucks in,” she said, because the lungs are working harder to breathe.
When a person is in the red danger zone, the peak flow meter is registering between 0 and 50 percent of the person’s personal best, and breathing function remains in the red zone after 15 minutes of quick relief treatment.
“You need to go to the emergency room if you need more than three in one hour,” Harvey said. “I normally tell them to go to the emergency room because after three times in one hour, they probably need to be on a continuous albuterol treatment.”
Sean’s pediatrician also sent him to a pulmonary specialist to help manage his asthma. There he received allergy testing and additional medication to help make his life as normal as possible. But there is nothing normal about a child not being able to simply go outside and play.
For more information about living with asthma, visit the Asthma and Allergy Foundation of St. Louis at aafastl.org or the American Lung Association at www.lung.org.
If you have been unable to access the asthma medicines due to high co-pays and other costs, contact Patient Services Incorporated at 800-366-7741; via e-mail at uneedpsi@uneedpsi.org or online at www.patientservicesinc.org.
