Asthma Health Article

Preventive measures

Many simple steps can be taken to reduce asthma triggers in a child's home. Because children spend many hours asleep in their bedrooms, a number of control measures can be directed toward that room. Mattress and box springs, blankets, books, stuffed toys, clothing, carpeting, and other items in a child's room can gather dust mites. Enclosing mattresses, box springs, and pillows in plastic covers is often helpful, as is washing all bedding (and curtains) in hot water once a week. Eliminating or reducing the number of stuffed toys in a child's room (or at the very least washing them weekly) is a good idea. Removing carpeting from a child's room is very often helpful, because hard floors will gather far less dust than carpets. Vaporizers and humidifiers foster the growth of molds and dust mites and should be used sparingly in an asthmatic child's bedroom.

Other ways of controlling asthma triggers include prohibiting smoking anywhere in the house, avoiding smoke-filled areas, and avoiding the use of fireplaces or wood-burning stoves. Heating and air conditioning filters should be changed regularly. High-efficiency particulate air (HEPA) filters are available, which are very effective for removing allergens from household air.

Although there is no way to completely prevent the common cold, children with moderate or severe asthma should receive an annual influenza vaccination. Research is currently underway for an immunization to prevent RSV disease.

Treatment

The two main types of asthma medications are anti-inflammatory medications and bronchodilators. Anti-inflammatory medications decrease the inflammation and swelling of a child's airways, help decrease mucus production, and make the airways less sensitive to irritants. These medications can be used to prevent asthma flareups in the long run, as well as to break the cycle of inflammation that prolongs a flare-up.

Anti-inflammatory medications can be divided into two types: steroids and mast-cell stabilizers. Steroids can be inhaled, swallowed, or injected. Inhaled steroids (beclomethasone, triamcinolone, flunisolide), used regularly, can prevent attacks and maintain good lung function in many children with moderate to severe asthma. Used in this way, they may decrease the need for oral or injectable steroids, which have a higher risk of major side effects. Oral steroids (prednisone, prednisolone, and methylprednisolone) can be given either in short bursts for several days to hasten the end of a flare-up or, in children with severe, chronic asthma, on a daily or every other day basis in order to prevent flare-ups. Injected steroids are commonly used during severe asthma attacks that require hospitalization.

The inhaled mast-cell stabilizers (cromolyn, nedocromil) can be used several times a day to prevent attacks.

Bronchodilators relax the airways and increase their diameter, allowing for freer passage of air. The two types of bronchodilators are the theophyllines (theophylline and aminophylline, which is metabolized by the body as theophylline) and beta-adrenergic agents. Although side effects are fairly common with the theophyllines, in certain patients they can be very useful. The theophyllines are chemically related to caffeine, and the most common side effects are restlessness and insomnia. At higher levels, theophyllines can lead to nausea, vomiting, seizures, or cardiac arrhythmias. In addition, the theophyllines interact with a number of common medications, so a patient taking theophylline should check with a pharmacist or doctor before taking other medications.

Beta-adrenergic bronchodilators (albuterol, metaproteronol, terbutaline) relax the muscles that surround the airways and provide quick relief of symptoms; however, they have little or no effect on the inflammatory process that sustains an asthma attack, so repeated doses are necessary. In patients with moderate to severe asthma, this cycle can lead to dependency. Bronchodilators can be given orally, by injection, by metered-dose inhaler (puffer), or by nebulizer (aerosol machine).

Many asthma experts recommend a device called a "spacer" to be used along with metered-dose inhalers. The spacer is a tube or bellows-like device held in or around the mouth into which the metered-dose inhaler is puffed. This device enables more medication from a metered-dose inhaler to actually reach the lungs (as opposed to being swallowed).

School-age and older children may also be prescribed peak flow meters, simple devices which measure how easy or difficult it is for a child to exhale. With home peak-flow monitoring, it is possible for many children with asthma to discern at an early stage that a flare-up is just beginning and adjust their medications appropriately.