The Enid News and Eagle, Enid, OK

Enid Features

June 6, 2014

Asthma control: Coordinated team approach needed for kids

It may not require a village, but sometimes it takes a well-coordinated team to control a child’s asthma.

Asthma is a complex inflammatory disease of the lungs and airways that affects more than 20 million children and adults in the United States. Anyone of any age can have asthma, but it disproportionately affects poor children and adolescents living in urban areas.

Particularly during certain times of year, the disease can cause symptoms severe enough to send many children to the emergency room. With good daily treatment and monitoring, most patients can avoid these episodes and live a fairly normal life.

Asthma occurs when the body’s immune system produces an inflammatory reaction in response to what it considers a threat: bacteria, viruses, pollen, dust or other irritants. The lining of the airways becomes inflamed and swollen, leaving less room for air to move through. The muscles around the airways tighten and cause what is known as a bronchospasm. Excess mucus is produced, making it even harder for air to move through.

The result is coughing, wheezing, tightness in the chest and shortness of breath. These can be very frightening, and about 200 children die of asthma-related issues every year. Emergencies can be prevented with careful use of medications and understanding of triggers.

Over the long term, inflammation can be lowered and managed with anti-inflammatory medications taken daily to keep asthma symptoms from occurring in the first place. For quick relief, when and if symptoms do occur, rescue medications must be prescribed and handy for use. These act quickly to relax the tightened muscles around the airways.

Finally, a person with asthma has to be aware of triggers in the environment — allergens, pollen, dust, molds, cigarette smoke, air pollution, cold air or exercise. For some of these, such as allergens, medications may be useful; generally speaking, though, the patient must learn to avoid these triggers whenever possible and be ready to respond should they trigger an attack.

With so many variables, most doctors recommend having a personal asthma action plan. This plan must be understood and followed by everyone who cares for the child — babysitters, day care staff, teachers, school nurses and camp counselors.

If all of that is not complicated enough, there is more. Most of the long-term and the quick relief medications involve using specialized devices and equipment — inhalers, spacers, discuses, compressors, peak flow meters, spirometers, nebulizers and masks.

There are many steps involved in using most of these devices properly. And a mistake means the child is not getting the proper dose and may be at risk of severe symptoms.

When emergency department staff see asthmatic children being brought in repeatedly, it’s pretty easy to figure out that at least some of these children either have no long-term Asthma Action Plan or else it is not being followed as closely as it should be.

The IMPACT DC (Improving Pediatric Asthma Care in The District of Columbia) program was based on such an observation. Doctors found that very few of the children being brought in to the emergency department were going back to primary care providers who could help them re-establish daily control.

The Asthma Clinic that was established as a result made substantial use of asthma educators, reviewing with families the basics of asthma care and the need for a coordinated treatment approach involving the family, school nurses, pharmacists and subspeciality doctors and nurses.

A study found that subjects at the clinic had dramatically fewer emergency department visits, significantly better use of daily controller medications and dramatic improvements in asthma-related quality of life.

The clinic was considered not an end in itself, but a means to an end — greater understanding by the patient and his or her family about the importance of day-to-day self-management in order to prevent short-term flare-ups.

It all starts with education — how and why to monitor your breathing and take-control medications, even when you don’t have symptoms. The many devices used by the patient are designed to make asthma control easier, but they do so only if they are used properly. The best way to learn is to have a health professional demonstrate proper use, then have you demonstrate back to them to make sure you have it right.


Rupp is care coordinator for Long Term Care Authority of Enid Aging Services. Contact her at 237-2236.

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