Managing Asthma
An estimated 17 million Americans have asthma, and many of them needlessly avoid physical activities, miss days from school or work, and deal with frequent or daily symptoms like coughing, wheezing, shortness of breath, and chest tightness. Although there is no cure for asthma, it is very manageable if you follow an asthma action plan, including controlling the triggers in the environment, monitoring symptoms and airflows (peak flow monitoring), and following the medication plan provided by your doctor. An otherwise healthy person who is diagnosed with asthma can lead a normal, active life. Anyone who has asthma and feels it is not being properly controlled should make an appointment with either a primary-care physician or internist who has special training in asthma management or with an allergist or immunologist. You do not need to endure asthma symptoms.
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A peak-flow meter is a device that measures how fast air comes out of the lungs when you exhale forcefully. This measure is called a peak expiratory flow, or PEF, and is measured in liters per minute (lpm). A person's PEF may drop hours or even days before asthma symptoms are noticeable. Readings from the meter can help you recognize early changes that may be a sign of worsening asthma. By taking medication before symptoms occur, you may be able to stop the episode quickly. The peak-flow meter can also be used to help you learn what triggers asthma, decide when to add or stop medication, and know when to seek emergency care.
A peak-flow meter is simple to use. Most children ages 4 and older as well as adults should be able to perform a PEF with good results. You will be instructed how to use the peak-flow meter by your doctor or care provider. Basically, it involves the following:
- Stand up, and take in a deep breath to completely fill your lungs.
- Place the mouthpiece in your mouth, with your teeth and lips sealed tightly around it.
- Blast the air out through the meter as hard and as fast as possible.
- Record the number on the meter.
- Repeat this two more times, and record the best of the three values.
There are predicted values for PEF readings, but all asthmatics should find their own "personal best" PEF. The "personal best" PEF is the highest number you or your child can achieve over a two- to three-week period when asthma is well controlled—meaning, you feel good and do not have any symptoms. The personal best PEF is the number to which all other peak-flow readings will be compared. Your doctor will tell you how to find your personal best PEF and what changes are important. This will be part of your asthma action plan.
An important part of learning to control asthma is keeping a daily diary of your symptoms and PEF measurements and following the action plan that your doctor has developed with you. Recording this information will help you be aware of early signs of asthma episodes. When your symptoms occur or your PEF (peak expiratory flow) readings decrease, you can add medications per your action plan and/or contact your doctor to determine the next step. Your doctor may also use this diary to evaluate how well a treatment plan is working for you. Your doctor may give you special forms or pamphlets that you can use as a diary.
One of the goals of asthma therapy is to maintain a normal, healthy lifestyle, which includes physical activity. Having asthma should not be used as an excuse to avoid exercise. Taking medications as prescribed by your doctor, avoiding triggers, and monitoring your symptoms and lung function will help you achieve this goal. If your symptoms prevent you from participating fully in physical activities, talk to your physician. A small change in your action plan may solve the problem.
Health experts generally agree that exercise should be performed four to five times per week for at least 30 minutes. Activities that involve short, intermittent periods of exertion such as volleyball, gymnastics, baseball, and wrestling generally are well tolerated by asthmatics. Swimming and biking may also be good choices. Activities that involve long periods of exertion (soccer, distance running, basketball, and field hockey, for example) and cold-weather sports are more likely to be problematic. However, many people with asthma are able to fully participate in these activities as well.
Here are some steps you can take to control symptoms:
- Inhaled medications taken prior to exercise can control or prevent symptoms. The preferred medications are the short-acting, beta 2-agonist inhalers (albuterol, pirbuterol), which can prevent the airways from spasming when taken 15 to 20 minutes before exercise. These medications can control EIA for four to six hours. Other medications that may be useful are the long-acting bronchodilators (salmeterol, formoterol), which provide 12-hour control. When these medications are taken before work or school, EIA symptoms may be avoided throughout the day. But it is still important to have a short-acting bronchodilator available in case symptoms occur during a workout. If these measures fail, your physician may advise daily therapy to control the underlying inflammatory process that results in airways sensitive to drier and colder air.
- Perform warm-up exercises as you begin a workout, and then cool down after exercise.
- If the weather is cold, exercise indoors or wear a mask or scarf over your nose and mouth.
- If you have allergies, avoid exercising outdoors when pollen counts are high. Be aware of days with high air-pollution levels as well.
- Restrict exercise only when you have a viral infection or other asthma flare-up.
- Exercise at a level that is appropriate for you.
People with asthma can travel happily and safely, but they may need to do some advance work. Here are some wise preparations:
- Get a physical: If your doctor has not examined you in a while, this is the time. Even if you don't need an exam, talk to your doctor or allergist if you are planning a long trip or if you have specific concerns about your asthma. Discuss with your doctor what you should do in case of an emergency, and take his or her phone number for emergency contact.
- Stock up on medications: Make sure that you have more than enough of each medicine, and keep them within reach at all times. If you have an attack on an airplane, whatever has been checked in won't help you. Pack your devices, your diary, and your asthma action plan. Continue to maintain your daily asthma diary as much as possible.
- Take a buddy: If possible, travel with someone who knows what to do to help you.
- Plan for shots: If you receive allergy shots, contact your allergist to determine if the length of time you will be away is a problem with your allergy-shot schedule. Remember, if you want to receive these injections while on vacation, you will need to arrange to have them given at a physician's office that can treat you if you have a reaction. Allergy shots should never be self-administered or administered without proper medical supervision.
- Check out medical care: Make sure your insurance will cover you where you'll be staying. Know where the hospitals are and what the emergency numbers and procedures are, just in case. Larger, reputable cruise lines typically have some medical facilities on the ship, but what if you need more care than they offer? In developing countries, especially, know where to find good medical care.
Beyond the medical preparations, here are some practical considerations to keep in mind:
- Are your hosts smokers? Do they have pets? How can you reduce your exposure to triggers?
- If you expect to try any physical activities you're not used to—mountain climbing or scuba diving, for example—be aware of the possibility of exercise-induced asthma. Build up gradually, and have a buddy with you.
- Talk to the chef. If you have a food allergy, it may be impossible to be absolutely sure that you are steering clear of triggers, but you can improve your chances by letting whoever is preparing the food—airline, cruise ship, hotel, restaurant, family member, or friend—know about your allergies as far in advance as possible. Keep your epipen with you at all times if your doctor has prescribed this for you.
- How polluted is your destination? Is smoking restricted in hotel rooms or restaurants? Will your nebulizer work on the voltage in that country?
- Some international flights are smoking flights, and if you have to take one, try to get seated as far away from the smoking section as possible. If you are renting a car, try to get a late-model, non-smoking car, and, if you are traveling through an area with pollen and molds, close the windows.
Working with your child's school
Children with asthma often have symptoms at school, so it is very important that school personnel be involved in prevention and care. This is true even if the child does not need to take asthma medicines at school. Since most schools have numerous children with the condition, chances are good that a number of teachers and the school nurses will be experienced at handling it. Still, it is important to take some steps to ensure that the child's condition is properly managed:
- Talk to your child and explain as much about the disease as is understandable. Ideally, he or she should be able to keep track of when it is time to take medicine, use the inhaler properly, and use a peak-flow meter, understand what the reading means, and know what to do if that number is too low.
- Tell school officials about the child's asthma, including how severe it is, what the triggers are, and what medications are used. Be sure they know how to properly administer the medication, how to use the peak-flow meter, and what to do in case of an asthma attack. The school personnel should have a copy of your child's asthma action plan available to each person who has direct contact with your child throughout the day.
- Check the child's classroom, and other areas where he or she spends time, for asthma triggers. If you identify possible triggers (dust mites are common triggers in a classroom, for example, as well as chalk dust and pets), work with the teacher to reduce exposure.
- Provide all medicines to the school nurse, along with the proper instructions, and restock on a regular basis.
- Check every few months or so that the school is on top of the situation.
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The more teachers and other adults at school who know about a child's asthma, the better. The child could have an attack in the library or music class or in the hallway, when the classroom teacher isn't present.
Here is a list of people at school who must be involved:
- Class teacher or teachers: The more the class teacher knows and the more vigilant he or she is, the better the chances that your child will be properly helped. Art and music teachers should be aware of the situation, too.
- Physical education teacher: The PE teacher is particularly important, as many children develop exercise-induced symptoms.
- School nurse: You must talk to the school nurse to determine what the school policies are. If your school shares a school nurse with other schools, make an appointment to see the nurse and find out who will be in charge when the nurse is not around. The school nurse will most likely provide forms that your doctor must fill out before the child can be treated at school. Make sure these are completed and returned in a timely fashion so as not to delay treatment should symptoms occur.
- Office staff, principal
- Counselor: The counselor should know what's going on, especially if the child has learning difficulties or problems interacting with other kids.
- Substitute teachers: Your child's regular teacher should inform any substitutes of his condition—this is where a written set of instructions from you can be particularly valuable. It's also a good idea to talk to substitute teachers yourself.
Today's treatments can control asthma so that, most of the time, students can participate fully in physical activities. But since symptoms vary from student to student and often from season to season, it's important that physical-education teachers and coaches understand the individual needs of their students. While modifications to a lesson or activity may be necessary at times, students with asthma should be included as much as possible.
Recognizing asthma symptoms and taking appropriate action in response are crucial to asthma treatment and control. The student's asthma action plan and the school's emergency plan should be easily accessible so that staff, substitutes, volunteers, and aides know what to do.
Symptoms of exercise-induced asthma may last several minutes to an hour or more and include chest tightness and shortness of breath quite different from the normal breathlessness that results from aerobic exercise. The student should stop what he's doing and follow his asthma action plan. The student may need help in using his or her inhaled medication. The teacher or coach should watch to make sure the medication works.
Every parent of a child with asthma worries about what will happen if the child has a severe asthma attack while at school. You'll worry less if you make sure the school is prepared to deal with an emergency.
- Give school officials a peak-flow meter, if possible. They should have a clear set of instructions (your doctor can help with this) about what is a low peak-flow reading, what symptoms they should look out for, and what treatment they should give (i.e. how to follow the action plan).
- Tell school officials when to call your doctor and when to call 911.
- Make sure that the instruction sheet you hand out to all school officials has your doctor's phone number, your preferred hospital emergency room, and your contact numbers.
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