Chuang Gung Medical Foundation, Division of Pediatric Allergy, Asthma and Rheumatology - UNREGISTERED VERSION

Health Education for Asthma – Parents

Liang-Shiou Ou, M.D

What is Asthma?
Asthma is a chronic inflammation reaction of the airway. The cause could be genetic in nature, and induced by external stimulation. This type of inflammation is different from bacterial or viral infection; inflammation of the airway causes it to contract, secrete more mucus, induce coughing and wheezing, and feelings of tightness in the chest. The symptoms occur frequently at night or during the early morning hours, so the key to treat asthma is to prevent inflammation of the airway.

When to Suspect Asthma?
Asthmatic patients usually display the following symptoms: intermittent difficulty in breathing, wheezing, chest tightness, and coughing; occurs frequently during the night or early morning. However, wheezing does not always indicate asthma, but prolonged coughing could be a sign of asthma. Asthma should be considered when the following symptoms arise:
(1) Prolonged or repetitive cold symptoms, especially more pronounced during seasonal changes;
(2) more visible during early morning and night;
(3) susceptible to wheezing and coughing after exercises;
(4) coughing, chest tightness and wheezing when in contact with allergens;
(5) repetitive during cold;
(6) symptoms improved when bronchodilator is used;
(7) family history of asthma or allergy.

Adjustment to Household Environment
Since Taiwan is situated in a sub-tropical region, the common asthma inducing allergens are dust mites, mold, cockroaches and pet skin debris; it is less common to be allergic to pollen as opposed to European and North American regions. The aforementioned allergens are usually found in beddings, blankets, pillows and curtains; that’s why environment adjustment is also an important part of asthma treatment.

Use a dehumidifier and controlling the relative humidity to around 50%; use nylon-based bedding, as cotton products are easier for dust mites to conceal and breed; avoid using curtains lest you wash them frequently; pillow cases and towels should be washed at least once every 2 to 3 weeks; immerse them in hot water at 65℃ before washing; replace spring mattresses with a wooden bed, or use a dust mite-proof bed covering; consider simpler interior furnishings.

Control Asthma Through Careful Monitoring
During an asthma attack, the airway constricts and reduces the amount of air. A peak flow meter will begin to decrease in values hours or even days before the onset of asthma symptoms; using such meter to predict the optimal treatment time can prevent the attack from happening or worsening. Therefore, it is recommended to monitor the conditions of asthmatic children daily with the peak flow meter.

Pre-treatment for Asthma Attack Before Seeking Medication Attention
Families with known asthmatic children who have medicine on hand should first test with a peak flow meter. If the value is less than 80% of the personal optimal value, use the bronchodilator; if the value remains lower than 80%, repeat usage every 15 to 20 minutes. If the value persists at lower than 80%, considering using oral steroids in conjunction with bronchodilators (or oral medicines). If there are signs of cyanosis, cold sweat, delirium or PEF lower than 60%, seek medical attention immediately. Keep calm during the process; drink lots of warm water and rest when breathing is slowed.

Can Asthmatic Children Participate in Exercises?
Although it was shown that 50 to 70 percent of asthmatic children will experience coughing, wheezing and shortness of breath during exercise, due to broncho-constriction, these symptoms are preventable. Exercise is crucial to the normal development of the body and mind of children. Asthmatic children should warm-up longer (30 min or more) before engaging in exercises, or use appropriate bronchodilators before exercise, to reduce the severity and chance of asthmatic attacks. Choosing a milder sport like swimming will also reduce chances of asthmatic attack, while keeping children fit and healthy.

Inhalant Type Steroid Does Not Affect Children’s Growth
As long as asthmatic children are getting proper treatment, their body weight and height will not be different from normal children. It is our wish to give asthmatic children the same schooling, sleep and exercise as normal children. With proper treatment, their growth is the same as normal children, so there is no need to worry about it. Studies have shown that even with 6 years or more of inhalant steroid usage, the body weight and height of asthmatic children are not affected. Their bone densities and adrenal functions also remained normal, so parents do not have to worry about the side effects of steroids on children growth.