Does your child have an asthma action plan?

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We’re finally back to familiar schedules and routines now that school is in session, but leaving children in the care of other adults can be understandably frightening for the parents of asthmatics. Whether your child is in school, at football practice or on a field trip, the reigns have to be handed over to other adults who know your child and their asthma background.

Prior to the beginning of the school year, most children will visit their pediatrician, primary care provider or allergist/immunologist for their annual well-child appointment. Here, most asthmatic children will receive or review (and possibly update) their existing asthma action plan. This well-outlined plan created by you and your physician is unique to your child’s asthma, and will serve as a guide for all parties to use in preventing and reducing your child’s asthma flare-ups (or attacks) and emergencies.

The asthma action plan should include most of the details you’d expect, including possible triggers, early flare-up symptoms to look for, how to manage them with medication and who to reach out to for help should your child’s health status become emergent, concerning or life-threatening.

Triggers are harmless to most people, but can bring about flare-ups for asthmatics. These commonly include:

• allergens (pet dander, dust mites, pollen, mold)
• change in weather
• exercise
• irritants or pollutants in the air (perfumes, cleaning products, fumes)
• respiratory infections (common cold, flu)

When triggers lead to an asthma attack, breathing becomes difficult due to irritated and swollen airways in the lungs. Some of these flare-ups are mild, but others can be life-threatening, which is why identifying early signs and symptoms is critical. These usually include:

• coughing
• chest tightness
• labored breathing, or shortness of breath
• grunting
• audible wheezing

If the flare-up is severe and rescue medications aren’t working, symptoms can drastically worsen. Whoever is with your child should call 9-1-1 immediately or take the child to the nearest emergency department if these symptoms are noted:

• difficulty speaking
• fatigue or drowsiness
• ribs visible during breathing (retractions)
• trouble breathing, even when sitting still
• blueness around lips or fingertips
• nostrils open wide when breathing

Your child’s asthma medications, both controller meds and rescue meds, will keep their airways from swelling/narrowing when triggers are absent or successfully avoided. The controller meds (i.e. Singulair, Flovent, Advair Diskus, QVAR) typically assist in preventing flare-ups and reduce the need for rescue meds (i.e. Albuterol).

How to use an inhaler (with spacer)

1. Assemble the spacer, if necessary.
2. Remove the inhaler cap.
3. Check the devices dose counter, if present.
4. Shake inhaler well for about 5-10 seconds.
5. Insert inhaler upright into the rubber end of the spacer
6. Put the mouthpiece between teeth (without biting) and close lips to form a good seal. If using a spacer with a mask on younger children, place the mask over the nose and mouth to form a good seal.
7. Breathe out gently into the spacer.
8. Keep the spacer horizontal and press down firmly on the canister once.
9. Breathe in and out normally for 3-4 breaths.
10. Remove spacer from mouth.
11. Breathe out gently.

Repeat steps 6-11 for the prescribed number of puffs.

How to use an inhaler (without spacer)

1. Remove the inhaler cap.
2. Shake inhaler well for about 5-10 seconds.
3. Breathe out completely.
4. Begin to inhale a slow deep breath in through the mouth and press down on the canister once.
5. Continue to take a deep breath in, count to 10 if possible.
6. Breathe out gently.

Repeat steps 3-6 for the prescribed number of puffs, and wait about one minute between puffs.

If your child was prescribed rescue meds, it’s important to always keep it on hand. It should go everywhere your child goes. Talk with your doctor about how often your child needs it. Even if your child takes controller meds, rescue meds are often still needed to manage flare-ups. For most kids with asthma, their medications and dosages will change over time. Their action plan should always be updated accordingly.

Following an asthma action plan will help your child do everyday things without asthma symptoms, and will ensure appropriate treatment for flare-ups and emergencies when you’re not present. Your child should learn about the plan, too! Remember, this plan can serve as a written guide to ensure no steps are missed and no medications are administered incorrectly. If your asthmatic doesn’t currently have an asthma action plan, check in with your asthma provider as soon as possible. 

To find your nearest Texas Children’s Pediatrics location, click here. If you’re interested in learning more about Texas Children’s Asthma Center, click here.