Asthma Action Plan

Asthma is a common disease that can lead to chronic symptoms, including coughing, wheezing, and difficulty breathing.

Although many children have mild asthma, or have their more moderate or severe asthma under good control with long-term preventative medicines, others have poorly controlled or hard-to-control asthma with:

• frequent asthma attacks
• poor sleep
• missed school days, sporting events, or other activities
• visits to the emergency room
• hospitalizations

Although asthma deaths in children aren't uncommon, there were almost 200,000 hospitalizations and 186 deaths among the 6.5 million children who have asthma in 2004. Not surprisingly, there were many more visits to the emergency room for asthma attacks -- about 750,000.

Asthma Action Plan

There is no way to prevent all asthma attacks. Having an asthma action plan, which lists all of your child's medicines and when he should take them, can help you keep your child's asthma under good control. This should help prevent many asthma attacks and keep you well prepared if your child does have an asthma attack.

The National Heart, Lung, and Blood Institute, in its Guidelines for the Diagnosis and Management of Asthma, recommends that doctors "provide all patients with a written asthma action plan that includes two aspects: (1) daily management and (2) how to recognize and handle worsening asthma. Written action plans are particularly recommended for patients who have moderate or severe persistent asthma, a history of severe exacerbations, or poorly controlled asthma."

Do you have an asthma action plan? If not, consider scheduling an appointment with your pediatrician to get one, which would include information about your child's daily and quick relief medications.

Daily Asthma Medications

A child's daily asthma medications may include long-term preventative asthma medications, including:

• inhaled steroids, such as Flovent HFA (fluticasone), Pulmicort Respules (budesonide), Pulmicort Flexhaler, etc.
• inhaled steroids that are combined with a long-acting beta₂-agonist, such as Advair (fluticasone and salmeterol) or Symbicort (budesonide and formoterol)
• Singulair (montelukast), which is usually combined with one of the above asthma treatments.

In addition listing all the names of your child's daily medications, his asthma action plan will outline how much of the medication to take and how often he should take it.

Daily Asthma Medications (example)
Take your daily asthma medications every day, even when you don't have any asthma symptoms:

Pulmicort Flexhaler 90 - one inhalation twice a day, every day
Singulair 5mg - one pill taken once a day at bedtime, every day

Quick Relief Asthma Medications

A child's quick-relief asthma medications are those he would take when he was having asthma symptoms, such as a cough, wheezing, or difficulty breathing. Ideally, they would be used infrequently and less than twice a week.

Examples of quick-relief asthma medications include albuterol (Ventolin, Proventil) and Xopenex (levalbuterol). Most are available to use with either a nebulizer or as a metered dose inhaler. The MaxAir AutoHaler (pirbuterol) is another quick-relief asthma medication that is available as a breath actuated inhaler.

Your child's asthma action plan will usually detail when to give your child his quick-relief asthma medication depending on which zone of asthma symptoms he is currently in:

• Green Zone - This is the zone that your child should be in every day. It means that he has no asthma symptoms and no limitations in his activities. If doing peak flows, they are within 80 to 100% of his personal best. In the green zone, your child should simply continue to take any daily long-term preventative asthma medications that he has been prescribed.
  
  
• Yellow Zone - This is a caution zone and means that your child is beginning to have problems with his asthma. He is likely having some asthma symptoms, including coughing, wheezing, and some trouble breathing. In addition, he may be waking up at night with asthma symptoms and may not be able to participate in his usual activities. If doing peak flows, they will be between 50 to 80% of his personal best.
  
  An asthma action plan should detail what to do when your child enters the Yellow Zone, which would usually include taking his quick-relief asthma medication, and include instructions on what to do if he doesn't return to the Green Zone in about an hour. These further instructions might include repeating his quick-relief medicine one more time, adding an oral steroid, and calling your pediatrician.
  
  
• Red Zone - This is a medical alert zone and means that your child is having severe asthma symptoms and may be very short of breath. He likely is limited in his activities. If doing peak flows, they will usually be less than 50%. The asthma action plan will usually instruct you to give a quick-relief asthma medication right away and then immediately call your doctor if your child is in the Red Zone. If you haven't gotten in touch with your doctor and your child didn't quickly improve, you may need to seek other medical attention by calling an ambulance or going to the emergency room.
  
  

Additional Things to Know

• Doubling the dose of inhaled steroid is not thought to be a good way to reduce how severe an asthma attack is going to be and is no longer a recommended treatment.
• Your child's asthma action plan may also include when you can start an oral steroid when your child is in the Yellow Zone or Red Zone.
• It should also include a school asthma action plan, which includes steps for a child to follow at school if he has asthma symptoms or an asthma attack.
• An asthma action plan will usually outline what your child should do if he has exercise induced asthma, such as taking a quick-relief medicine before exercise.
• Children age five and older can begin to be involved in developing their asthma action plan.

_Sources:

CDC. The State of Childhood Asthma, United States, 1980-2005.

National Heart, Lung, and Blood Institute of the National Institutes of Health. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma. 2007.