Going Home with Asthma Your child’s personal information...
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1 Your child’s personal information Your child’s name: ......................................................................... Hospital Doctor-in-charge: ........................................................... Family Doctor tel no: ..................................................................... Your local Practice Nurse: ............................................................ (The Nurse who runs your local asthma clinic) Your child’s asthma treatment 1. Your child’s reliever is ............................................................. Use this when your child has a cold, is wheezy, coughing or out of puff. 2. Your child’s preventer is ......................................................... Use this every day, as instructed by your doctor or nurse. 3. Any other treatments Protectors ................................................................................. Tablets ....................................................................................... 44 Going Home with Asthma Checklist for Parents Have you been told about the treatments your child has received? yes no Have you discussed your ‘going home’ asthma plan with medical staff? yes no Do you have the medicines you need or a prescription for these? yes no Do you know how and when to give these medicines? yes no Have you been told about emergency asthma management at home? yes no Have you been told about when to get help? yes no Make sure that you have been through all the above before you take your child home. asthma_booklet_2010.pdf 1 asthma_booklet_2010.pdf 1 4/14/2010 9:35:30 AM 4/14/2010 9:35:30 AM
Transcript of Going Home with Asthma Your child’s personal information...
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Your child’s personal information
Your child’s name: .........................................................................
Hospital Doctor-in-charge: ...........................................................
Family Doctor tel no: .....................................................................
Your local Practice Nurse: ............................................................(The Nurse who runs your local asthma clinic)
Your child’s asthma treatment
1. Your child’s reliever is .............................................................Use this when your child has a cold, is wheezy, coughingor out of puff.
2. Your child’s preventer is .........................................................Use this every day, as instructed by your doctor or nurse.
3. Any other treatmentsProtectors .................................................................................Tablets .......................................................................................
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Going Home with Asthma Checklist for Parents
Have you been told about the treatments yourchild has received? yes no
Have you discussed your ‘going home’ asthmaplan with medical staff? yes no
Do you have the medicines you need or aprescription for these? yes no
Do you know how and when to give thesemedicines? yes no
Have you been told about emergency asthmamanagement at home? yes no
Have you been told about when to get help?yes no
Make sure that you have been through all the above beforeyou take your child home.
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Index
Introduction
Part 1 What is asthma?Asthma triggers
Part 2 Asthma medicines and devicesTips for getting a young child/baby used totheir inhalerGiving your child’s medicationSteroids for asthmaSide effectsCommon questions about asthma medicines
Part 3 Asthma at homePeak flowsAvoiding asthma triggersThe house dust mite
Part 4 Coping with attacksSpotting asthma warning signsTreating warning signs quicklyGetting advice if things are notgetting betterGoing on holiday
Part 5 General questions about asthma
Part 6 Get the most from your hospital doctorThe consultationQuestions for the doctorChecklist for parents
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If you do not think you will stick to the medicationthe doctor has given you.....be honest with the doctor. If you have concerns about themedication, discuss them. You should be able to agree a planwith the doctor that you can stick to. Your child’s treatment shouldfit into your family’s routine.
If you have been told different things by differentpeople about your child’s asthma....tell the hospital doctor. They are experts in asthma. They havebeen specially trained and deal with it every day. The hospitaldoctor will help solve any conflicting advice that you have beengiven. But they can only do this if you ask.
If you are unsure how to give your child’smedication....ask the doctor to show you how to use the inhaler/spacer.
If it helps, take notes when talking to the doctor. Readthem back to the doctor at the end, to make sure yournotes are correct.
At the respiratory clinics at Yorkhill, the doctorswill also send you a copy of the letter they sendto your GP to help you remember what was discussed.
When you think of questions between visits to the doctor, writethem down so you remember them. On the next page of thisbooklet there is space for you to note questions for the doctor.
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Can I try complementary medicinesfor my child’s asthma? (e.g. Chinese,herbal, homeopathic, vitaminsupplements, Buteyko method)If you try a complementary medicine you should alwayscontinue giving your child their prescribed medication.Discuss any alternative treatments with the doctor.
When are asthma symptoms most likely to happen?In children, asthma symptoms are most likely to happen at nightor after exercise.
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Part 1 - What is asthma?
Asthma is a disease which affects the airways and breathing. Itcan affect people of all ages, but is most common in childhood.In Britain, between 10-20% of children have asthma.
What happens in asthma?The lining of the airways becomes swollen and inflamed. Theairways produce thick mucus. The muscles around the airwaystighten and make the airways narrower. This blocks the flow of airinto the lungs and makes it difficult to breathe. People with asthmasometimes say it is “like breathing through a straw”.
How does the doctor know your child has asthma?There is no definite test for asthma. There are no blood tests orX-rays that can show that your child has asthma. The doctor willlisten to your story of their symptoms and when they happen andexamine your child carefully. From this the doctor can recognisethe patterns seen in asthma.
What are the most common asthma symptoms?• cough• difficulty breathing• chestiness• noisy breathing• wheezing• chest tightness or pain
Are complementary medicines safe?Not always - some complementary medicines can have very seriousside effects for people with asthma and should be avoided. Forexample, royal jelly can cause a serious allergic reaction. Naturalremedies have not been researched as much as conventionalmedicines, so there is less information available about sideeffects.
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Should my child have the “Flu” vaccination?Yes - we think that children with asthma should get thevaccination every year. Ask your family doctor around Octobertime. The only exception is if your child is allergic to eggs.Children who are allergic to eggs may be able to have the vaccinebut it should only be given under supervision in hospital.
What is meant by seasonal asthma?Some children only get asthma symptoms at a particular timeof year, such as the summer or autumn. This may be due todifferent pollens being in the air - grass in the summer or treepollen in the autumn.
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Take relievers before exercise: Mostchildren with asthma get wheezy when runningaround. Children should use their reliever 5 or 10minutes before starting exercise.
Part 2 - Asthma medicines anddevices
Good newsChildren with asthma can lead a normal active life. This dependson avoiding triggers and finding the right doses of the rightmedicines for your child. Some famous people with asthma wholead very active lives include - Paul Scholes (footballer) and PaulaRadcliffe (world record marathon runner).The 2 most common types of medicines for asthma are: relieversand preventers.1. Relievers (usually in blue containers)
• Relax the muscles around the airways.• Work quickly within 5-10 minutes.• Give quick relief, not long lasting protection.• Should be used when symptoms appear or before exercise.• The most common are Ventolin (salbutamol) and Bricanyl
(terbutaline).• You do not get addicted to reliever medicines.
Tips for using your relieverUse relievers early::::: Use early, at the first sign thatyour child’s asthma is getting worse. Watch out for yourchild’s early warning signs. (More about this on page 35).
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Going on holiday
With a bit of planning holidays are not a problem,even if you go abroad. Many parents tell us theirchild’s asthma gets better on their holidays.
The main things to remember are to:
• take your asthma plan*
• take enough asthma medicines with you
• take a spare inhaler in case you lose one
• take a written note of your asthma medicines
• ask your Family Doctor for some steroid tablets to takewith you in case an asthma attack starts
‘Never run out of reliever’ - take plenty with you. Unfortunately,there is no easy way to find out how much medicine is left in acanister.
*If you don’t have an asthma plan ask the doctors at the Hospital,or your Family Doctor, to write out a plan to take with you.
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Other asthma medicinesSometimes inhaled preventers are not enough to control asthmasymptoms. Your doctor may then recommend other medicines tohelp.The most common are:
Inhaled Protectors - Serevent (Salmeterol) or Oxis(Formoterol)Tablets - Singulair (Montelukast) or Accolate (Zafirlukast)Steroid tablets - Prednisolone
Protectors (usually green containers)• Protectors relax the muscles around the airways.• They do this for a longer time than blue inhalers.• They only need to be taken once or twice a day.• They do not work immediately, so• You should not use a protector instead of your blue
inhaler.Singulair or Accolate• These tablets are not steroids.• They reduce inflammation in the airways.• They need to be taken every day.Steroid tabletsYour child may be prescribed a short course to cure an acuteattack. Occasionally children with very severe asthma mayneed to take steroid tablets every day.Prednisolone is the most common tablet. (There ismore about steroid tablets on p21).
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2. Treating the warning signs quickly
When you see the warning signsAs soon as you see your child’s warning signs start using theirblue inhaler straight away – by acting quickly at home you mightstop the asthma getting worse. You may even stop a hospitaladmission.If symptoms are mild give up to 5 puffs of the blue inhaler using aspacer every 3-4 hours for a few days while symptoms last.
Breathing at nightPeople with asthma find it harder to breathe atnight. In fact in the early hours of the morningeveryone’s airways become a bit narrower.People without asthma don’t notice anything.People with asthma will find their breathing lesseasy at this time and may wake up.
Beware of asthma signs at night
If your child’s asthma is getting out of controlor an attack is coming on, an early sign maybe waking at night with coughing or wheezing.
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Asthma devices and using themproperly
InhalersMost asthma medicines are inhaled.Using inhalers means:• The medicine goes straight to the airways.• Much smaller doses of medicines can be used.• There are fewer side effects.Asthma inhalers come in all shapes and sizes. They are oftencalled devices.
To make sure young children get the medicine properly we usespacers. Commonly used spacers are:
• Aerochambers • Nebuhaler• Babyhaler • Volumatic• Nebuchamber
Young children should always use a spacer with any inhaler as itis too difficult for them to breathe the medicine in properly,otherwise - they swallow it. With spacers the child can breathe inand out normally and still get the medicine.
Spacers are also used for emergency treatment with children ofALL ages (see page 34, coping with attacks). If you don’t have aspacer for your child ask your doctor for one.
For older children, dry powder devices are smaller and easier tocarry around: • Turbohaler • AccuhalerPictures of all of these asthma devices are on the next pages.
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Part 4 - Coping with attacks
The next part of the booklet shows you how to cope when yourchild’s asthma is getting worse. There are 4 action steps to take:
The 4 steps
1. spotting asthma warning signs2. treating the warning signs quickly3. getting advice if things are not getting better4. knowing when to get emergency help
By acting quickly at home, you might stop the asthma attackgetting very bad. You might even stop a hospital admission.
Read the next few pages carefully. If there is anything that youstill do not understand, ask the doctor or nurse looking after yourchild.
Remember, the most importantthing to do for an asthma attackis to give the blue reliever every3 to 4 hours using a spacer.
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Dry Powder Devices
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The house dust miteChildren with allergic asthma are nearly always extra sensitive tothe house dust mite. The house dust mite can be found in everyhome no matter how often you clean. The dust mite levels arehighest in the living room and bedrooms.
1. Anti-house dust mite bed covers & sheets
There are new bedding sets (sheets, duvetcovers and pillowcases) which are beingrecommended for asthma sufferers. Most dustin the bedroom is in the bed. We think coversmight help if your child is actually allergic to house dust mite.However, these sets are expensive, and will not work unless youcover everything (pillow, duvet, mattress). If you do buy one, get acover that the mattress fits right into. Just covering the top of themattress is not good enough.
accuhalerturbohaler2. Avoiding house dustDust collects on furniture, carpets and soft toys. Here are somethings that you can do to cut down dust in the bedroom:• “damp dust” all surfaces in the bedroom every day or so• vacuum the mattress once a week• change & wash all bed linen once a week
(hot wash at over 60°C to kill the dust mites)• wash soft toys or
put in freezer monthly (in freezerfor 6 hours, then vacuum the toy)
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Tips for getting a young child/baby used to their inhaler
It is important to get your child used to their inhaler. Young childrenare not frightened of inhalers but can find them upsetting at first.
You should take at least a week getting your child comfortable withtheir inhaler and spacer before you give any medicine.
1. For the first couple of days get your child used to the mask.Play some games with the mask - put it on top of child’s head,make it fall off. Let your child hold the mask and play with it.
2. After a few days get your child used to the mask being placedover their nose and mouth. While you are doing this countslowly up to 10.
3. Next join the mask to the spacer. Hold this to your child’s faceand count to 10. Some parents sing a nursery rhyme insteadof counting.
4. When your child is happy doing this, get them used to a shorthissing noise when the mask is on their face. The medicinemakes a noise when you press it and some children get afright at this.
5. Once your child is used to all of this, repeat twice a day.
Your child is now ready to be giventhe medicine.
How does a peak flow help me keep mychild’s asthma under control?Once you know your child’s best peak flow this will help you spotwhen your child’s asthma is getting out of control.
When your child’s asthma is under control their peak flow readingswill be fairly constant – the rate may vary up or down by about8-10%.
When your child’s asthma is getting out of control the peak flowwill fall.
If your child’s peak flow falls to 70% of their best they will usuallyhave more symptoms and are likely to be wheezy. You should beusing more reliever.
If your child’s peak flow falls to 50% of their best they will be verywheezy/chesty. You need to use more reliever and contact yourdoctor. If you have steroids at home start giving these to yourchild.
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Giving your child’s medication
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To give medicine to a baby:1. Get everything you need:
inhaler, spacer device, mask2. Shake the inhaler3. Attach the inhaler to the
spacer4. Make sure your baby is in a comfortable position, lying
on her/his back5. Put the mask over your baby’s nose and mouth – press
very gently to make a seal6. Press the inhaler once and7. Count slowly to ten (this should take 10-20 seconds)8. Take the spacer away from your baby’s face9. Take the inhaler out of the spacer
Repeat steps 2-9 until you have given the number of puffsneeded.
In an emergency you can give your child 10 single puffs ofthe blue inhaler using a spacer, over 5-7 minutes, while youget medical help and advice - this is called multi-dosing.
Using a peak flow meter
How does my child use a Peak Flow Meter
Always do the peak flow readings BEFOREyour child takes the asthma medicines
• Put indicator to zero
• Get child to stand up
• Ask them to take a deepbreath and
••Seal lips around themouthpiece
• Tell them to blow out as hardand as fast as they can -as though blowing out candleson a cake
• Write down the number
• Repeat this 2 more times
• The largest of the 3 numbers isyour child’s best peak flow
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Can I stop giving the inhaled steroids (preventer),but start again if the asthma symptoms return?
Unfortunately, inhaled steroids (preventer) cannot cure asthma.For most children, inhaled steroids (preventer) have to be usedevery day without a break to get the full effect. If you feelyour child’s symptoms are much better, discuss it with the doctor.It may be that the level of medication is just right and that is whyyour child has no symptoms. However, it may be possible to cutdown the dose.
Will using inhaled steroids (preventer) stuntmy child’s growth?
See answer on page 24 under Growth.
My child only has symptoms in winter - do Ineed to use inhaled steroids (preventer)
all of the time?For some children, asthma is only a problem at certain times ofthe year e.g. in the winter. It may be possible to give the inhaledsteroids (preventer) only at that time.
My child only has symptoms with viral infections- do we really need inhaled steroids (preventer)?Some children who wheeze with viral infection (‘colds’) benefitfrom inhaled steroids (preventer), and some do not. Your doctorwill check to see if the inhaled steroids (preventer) help yourchild. If your child is very allergic (e.g. eczema, food allergies)then steroids are more likely to be of benefit.
How long will my child need medication?This is very difficult to predict. Many children will need at least1-2 years of treatment and sometimes much longer. The doctorswill work with you to cut the medicines to the lowest dose and tostop them if possible.
To use a spacer correctly:
1. Get everything you need:inhaler, spacer device
2. Shake the inhaler.3. Attach the inhaler to the
spacer.4. Make sure your child is in a comfortable position
- hold them if you need to.5. Put the mouthpiece between your child’s lips and teeth
- make sure their tongue is not in the mouthpiece.6. Get your child to breathe in and out through the spacer.7. Press the inhaler once and8. Count 5 normal breaths in and out - you should hear a
clicking noise with each breath. (If you do not hear theclicking noise tilt the spacer up at the inhaler end - thiswill open the valve and help the child breathe in themedicine).
9. Take the spacer away from the child’s face.10. Take the inhaler out of the spacer.
Repeat steps 2-10 until you have given the number of puffsneeded.
In an emergency you can give your child 10 single puffs ofthe blue inhaler using a spacer, over 5-7 minutes, while youget medical help and advice - this is called multi-dosing
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Growth
Will using inhaled steroids (preventer) stunt mychild’s growth?A great deal of research has been carried out on this.• For children taking 400 micrograms or less a day no effect on
growth has been found.• There is some evidence that the growth of children who need
over 400 micrograms a day may be slowed down in the short-term. However, these children often have their growth spurtlater and eventually reach their normal predicted adult height.
• Chronic untreated asthma in children will cause poor growth.
Adrenal glandsThe adrenal gland produces the body’s own steroid, calledcortisone. The body makes extra cortisone during illnesses likeflu, tonsillitis, and gastro-enteritis.When a child is taking high doses of steroids - either in tablet orinhaled form - the body produces less of its own steroid for a while.When high doses of steroid medicines have been used and arecut down the body will slowly start making its own steroids again.
You must never suddenly stop giving high doses of steroid medi-cines that have been used for more than a few weeks. Your child’sbody will not have enough of its own steroid to help fight illnesseslike flu etc. It takes time for your body to make its own steroids again,so high doses of steroid medicines must always be cut down slowly.
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What is the difference between inhaled steroids(preventer) and steroid tablets?
1. The amount of steroid used in inhaled steroids (preventer) ismuch less than that used in steroid tablets. This is because theinhaled medicine goes straight to the lungs.
2. One steroid tablet is at least 50 times stronger than a puff froma standard preventer inhaler.
3. Because of this, side effects are not very common with inhaledsteroids (preventer).
4. Inhaled steroids (preventer) taken over a long period of time aresafer for your child than lots of short courses of steroid tablets.
What about short courses of steroid tablets?
If your child’s asthma continues to get worsedespite being on a preventer, then a shortcourse of steroid tablets may be prescribed.Your GP or hospital doctor can prescribesteroid tablets.
A short course for just 3-5 days has few side effects, even withhigh doses. However, if your child needs steroid tablets often, thechance of side effects increases.That is why using preventerinhalers is better.
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Steroids - Side effects
Side effects are not very common with inhaled steroids(preventer). The medicine goes straight down to the airwayswhere it is needed. Very little is taken into the rest of the body.Using a spacer helps even more of the medicine go exactly whereit is needed.
Generally, low doses of inhaled steroids (400 micrograms dailyor less) with occasional short courses of steroid tablets areenough to control asthma in most children. Side effects are morecommon in people with very severe asthma who have to takesteroid tablets all the time.
To work out how many micrograms your child is taking, look atthe label on your preventer medication (brown or red). Thistells you how many micrograms are given for each puff(actuation)e.g. 2 puffs twice a day of Pulmicort 50 equals
200 micrograms daily.
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What side effects are seen withsteroids?
Side effects for children might be:
• mouth infections• temporary slowing of growth
This is why we examine your child’s mouth and measure theirheight when we see them at the hospital clinic.
TIP
Using a spacer and brushing teethafter taking medicine can help
prevent mouth infections
Inhaled steroids (preventer) have no effect on a child’s appetite orweight.
There is no evidence that steroids damage the lungs. However,asthma that is left untreated can lead to permanent lung damage.
NOTE: Steroids used for asthma are different from the bodybuilding (anabolic) steroids. Anabolic steroids do not reduceinflammation.
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Steroids for asthma
What are steroids?Steroids are chemicals made naturally by the body.They can alsobe made art ificially as drugs. There are different types of steroids.Steroids made by the body to fight inflammation are calledcorticosteroids. If you have asthma, these corticosteroids helpfight the inflammation in the airways. When you give your childtheir preventer medicine you are giving them extra corticosteroidsthat they need.
Why do we use steroids in asthma?Steroids work by reducing the amount of inflammation, swellingand mucus in the airways. They are very effective for asthma iftaken regularly.
How are they given?There are three different ways that steroids can be given:
• inhaler - for daily preventive treatment. Thisgives a very low dose that goes straight tothe lungs.
• tablets - short courses to cure an acuteattack, or for use in very severe asthma.Prednisolone is the most common tablet.
• injection - for the very ill in hospital, or forchildren who have an upset tummy and can’tkeep the tablets down.
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Common questions aboutasthma medicines
Do children get addicted to asthma medicines?No - children do not get addicted to preventer or relievermedicines. Children should always be allowed to use their relieveras soon as their asthma symptoms appear.
Do the inhaled asthma medicines lose effect ifthey are used too often or for too long?
No - using inhaled steroids (preventer) every day does not meanthat they become less effective. Your child’s body does not becomeso used to the medication that your child needs to take more andmore of it.
How long does it take for the inhaled steroids(preventer) to start working?
It can take a few weeks before you notice any improvement inyour child’s asthma. It may be a few months before they feel thefull effects of the inhaled steroids (preventer).
Can I change the amount of inhaled steroids(preventer) my child is getting depending on
their symptoms?You should only change the amount of inhaled steroids (preventer)if you have agreed this with your doctor or nurse.
Is my child too young to start usinginhaled steroids (preventer)?
No. For children with asthma, inhaled steroids (preventer) are nowstandard treatment from infancy onwards.
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Part 3 - Asthma at homePeak flows
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To use an aerochamber correctly:::::
1. Get everything you need:inhaler, aerochamber
2. Shake the inhaler.3. Attach the inhaler to the
aerochamber.4. Make sure your child is in a comfortable position -
hold them if you need to.5. Put the mask over your child’s nose and mouth -
press very gently to make a seal.
6. Get your child to breathe in and out through theaerochamber.
7. Press the inhaler once and8. Count slowly to ten (this should take 10-20 seconds).9. Take the inhaler away from the child’s face.
10. Take the inhaler out of the aerochamber.Repeat steps 2-10 until you have given the number of puffsneeded.
In an emergency you can give your child 10 single puffs ofthe blue inhaler using a spacer, over 5-7 minutes, while youget medical help and advice - this is called multi-dosing
What is peak flow?A peak flow meter measures howfast your child can breathe out.
If the airways are open the readingon the meter is high and if theairways are tight the reading is low.
When can my child start using a peakflow meter?Children can start doing peak flows from about age 5. If they trywhen they are too young the readings are not always accurate
What peak flow reading should my childhave?Peak flow will be different for every child.
Your child’s peak flow will vary depending on their height and theirasthma diagnosis (e.g. if two children are the same height but onehas mild asthma and the other has severe asthma the peak flowfor the child with mild asthma is likely to be higher).
As your child grows their peak flow should get higher - it isimportant that you know what their best peak flow is (do notassume that the best peak flow they had 6 months ago is thesame as it is now).
peak flow meter
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Your child is now ready to be given their medicine
Remember
• Always try to make it fun.
• Never force your child to take their inhaler.
• If your child is not letting you use the inhaler, put it awayand don’t make a fuss.
• Children who are crying breathe in very little medicine.
• If you are finding it very difficult to get your child toco-operate, stop altogether for one week, then try again.
• Always use the spacer when your child/baby is in acomfortable position:Baby - lying on their backSmall child - sitting on your knee.
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How do I record my child’s peak flow?The best way to do this is to keep a chart of their peak flowreadings. We recommend measuring the peak flow first thing inthe morning and last thing at night before taking any inhaledmedicines.
BELOW is an example of a peak flow chart that a child kept athome. The ‘up and down’ line happens when asthma is out ofcontrol.
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160
135
110
85
601 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Days of week
Peak
flow
(litr
es / m
in)
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
normal value for height
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Avoiding asthma triggersThere are triggers all around, and it is impossible to avoid all ofthem. You have no control over some, like the weather! However,here are some tips:
• Don’t smoke near your child, and your child should avoidsmoky places.
• Avoid animals your child is definitely allergic to.
• In summer, avoid long grass.
• In the pollen season (summer or autumn) keep bedroomwindows shut.
• Arrange for your child to play indoors on colder days.
• Remember to give them their reliever before any exercise.
• Ease your child gently into vigorous exercise
14
Tips for remembering medication• Almost everyone forgets to take medicine sometimes.• The best thing to do is to give medicine as part of some
other routine:e.g. brushing teeth, having a wash,getting dressed.
• You could also try keeping the preventer where you will alwayssee it.
• If you feel that you forget the medicine a lot, tell your doctor.
What happens if my child does not take theirpreventer every day?Preventers stop the inflammation and swelling in the airwayswhich cause asthma symptoms. Forgetting or stopping thepreventer medication for a few days means this protectionwill begin to disappear. Your child may then develop asthmasymptoms again or have more frequent attacks. This may lead toyour child needing more courses of steroid tablets.
My child has no asthma symptoms. Can I stopgiving them their preventer?When the preventer is working well your child may not have anyasthma symptoms or need any reliever. However, the airway canstill be inflamed so do not stop using the preventer on gooddays. If you feel your child has not had any symptoms for sometime tell your doctor.
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• avoid curtains, use washable blinds• remove carpets• avoid lower bunk beds as dust constantly falls on top of
the child
3. Anti-house dust mite spraysYou may also have heard about new chemical sprays which arenow on sale. As yet these have not been very successful and theyare still very expensive. Better to do the simple things first.
4. Does the make of vacuum cleaner matter?
There is some research being done in Britainright now looking at the different makes ofvacuum cleaners. We do not know which isthe best one to buy yet, so we cannotrecommend one.
12
Spacers
aerochamber
for use with ventolin, flixotide and becotide
for use with bricanyl and pulmicort
suitable for any puffer
nebuhaler nebuchamber
babyhaler volumatic
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Wheezy / noisy breathingChronic cough, especially at nightDifficulty breathingChest starts to get tight or hurtsBreathing faster than normalGetting out of breath easilyTiredItchy, watery eyesItchy, scratchy or sore throatStroking chin or throatSneezingHeadacheFeverVery tearfulRunny noseChange in face colourDark circles under eyesMood change
1. Spotting asthma warning signs
Asthma attacks do not usually happen without warning. Mostchildren have early warning signs. You might see these a day ortwo before the asthma flares up. Can you see any of your child’swarning signs on this list? Add any others your child has. Youshould start treating your child’s asthma as soon as you seethe warning signs.
Other warning signs mychild has:
10
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3. Getting advice if things are not gettingbetter
The advice in this book is not to be used instead of seeing yourfamily doctor or going to the hospital.The tricky bit is knowing when to ask for help.
If you feel that your child’s symptoms are getting worse oryou are using the blue inhaler more often than every
4 hours, increase the blue inhaler to 10 puffs every 3-4hrs.AND
Contact your GP straight away for advice.
4. Knowing when to get emergency help
Your child will need emergency help if they are:• Distressed• Gasping for breath• Unable to eat or drink• Finding it hard to speak• Looking pale or their lips going blue• Quiet or drowsy• ‘Not with it’
If you notice any of these, or if you are very worried about yourchild’s breathing you should call the emergency doctor oran ambulance straight away.
Remember - Don’t be afraid to make a fuss!
8
2.Preventers (usually brown or red containers)
• Are all inhaled corticosteroids, or ‘steroids’ for short.
• Stop the inflammation and swelling in the airways whichcause asthma symptoms.
• Give long lasting protection, and help prevent asthma attacks.• The main ones are Pulmicort (budesonide), Becotide
(beclomethasone) & Flixotide (fluticasone).
Importance of preventer
• Preventers do not work immediately.It can take a few weeks before younotice any improvement in your child’sasthma.
• Your child must take their preventer regularly every daywithout a break. Once the preventer starts to work, theairways become less inflamed and less sensitive to triggers.
• Do not stop using the preventer on good days because theairway can still be inflamed. Tell your doctor if you feel yourchild has not had any symptoms for some time.
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Part 5 - General questions aboutasthma
How can the doctor be sure my child has asthma?There is no definite test for asthma. Doctors can recognisethe patterns of wheeze and cough seen in asthma. If your child isalso helped by taking asthma medicines then they can be more sureit is asthma. It may take some time before the doctor is certain.
Will my child grow out of asthma?Not always - All children tend to improve around puberty. Surveysshow that about half of children with asthma grow out of it whenthey are teenagers. For some, asthma comes back in their 20’sor 30’s.
Does air pollution cause asthma?There is no scientific evidence to prove that air pollution causesasthma. It does make asthma worse in people who already haveit. Cigarette smoke is a very common culprit.
Should we get rid of pets?If you have family pets it can be very upsetting to get rid of them.The best you can do is always keep them out of your child’sbedroom. Washing the animal weekly may help. If you are thinkingabout getting a pet, remember that an animal inthe house may make your child’s asthma worse.
6
Asthma triggers
People with asthma have airways that can be sensitive to lots ofdifferent things. These different things are called “triggers”. Whensomeone with asthma comes into contact with their trigger, theirasthma is started off. The airways tighten up, become swollen andproduce too much mucus.
Most children’s asthma is set offby catching a ‘common cold’, notby allergies.
Here are some triggers that people with asthmaare sensitive to - which are your child’s triggers?
• colds/chest infections• exercise/physical activity• cigarette smoke• cold weather• changes in the weather• laughing, crying or getting upset• house dust (more later)• animal fur/feathers• pollens• air pollution• others - please write in..............................
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Part 6 - Get the most from yourhospital doctor
The consultationDon’t be afraid to ask the doctor questions. Ifyou don’t understand something or you want moreinformation, just ask. The doctor is there to help you.
If you are upset about your child’sprogress.....tell the doctor. They may think your child is doing well and see noreason to change things. Tell the doctor what is on your mind orwhat is happening. Your child may not get the treatment theyneed otherwise.
If you don’t understand what the doctor says.....ask questions. Doctors are busy and sometimes do not takeenough time to explain things properly. They work with asthmaevery day. Things that seem simple to them may be complicatedfor you. If you say “I didn’t understand that”, you’ll remind themthat not everyone is an asthma expert.
If you stop giving, forget, or increase themedicine.....don’t be afraid to tell the doctor this. Like you, they want tomake sure that your child gets the minimum amount of medicinenecessary to keep healthy. If you don’t tell the doctor, they maythink your child’s asthma is better or worse than it really is. Thiscould alter the dosage of steroids prescribed.
4
Introduction to the bookThis book has been written for parents who have children withasthma. It tells you a bit about asthma and its treatment. We hopeyou will like it and find it helpful.
It is hard to put everything into such a smallbook. If we have missed out something specialthat you want to know, ask thedoctors or nurses looking after your child.On page 43 there is space for your questions. Please write downany questions you have for the doctors or nurses. Take them withyou the next time you visit the doctor or nurse.
Finding out more about asthma
You can get more help and advice by phoning:Your General Practitioner or Practice Nurse
OR
The Asthma UK HelplineTel: 0845 701 0203 Monday to Friday 9am-5pm
(staffed by asthma specialist nurses)
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Questions for the doctor
Please write your questions for the doctorhere. Take them with you when you nextvisit the clinic.
1.
2.
3.
4.
5.
6.
7.
8.
2
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AsthmaA Guide for Parents
Originally developed for the Department of Respiratory Medicine,Royal Hospital for Sick Children, Glasgow G3 8SJ.
October 2003 • ref 39041, reprinted November 2007
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