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Living with Asthma

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When to Go to the ER

What's an Asthma Emergency?

As a parent of a child with asthma, you want to avoid the emergency room (ER) as much as possible. But it's also important to know when going to the ER is the right choice.

Sometimes, kids with asthma need medical care very quickly. If any of these symptoms happen, see your doctor immediately, go to the ER, or call an ambulance:

  • Your child has constant wheezing.
  • Your child uses quick-relief medicines (also called rescue or fast-acting medicines) repeatedly for severe flare-up symptoms that don't go away after 15–20 minutes or return again quickly.
  • Your child has a lasting cough that doesn't respond to inhaled quick-relief medicine.
  • There are changes in your child's color, like bluish or gray lips and fingernails.
  • Your child has trouble talking and can't speak in full sentences.
  • The areas below the ribs, between the ribs, and in the neck visibly pull in during inhalation (called retractions).

How Can ER Visits Be Less Stressful?

Planning can make trips to the ER less stressful for you and your child. Here are some tips to try:

Know the location of your closest ER. If there's a children's hospital ER nearby, go there and have the address and phone number handy (written on the asthma action plan, for instance).

  • If you have other kids, try to make arrangements with a relative or other caregiver who can take them in an emergency. But don't let the lack of a babysitter delay your trip to the ER. Someone can always come to the hospital later to pick up your other kids.
  • Take a copy of your child's asthma action plan or a note with the names and dosages of any medicines your child takes to share with the medical staff at the ER.
  • Try to keep a written record of when your child uses a rescue inhaler.

How Can We Avoid a Trip to the ER?

Well-managed asthma is rarely life-threatening. Taking asthma medicines as prescribed can help prevent severe asthma flare-ups and the need for emergency care.

Be sure to schedule and keep follow-up visits with your doctor and pulmonologist to track your child's asthma.

 

It's important to monitor your child's asthma using the written asthma action plan your doctor helps you create. This plan will outline day-to-day treatment, symptoms to watch for, and step-by-step instructions to follow during a flare-up. 

Taking asthma seriously and working to manage it can make it less likely that your child will need to go to the ER.

What Else Should I Know?

Many kids go to the ER simply because they didn't have their quick-relief medicines handy. Your child should have this medicine available at all times, including at school, at sporting events, and while traveling.

 

Reviewed by: Aledie A. Navas, MD

Date reviewed: March 2018

Traveling and Asthma

Is Travel OK for Kids With Asthma?

Having asthma shouldn't stop kids from enjoying a family vacation, sleepover camp, or a trip with friends. With careful planning, they can get all the benefits of time away from home.

Before you travel, make sure that your child's asthma is well controlled. If it's been getting worse, check in with the doctor. Your child might need a change in medicines or a visit with the doctor before going away.

What Should We Pack for Traveling?

When packing, be sure to include:

  • Medicines: Keep quick-relief medicine (also called rescue or fast-acting medicine) and long-term control medicine (also called controller or maintenance medicine) handy, not buried in the car trunk. If you're flying, take them in your carry-on luggage. That way, you'll have them if needed during the flight or if your checked bags go astray. Time zone changes can be tricky. While traveling, try to have your child take medicines at the usual home time. Upon arrival in another time zone, adjust the dosage times to the local clock.
  • Nebulizer: If your child uses one, you might want to get a portable version. Many of these can be plugged into a car's 12V accessory power outlet (or the cigarette lighter in older vehicles). If you're traveling abroad, make sure you have the adapter you need to use it.
  • Peak flow meter, if your child uses one.
  • Important information: Be sure to have your health insurance cards and information, your child's asthma action plan (that way you'll have the names of medicines, dosage information, and your doctor's phone number, just in case). For travel abroad, consider taking a letter from the doctor that describes your child's diagnosis, medicines, and equipment. This can help you with airport security or customs. It's also a good idea to have the generic names of all medicines, in case they're called something else in another country.

How Can We Avoid Asthma Triggers During Travel?

Triggers are everywhere, and your child may run into a few while traveling. Always be sure to have quick-relief medicine handy in case of emergencies.

Here are some tips for the trip:

Traveling by Car

If pollen counts or pollution levels affect your child's asthma and are high during your trip, travel with the windows closed and the air conditioner on. If your child is allergic to mold or dust, run the air conditioner or heater, with the windows open, for at least 10 minutes before getting in the car. This helps clear the air.

Traveling by Plane

The air quality on planes may affect your child's asthma. Smoking is banned on all U.S. airlines' commercial flights, and on all foreign flights into and from the United States. But rules differ on charter flights, so if you're taking one, ask about their smoking policy and request seats in the non-smoking section.

The air on planes is very dry, so encourage your child to drink plenty of water. Many airlines allow the use of battery-operated nebulizers (except during takeoff and landing), but check on this in advance. Nebulizers aren't routinely included in aircraft emergency kits due to their bulky size. But inhalers with spacers have been shown to be as effective as nebulizers in treating asthma and might be easier to keep handy during travel.

How Can We Avoid Asthma Triggers at Our Destination?

Your child's triggers will determine the best ways to avoid them and prevent flare-ups. 

Watching Out for Weather Conditions

If pollen or air pollution are triggers and you're traveling to an area with high readings, you may want to go during times of the year when pollen counts and smog levels are lower.

If your child's asthma is well controlled, you should be able to enjoy sightseeing, hiking, and other fun activities. Just keep the asthma triggers in mind when planning what you'll do. For example, avoid lots of walking or hiking when air pollution or pollen counts are high or in very cold and dry weather. If you're camping, keep your child away from campfires. Ski vacations or hiking trips aren't out of the question. But make sure you plan for plenty of rest (indoors if possible), and carry your child's quick-relief medicine at all times.

Be prepared to change your plans if your child is struggling with asthma symptoms.

Staying With Friends or Family

Make sure any friends or family you stay with know about your child's asthma triggers before you arrive. Although they won't be able to clear away all dust mites or mold, they can dust and vacuum carefully, especially in the room where your child will sleep.

Because it can take months for animal dander to be effectively removed from a room, even if a pet isn't allowed in it, you might not want to stay with friends or family who have a pet if animal dander is a trigger for your child.

Renting a Room

If you stay in a hotel, ask if it has allergy-proofed rooms. Requesting a sunny room away from the hotel's pool might also help. If animal allergens are a trigger, request a room that has never had pets in it. And you should always stay in a nonsmoking room.

If you're staying in a rented cottage or cabin that's near the beach or in a forest, ask that it be thoroughly aired out before you arrive.

Wherever you stay, consider bringing your child's pillow and blanket from home so there's some hypoallergenic bedding.

Can Kids With Asthma Travel Alone?

If your child travels solo (to sleepover camp, to friends or family, etc.), talk with the adults in charge. It's very important for parents, counselors, or chaperones to have copies of the asthma action plan, a list of medicines, and all emergency phone numbers. Also send written (and notarized) permission for them to care for your child in an emergency.

Sit down with your child before the trip to go over the asthma action plan and what to do in an emergency. Your child should know his or her asthma triggers, when and how to take medicines, and how to recognize the signs of a flare-up.

 

Reviewed by: Elana Pearl Ben-Joseph, MD

Date reviewed: May 2017

 

School and Asthma

Asthma flare-ups are the main reason that kids with asthma miss school. And they miss a lot — in the U.S., more than 13 million schooldays are missed each year because of asthma, according to the Centers for Disease Control and Prevention (CDC). 

But well-managed asthma is far less likely to result in a sick day. When kids' asthma is under control, they have far fewer flare-ups.

How Can I Keep My Child Healthy for School?

The first step is to work with your doctor to create a written asthma action plan that will tell you what medicines your child needs to take, how they should be taken, what triggers to avoid, and more. Make sure to give the school staff a copy of the asthma action plan.

At the start of each school year, meet with your child's teacher and other school staff to discuss the plan. You should talk about:

  • the history of your child's asthma
  • whether your child can manage asthma independently
  • how to reach you and your child's doctor
  • plans for handling treatment during any off-site activities, such as field trips
  • what the school's rules are for kids old enough to handle asthma care (can kids keep an inhaler on hand or do they have to go the health office to use it?)
  • who handles asthma care if your child isn't old enough to take care of monitoring and treatment. For example, someone on the school's staff should know how to work an inhaler and/or peak flow meter, if your child uses one. Ideally, a health professional at the school will do this. If not, find out who will.

A supportive school environment that helps kids take charge of their own care is important. Without it, kids might avoid taking their medicines. Encourage the school's staff to help your child settle into a comfortable routine.

How Can We Handle Asthma Flare-Ups at School?

Ideally, quick-relief medicine (also called rescue or fast-acting medicine) should always be readily available to kids. For kids who aren't old enough to take the medicine on their own, this means that the teacher will have it in the classroom. And if not, it will be readily available (not under lock and key) in the school nurse's office.

Once kids are old enough to know how and when to take their medicine, they should carry it at all times, if the school allows. Your doctor can help you decide when your child is responsible for the medicine.

Talk to school officials and find out what they allow. Stress the importance of immediate treatment during an asthma flare-up. They might let your child take the medicine on his or her own, but might ask you to sign an "asthma contract." This might say that you give permission for your child to take medicine and, if needed, who can give it to your child.

How Can We Deal With Asthma Triggers at School?

Part of avoiding flare-ups is to avoid triggers like dust mites and chalk dust. Let the school staff know your child's triggers. You also might:

  • Ask teachers to use "dustless" chalk or dry-erase boards.
  • Ask that any caged pets be kept out of your child's classroom.
  • Ask the staff to avoid using perfumed cleaning products or soaps.
  • Request the use of air conditioners and dehumidifiers.
  • Make sure that the school is vacuumed and dusted regularly, that it's routinely treated by a pest control company, and that it's completely smoke-free.

 

Reviewed by: Aledie Amariah Navas Nazario, MD

Date reviewed: August 2018