Asthma, Part 2 — Treatment, Side Effects, and Implications for School

Treatment

Every child with asthma should see a physician on a regular basis. Sometimes a specialist is needed, such as an allergist or a pulmonologist, who specializes in the care of persons with asthma. The specialist will work in conjunction with the child's primary care provider to develop a plan that helps avoid asthma triggers while monitoring symptoms of the disease. Together they will optimize the child's asthma medications. The specialist, primary provider and the parents should develop a plan of action if the child shows signs of an asthma attack.

There are two basic kinds of medication for the treatment of asthma:  long-term control medications (called "controllers") and quick-acting, or "rescue", medications. The long-term control medications are used on a regular basis to prevent attacks. Quick-acting medications are used to treat the active symptoms of an asthma attack.

A child with mild, infrequent asthma might only require rescue medications. A child with persistent asthma will generally require both types of medication. A child who is having a severe asthma attack will require medical evaluation, and may need hospitalization, oxygen and intravenous medications.

Examples of asthma medications

  • Long-term control medications
    • Inhaled steroids (e.g., budesonide, beclomethasone and fluticasone) to prevent inflammation
    • Leukotriene inhibitors (e.g., montelukast and zafirlukast)
    • Long-acting bronchodilators (e.g., formoterol and salmeterol) to help open airways
    • Cromolyn sodium and nedocromil sodium
    • Aminophylline and theophylline (used less frequently than in the past)
    • Combination of anti-inflammatory and bronchodilator
  • Quick relief (rescue) medications
    • Short acting bronchodilators (e.g., albuterol and levalbuterol)
    • Oral or intravenous corticosteroids (e.g., prednisone and methylprednisolone) to stabilize severe episodes

Treatment of asthma in children may pose some challenges. It is often difficult for kids to use inhalers, so their medication may be dispensed through a nebulizer. Dosages of medications for children are different than those for adults.

Families can help a child with asthma significantly by ridding the indoor environment of potential triggers, such as dust amd pet dander. Ridding the child's environment of tobacco smoke is one of the single most important factors in reducing asthma attacks. Smoking outside is not enough; even the residue left in clothing and hair may cause an asthma attack in a child.

Children with asthma need the adults in their world to help them control triggers that may cause a serious asthma attack. Some of the ways adults can help include:

  • Reduce humidity in the house
  • Fix leaks, which can promote the growth of mold and other organisms
  • Eliminate cockroaches from the environment, by thorough cleaning, and keeping all food in containers and out of bedrooms
  • Use only unscented cleaners and detergents
  • Use allergy-proof ("hypoallergenic") polyurethane-coated casings or covers on bedding, including matresses and pillows, to reduce exposure to dust mites
  • Quit smoking
  • Encourage the child to use a peak flow meter to anticipate changes in asthma status and hopefully prevent a full-blown attack (recommended for children over 5 years)

Due to the increase in the incidence of asthma, many people believe that it no longer causes concern. That belief is dangerous and erroneous. With good treatment, a child with asthma can lead a normal life. However, asthma still can be a life-threatening condition. Unfortunately, children and adults die every year due to poorly controlled asthma.

Working together as a team, the child, parents, healthcare providers and school staff will ensure the best possible outcome for the student with asthma.

Possible medication side effects

Side effects of asthma medications depend on the type of medication used. If side effects of medication pose a significant problem, the child's doctor should be contacted to discuss possible solutions. It is important that the child's medication is not stopped without first talking to the doctor.

Some of the possible side effects of asthma medication include:

  • Tremor, rapid heart rate, insomnia and anxiety with short-acting bronchiodialators, such as albuterol and levalbuterol
  • Dry mouth with a class of medicines called "anticholingerics", such as ipratropium
  • Hoarseness and yeast infection in the mouth with inhaled steroids, such as fluticasone, budesonide and beclomethasone
  • Slow growth, thinning of bones and osteoporosis with oral steroids, such as prednisone, prescribed at high doses over a very long time
  • Rare headache and upset stomach with leukotriene modifiers, such as montelukast and zafirlukast

Physical, dietary and other restrictions

With proper treatment and control of triggers, most students with asthma can participate fully in activities at school. In rare circumstances, such as when a child is having difficulty with asthma control, an adaptive physical education program may be required. The child's doctor can determine if this is necessary.

When the child is not having difficulty with asthma, it is very important to encourage full participation in physical education, recess and any other activities. Needlessly forcing a child to "sit on the sidelines" will result in isolation and disconnection from peers.

If a child has food allergies that could trigger an asthma attack, the child should avoid those foods at school. Arrange a conference, including the parents, the school staff and the healthcare providers, to discuss what foods, if any, may be of concern for the child.

Adequate fluid intake, especially during symptoms of asthma, is recommended.

Implications for school

Several areas of concern may exist for the student with asthma at school, including academic, social and health concerns. It is recommended that the student be evaluated for possible eligibility under the Individuals with Disabilities Education Act (IDEA) as a student who is "other health impaired" (OHI). If the student is not eligible, parents should ask the child's teacher or principal about the possibility of developing a 504 Plan.

Frequent school absences may cause the student with asthma to miss vital academic information, which may result in gaps in the building blocks of learning. Thus, it is important to frequently monitor the child's progress to ensure that essential components of learning have not been missed. If the child qualifies as OHI under IDEA, the child would be eligible for an Individualized Education Plan (IEP). An IEP or a 504 Plan will aid in developing a plan that will prevent academic gaps for the student with asthma.

Social concerns may develop if a student is restricted from physical activity or otherwise unable to participate fully with peers. If physical restrictions are recommended by the child's physician, school personnel should find other ways to include the child in school activities. For example, a child who cannot participate fully in PE, recess or other physical activities, should be given another meaningful task to perform, such as score keeper or equipment manager. Staying inside during recess to read a book or complete homework missed during an absence, suggests that the child is different, and will only increase feelings of isolation and rejection. If necessary, the child could invite classmates to engage in a game in the library or the classroom during recess. Implementing strategies that will keep the child involved, connected to peers and perceived as a "regular class member" is imperative for optimal social adjustment.

Each child with asthma will have unique medical or health needs, and those should be identified in an Asthma Care Plan or Special Health Care Plan, which should be kept in the nurse’s office. This plan should provide important information, including potential triggers to asthma attacks, what to do in case of an emergency, medication regimens and when to call 911. The school nurse, parents and health care providers should collaborate to develop this Special Health Care Plan to address the individual needs of the student. With a plan in place, emergency situations hopefully can be avoided; but if they occur, they can be addressed in the appropriate manner.

KU Kids Healing Place

During treatment for Asthma, there are many challenges for the child and family. In addition to the essential medical treatment for Asthma it is important to care for the psychological, social and spiritual needs of the child and family. This type of care, called palliative care, previously had been reserved for only the sickest patients. However, research has demonstrated that palliative care helps maintain normalcy throughout treatment, recovery and life. Today, every child with Asthma receives the benefit of palliative care, along with all family members. The KU Kids Healing Place (KUKHP), through the Department of Pediatrics at the University of Kansas Medical Center, focuses on treating all aspects of the child and family, ensuring that each receives the care needed to maintain psychological, social and spiritual well-being during treatment for Asthma and on into life. The entire treatment team will work to ensure that the needs of the child are recognized and addressed both in the hospital and in the community, including school, sports, worship and activities. KUKHP partners with school professionals, peers, clergy, coaches, scout leaders and many others to ensure that the child continues to grow and achieve in all environments.


For more information

Asthma, Part 1 — Introduction, Incidence and Symptoms

The American Lung Association®

61 Broadway, 6th Floor
NY, NY 10006
212-315-8700
http://www.lungusa.org/

Asthma and Allergy Foundation of America

http://www.aafa.org/

Contributed by:

Juan Ruiz, MD
Assistant Professor
Department of Pediatrics
University of Kansas Medical Center

Kathy Davis, MSEd, PhD
Associate Professor
Project Director, Connected Kansas Kids
Director, KU Kids Healing Place
University of Kansas Medical Center