A Plan To Keep Your Child With Asthma Out of the ER

By Mandie Svatek

Editor’s note: This post first appeared in Alamo City Moms Blog.

At University Hospital, we see kids brought to our emergency department for out-of-control asthma attacks that can require admission to the hospital—including the ICU. In fact, asthma is one of the top five reasons children are admitted to a hospital.

The good news is, by developing an asthma action plan with your child’s physician, understanding it, and providing copies to caregivers and your child’s school, you can lower the chances of needing to visit the hospital in the first place. These plans are available in both English and Spanish.

First, the basics. Asthma is a chronic disease in which the airways in the lungs become swollen and inflamed. When something triggers asthma, the inflammation gets worse, causing coughing, wheezing, and shortness of breath as oxygen has difficulty entering the lungs.

There is no cure for asthma, but it can be managed with asthma education and an asthma action plan.

Asthma action plans—which are organized by the colors of a traffic light—list the steps that should be taken when the child is breathing normally (green), when he or she is having symptoms (yellow), and when those symptoms aren’t responding to medications (red).

Here are some basics to help keep your child out of trouble—and out of the emergency room. 

Medications: Typically, your child will get two different medicines to control asthma. The first is taken daily to prevent symptoms. The second is a quick-relief medicine when the child is wheezing or has difficulty breathing. Your doctor will also want to treat other conditions that can worsen asthma or interfere with treatments.

Triggers: Common things in the environment can trigger or worsen asthma symptoms. It’s important to know what triggers your child’s asthma in order to recognize and avoid them. Examples can include dust, pollen, air pollution, molds, cigarette smoke, pets, and cockroaches. And while exercise can be a trigger for some kids, the health benefits of physical activity far outweigh the risks. Your doctor can discuss medicines that can prevent exercise-induced asthma symptoms.

Symptoms: Wheezing, tightness in the chest, shortness of breath, and coughing are tell-tale signs of an asthma attack. Coughing often occurs at night or early in the morning, and some parents I talk to don’t immediately associate coughing with asthma. But a nighttime cough is a sign of spasms in the airway as a result of inflammation and secretions.

Spacers: In recent years, spacers have become more common in the management of asthma. These resemble a clear water bottle that attaches to the inhaler, with a mouthpiece on the other end. This device makes inhalers a little less inconspicuous (but easy to carry in a purse and clean in the dishwasher); however, it makes sure that the entire dose of medicine reaches the child’s lungs in just a few breaths. Studies have shown that the medication particles can escape into the air or just reach the back of the throat when using the inhaler by itself.

Peak Flow Meter: These hand-held devices measure how well your child’s lungs are functioning. Tracking your child’s peak flow scores can tell you how well the asthma is being controlled, and even predict an attack before symptoms appear. You might also want to keep a journal of your child’s symptoms to see how well treatment is working.

At University Health, we’ve created a streamlined asthma program to help our patients and have organized an ACCT, or Asthma Coalition for the Community Team. Most of our clinics follow an asthma protocol so if a child comes in with asthma symptoms, a course of treatment can be prescribed. This protocol starts with an exam, after which your child will be given a clinical respiratory score, or CRS. This score is based on a number of factors such as oxygen saturation, breathing rate, symptoms, and so on.

Their clinical respiratory score determines the course of treatment. A child with a high score might begin with a more aggressive course of treatment than another child whose score is low. And if the child does have to go to the emergency room for an asthma attack, the clinic staff will inform the hospital what the child’s CRS score is and what treatment has already been given, allowing for streamlined care.

University Health also offers a free, online pediatric asthma risk assessment at CheckMyHealthSA.com. And we're also sponsoring a free day camp for children with asthma, ages 7-12. You can find more information here.

You can do your part—and be part of the team—by developing an asthma action plan for your child and familiarizing yourself with it. Having a child with asthma can be scary, but knowing what to do can keep it under control.

Dr. Mandie Svatek is a hospitalist at University Hospital and assistant professor of pediatrics at the UT Health San Antonio. 

Photo by Mark Greenberg Photography

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