Managing Asthma At Home:

The more allergies a child has, the more severe the asthma. Making lifestyle changes to reduce allergy attacks and other triggers is extremely important.

Asthma Action Plans

Asthma action plans create a written document for patients and parents to manage asthma during stable times and to more easily identify when asthma is worsening. Important components of a home program include:

• A clearly written plan for taking asthma medications when condition is stable
• A complete education regarding the difference between long-term control medications and quick-relief medications
• Monitoring of asthma on a daily basis. Symptom monitoring is adequate for patients with intermittent or mild persistent asthma. Peak flow monitoring should be performed in patients with moderate or severe persistent asthma or those with a history of more severe exacerbations (sudden worsening or increase in severity of symptoms).
• A list of environmental control measures that need to be taken
• When to seek medical care

Managing Asthma Exacerbations. Always refer to the written action plan from your doctors and nurses. Treatment approaches generally include:

• Recognizing symptoms and measuring peak flow
• Using for the first time or increasing usage of short-acting medications
• Eliminating or withdrawing from any triggers or irritants that may be responsible for increase in severity of symptoms
• Depending on written instructions from doctor, begin oral corticosteroids if available
• Monitoring response to treatments and communicating with doctor if symptoms worsen or if severe symptoms occur. [See: "Symptoms" section.]

Follow-up generally depends on the severity of asthma, how recently asthma was diagnosed, patient compliance, and whether recent changes in treatment were made.

Avoiding Environmental Triggers

House dust is a reservoir for pollen and dust mites. Some doctors believe that reducing household allergens and pollutants in the home could reduce asthma in children by 40%.

Controlling for Dust. Spray furniture polish is very effective for reducing both dust and allergens. Air cleaners, filters for air conditioners, and vacuum cleaners with High Efficiency Particular Air (HEPA) filters can help remove particles and small allergens found indoors. Neither vacuuming nor the use of anti-mite carpet shampoo, however, is effective in removing mites in house dust. In fact, vacuuming stirs up both mites and cat allergens. If possible, avoid carpets and rugs.

Controlling Pets. For children who have an existing allergy to pets:

• If possible, keep pets outside.
• If this isn't possible, confine pets to carpet-free areas outside the bedroom. Cats harbor significant allergens, which can even be carried on clothing. Dogs usually cause fewer problems.
• Wash animals once a week to reduce allergens. Dry shampoos, available for both cats and dogs, can remove allergens from the skin and fur and are easier to administer than wet shampoos.

Bedding, Curtains, and Bedroom Environment.

• Replace curtains with shades or blinds, and wash bedding using the highest temperature setting.
• Encase mattress and pillow in special dust mite proof covers (synthetic pillows may pose a higher risk for asthma attacks than feather pillows, or no pillow at all).
• Wash pillow in water hotter than 150° F, or in cooler water with detergent and bleach.
• Wash sheets and blankets weekly in hot water.
• Avoid sleeping or lying on cushions or furniture that are cloth covered.
• Keep stuffed toys away from the bed and wash them weekly in hot water. Placing toys in a dryer or freezer may help, but is not as helpful as washing.
• Avoid the bottom bunk of the bunk bed. In general, children should sleep as high off the floor as possible.

Exterminating Pests (Cockroaches and Mice).

• Use professional exterminators to eliminate cockroaches. (One study reported that ridding a home of cockroaches and cleaning the house using standard housecleaning techniques failed to eliminate the cockroach allergens themselves.)
• Exterminate mice, and attempt to remove all dust, which might contain mouse urine and dander.
• Keep food and garbage in closed containers.
• Keep food out of bedrooms.

Reducing Humidity in the House. Living in a damp environment is counterproductive. Humidity levels should not exceed 30 - 50%.

• Fix all leaky faucets and pipes, and eliminate collections of water around the outside of the house.
• Dehumidify basements, but empty humidifiers and clean them daily with vinegar solution.
• Clean often any moldy surfaces in the basement or in other areas of the home.
• Avoid prolonged used of vaporizers to manage symptoms during asthma attacks.

Many of the same substances trigger both allergies and asthma. Common allergens include pollen, dust mites, mold, and pet dander. Other asthma triggers include irritants like smoke, pollution, fumes, cleaning chemicals, and sprays. Avoiding exposure to known allergens and respiratory irritants can substantially reduce asthma symptoms.

Preventing Exposure to Cigarette and Cooking Smoke. Parents who smoke are strongly urged to quit. Studies indicate that exposure to second-hand smoke in the home increases the risk for asthma and asthma-related emergency room visits in children. Even smoky cooking can worsen asthma.

Avoiding Outdoor Allergens. The following are some recommendations for avoiding allergens outside:

• Avoid scheduling camping and hiking trips during times of high pollen count (generally, May and June for grass pollen and mid-August to October for ragweed).
• Avoid strenuous activity when ozone levels are highest, which usually occur in early afternoon, particularly on hot hazy summer days. Levels are lowest in early morning and at dusk.
• Asthma attacks are often higher during thunderstorms. It is not clear why. Some evidence points to a build-up of ozone that accompanies such storms.
• Patients who are allergic to mold should avoid barns, hay, raking leaves, and mowing grass. Exposure to automobile fumes may worsen asthma. Fungi in car air conditioners can also be a problem.
• Air pollution can worsen existing asthma. Avoid strenuous activity during times of high air pollution.

Managing Asthma at School

Parents should make sure that their childâ ' s school has a copy of the written asthma action plan. The plan should contain a list of medications the child takes (including which ones need to be taken during school hours), identified asthma triggers, and emergency contact numbers. Parents should also make sure that the school staff is trained in the steps to take in case of an asthma attack.

Exercise

Asthma is no reason to avoid exercise. Historically, about 10% of Olympic athletes have asthma. Some studies indicate that long-term exercise may help control asthma and reduce hospitalization. Exercise can help control weight, which can help with asthma symptoms.

Encourage children with asthma to swim and play sports, such as baseball, that will be less difficult for them. Intense activities lasting less than 2 minutes, such as sprinting or competitive swimming, may cause fewer problems than longer-lasting exercises.

Young people who enjoy running should probably choose an indoor track to avoid pollutants. Swimming is excellent for people with asthma. Yoga, which uses stretching, breathing, and meditation techniques, may have particular benefits.

Patients should consult their doctors before starting any exercise program. Exercise-induced asthma (EIA) is a limited condition that has specific recommendations.

Hints for Reducing Exercise-Induced Asthma (EIA). EIA occurs only after exercise and is more likely to occur with regular paced activities in cold, dry air. The following are some suggestions for reducing its impact:

• Comply with long-term control medications, particularly inhaled corticosteroids, when prescribed.
• Warm-up and cool-down before and after exercise.
• Participate in activities with short bursts of exercise (such as tennis and football) over exercises involving long-duration pacing (such as cycling, soccer, and distance running).
• Breathe through a scarf or through the nose. This helps warm up the airways when exercising in cold air.

Medications.

• Short-acting beta2-agonists taken before exercise are generally considered the first choice, and they last for 2 - 3 hours
• Cromolyn is another option but it is not as effective
• Leukotriene antagonists are another option, but they generally take hours to be effective

Preventing and Treating Respiratory Infections

People with asthma should try to minimize their risk for respiratory tract infections. Washing hands is a very simple but effective preventive measure.