Asthma update

New medications and preventions can help kids breathe easier

Zero. If, like one in five Canadian kids, your child has asthma, experts say that’s the number you should be shooting for: “Zero cough, zero wheeze, zero breathlessness, zero running to the emergency room, zero limitations on exercise and zero grabbing for rescue medication,” underscores Mark Greenwald, chair of the Asthma Society of Canada’s medical and scientific advisory committee.

Does that mean a dependence on puffers is preferable to an occasional flare-up? Actually, yes. An acute asthma attack is like a sunburn: Just as keeping your kid out of the sun and slathering on sunscreen reduce her chances of getting skin cancer in adulthood, preventing asthma flare-ups by avoiding triggers and using daily controller medications (a “puffer” such as Flovent) lowers the odds of later lung damage — not to mention improving quality of life in the short term! So while it’s not always possible to eliminate symptoms, Greenwald says that should be the goal.

Yet many parents aren’t getting that message. According to research by the Canadian Network for Asthma Care, nearly one in four children with the condition reported suffering nighttime coughing, wheezing or shortness of breath at least once a week — even though 80 percent of parents in the same survey said their child’s asthma was well or completely controlled.

Why the disconnect? “People get used to living with symptoms,” Greenwald explains. When a kid coughs for weeks with every cold, or a hockey player opts for playing goalie because cold air leaves her too breathless to speed skate, “parents think that’s just the way that child is.”

Happily, however, we now have better tools to break asthma’s chokehold — from new medications to updated asthma management guidelines put out by the Canadian Network for Asthma Care. Here’s what’s new — and what you might not know about tried-and-true methods for controlling your child’s asthma.

New medications
Oral option. A completely new kind of asthma drug may bring symptoms in check when controller medications can’t do the job alone. A convenient daily pill called montelukast sodium (brand name Singulair) can reduce reliance on rescue puffers and even cut down on doses of controller puffers needed to prevent flare-ups. And unlike a corticosteroid pill, Singulair doesn’t knock out cells that fend off viruses, bacteria and yeast infections; instead, it intercepts a chemical message that sets allergy-related asthma symptoms in motion.

Longer-acting airway openers. Relatively new inhaled medications can be used to keep airways open at night and during exercise. “They’re different because they usually last 12 hours” versus four to six for Ventolin, explains Alexander Ferguson, head of the division of allergy at BC Children’s Hospital in Vancouver. Since these newer drugs start working more slowly, however, they can’t be used to reopen airways during an acute attack.

Longer-acting airway openers do have one drawback: Because they suppress symptoms so effectively, people sometimes rely on them alone rather than in combination with controller medications, which may not prevent an acute asthma attack.

Take-Control Strategies
Assess lung function. Rather than relying on parents or doctors to eyeball symptoms, experts recommend having an asthma specialist give a “blowing” test, which measures lung function, to diagnose asthma in school-aged kids (preschoolers usually can’t follow the necessary instructions). Not only does testing reduce the odds of misdiagnosis, it’s also better at picking up problems than simply asking questions. “When I tell parents, ‘This test is telling me your child’s asthma is active right now,’ they’re shocked,” observes Sharon Dell, a paediatric respirologist at Toronto’s Hospital for Sick Children.

Avoid allergens. Allergens play a significant role for about 85 percent of school-aged kids with asthma, and a recent study showed that getting tough on these triggers can add two symptom-free weeks to a child’s calendar every year. Children of parents who were taught to reduce allergens (for example, by encasing pillows and mattresses in allergen-impermeable covers and installing special air purifiers) suffered an average of 34 fewer days of wheezing over two years compared to kids whose families received no such instruction. This strategy also minimizes medication needs.

Attain an expert ally. A certified asthma educator, who can provide one-on-one tutoring and advice, can be an invaluable ally in your quest for symptom control. “I can’t overstress the importance of an asthma educator,” says Dell. To find one in your community, call your local hospital, or visit asthma.ca and click on “Asthma Education Centre Locator.”

Anticipate flare-ups. Sit down with your doctor and draft an asthma action plan. (Download a template from asthma.ca or lung.ca.) If your son’s symptoms flare during fall ragweed season, your doctor might suggest upping his corticosteroid dose the minute the pollen count starts climbing. Or, if your daughter’s asthma acts up when she catches a cold, your physician might recommend taking controller medications only during winter, or starting corticosteroids at the first sign of sniffles.

Ask about symptoms. Kids don’t always tell you when they start feeling subpar — some won’t want to worry mom or dad, while others may write off chest tightness as a sore tummy. Asking focused questions is one way to stay on top of how well treatment is working. (“Did you have to stop and sit on the bench during gym? Did your coughing wake you up last night?”) Using a peak flow meter (a gadget that measures air pushed out by the lungs) to track airway function can also be helpful, since it may pick up changes even before obvious symptoms appear.

Assume proper puffer technique. “I’ll bet 80 percent of my patients initially use their respiratory medication devices incorrectly by not inhaling them properly, not loading them right or using them when they’re empty,” says Ann Bartlett, a certified asthma educator and nurse-clinician at the Firestone Institute for Respiratory Health at St. Joseph’s Health Care Hamilton. Have your child review proper puffer technique with her doctor, pharmacist or asthma educator. And if she doesn’t use a holding chamber (spacer) with her puffer, raise the issue with the physician: These devices, strongly recommended for children, substantially increase the amount of medicine that gets into the airways, which means you’re not wasting precious puffs of that $50-plus prescription.

Adopt an anti-inflammatory diet. Recent research suggests limiting red meat and fast food can help reduce wheezing episodes in teens with asthma. No doubt that news will leave your child all choked up in an entirely different way!

True or False?

About 50 percent of kids with asthma eventually outgrow it.
True (sort of).

The truth of this statement depends on how you define asthma. A lot of doctors refer to wheezing that comes on with viral infections — a condition that commonly crops up in preschoolers — as “asthma” because asthma medications relieve it. Whatever the label, about half of the preschoolers with virus-linked wheezing do grow out of it. School-aged kids, however, are less likely to outgrow asthma, particularly if they have eczema, allergies or a family history of asthma or allergies. The bottom line? “If you look at the overall outcome of wheezing, then probably about half of these kids will be fine when they get to adolescence,” says Alexander Ferguson, head of the division of allergy at BC Children’s Hospital in Vancouver. “And about one-third to one-half of the group who get better in adolescence will actually get asthma again as adults.” One point experts agree on, however, is that the severity of a child’s asthma will likely remain constant throughout her life — so if it’s mild now, chances are good it’ll stay that way.

A child who’s admitted to hospital for treatment three or four times a year has out-of-control asthma.
True.

While this seems like a no-brainer, some parents truly don’t understand that anything but the very mildest form of asthma is actually like swimming in shark-infested waters — you have to wear your protective suit (or take your daily controller medication) even on days you don’t see fins. “Those parents think, oh, we just go to the hospital every three months, but he gets his medications, and then he’s fine,” points out Sharon Dell, a paediatric respirologist at Toronto’s Hospital for Sick Children. “That’s not fine — it should be considered poorly controlled asthma, and should probably be treated with a daily controller medication.”

Asthma should limit your child’s physical activity level.
False.

“I tell all my patients, ‘because you have asthma, you actually have to be in better shape than me,’” says certified asthma educator Ann Bartlett, to keep their lungs functioning at peak efficiency. Exercise-induced coughing, wheezing or chest tightness is considered a clue that your child’s treatment needs adjusting.