By Debbie Swartz, R.N.

Does your child have a cough that won't go away? Does he or she experience difficulty breathing when running or playing sports, when around people smoking cigarettes or after playing with a pet? Do colds result in a cough that lasts a long time?

Symptoms of asthma include a cough, tightness in the chest, wheezing (a whistling sound when you breathe), difficulty breathing, tiring quickly during exercise and difficulty sleeping at night. Although a cough may occur for reasons other than asthma, such as a viral infection or postnasal drip, it may also be a sign of asthma.

In fact, for some children the only symptom of asthma may be a cough, which typically occurs during exercise, at night, with a viral infection or when exposed to cold air. Contact your health care provider if your child is experiencing these symptoms, even if he or she has already been diagnosed with asthma. These may be signs that the asthma is not under control.

What is Asthma?
Asthma is a chronic disease that affects the airways, which are the tubes that carry air in and out of the lungs. With asthma, the walls of the airways become inflamed (swollen). This inflammation makes it easier for the airways to react to allergens or irritants. When this happens, less air gets into the child's lungs because the airways become narrow.

What Causes Asthma?
It is believed that asthma may be the result of one or more components: environmental triggers, immune system involvement or heredity. Although it is not always clear what causes asthma, for many children it is environmental triggers that lead to asthma symptoms. Examples of triggers are:

• Allergens: Animal dander, pollen from trees and grass, dust mites, cockroaches, mold
  
• Irritants: Cigarette smoke, air pollution, smoke from a fireplace, cold air or changes in weather, strong odors (paint, perfume)
  
• Others: Medicines, sulfites in foods or beverages, infections, medical conditions

Is Your Child's Asthma Controlled?
There is no cure for asthma, but most people can control asthma and be free of symptoms most of the time. However, your child may experience times when his or her asthma symptoms are not controlled, such as when he or she has a viral illness or is unable to avoid a specific trigger like pets or cigarette smoke.

In general, your child's asthma is not under control when he or she:

• Has symptoms more than twice a week
  
• Uses rescue medication (Albuterol® or Xopenex®) more than twice a week
  
• Awakens with asthma symptoms more than two nights a month
  
• Is unable to perform normal activities
  
• Has a peak flow reading of less than 80 percent of his or her personal best

A quick test called the Asthma Control Test is available to assist you in determining if your child's asthma is under control. The American Lung Association supports this test.


How to Help Your Child Control Their Asthma
You will need to work closely with your child's physician to manage and control their asthma symptoms. Components of asthma management include:

• Work with your child's health care provider to develop an asthma action plan.
  
• Implement and maintain the asthma action plan.
  
• Identify triggers and develop a plan to minimize your child's exposure to triggers.
  
• Monitor symptoms.
  
• Contact your child's physician when the action plan is not controlling asthma symptoms.
  
• Assist your child in using medicines and devices (such as a peak flow meter) as prescribed by his or her physician.
  
• Help your child to learn about asthma and how to control it.
  
• Encourage your child to exercise daily and participate in normal activities-aerobic exercise improves airway function.
  
• Meet with teachers, coaches, school nurses and other key school staff members at the beginning of the school year. Provide them with your child's asthma action plan and discuss how the school staff can assist your child in managing his or her asthma while at school. Establish an effective method for communicating during the school year to address concerns and update the action plan as needed.
  
• Review your child's action plan with caregivers.

Debbie Swartz, R.N., is a health educator in PAMF's Community Health Resource Center at the Palo Alto Clinic and a member of PAMF's Asthma Committee.