What causes the flare ups…it’s different in every individual
It’s important to figure out what causes flare ups for a child, because it’s different in every individual. We focus a lot on identifying triggers for asthma in our patients. Triggers range from upper repertory infections – some kids get asthma every time they get a cold, to allergen exposure – some kids have specific things that they have allergies to (like certain pets or foods), or exposure to extremes of temperatures – going out on a really cold day it makes some kids cough. Also, exercise makes some kids cough; emotional stress can cause asthma attacks in some kids. If we can get a good handle on what a child’s triggers are, then we can deal with the triggers individually to see how we’re going to reduce that kid’s exposure to them.

If a cat is a trigger, for example, we can figure out how to prevent exposure to the cat. If the kid has to be exposed to a cat, we can work to see if there is something we can do right before the exposure to prevent that exposure from leading to an asthma flare up, like giving him or her asthma medicine before he or she comes into contact with the cat. If a trigger is cold air, and the child plays hockey and is exerting himself or herself and being exposed to cold air at the same time, there are things we can do to minimize the cold air exposure. They can wear one of those masks that covers your mouth when you breathe, and/or use some asthma medicines right before hockey practice. A lot of what we talk about in clinic is what the triggers are and to identify the best strategies to prevent those triggers from actually causing an asthma attack.

Hans Oettgen, MD, PhD, Associate Chief, Division of Immunology

Avoiding the triggers
I really focus on avoiding the triggers. If pets really trigger a child’s asthma and the family has a pet, at a certain point you have to make a tough decision about what you want to do – either remove the pet or minimize the exposure to the pet.   Maybe the cat doesn’t go into the child’s bedroom and the bedroom is a cat free zone, or there’s only one room in the house that the cat’s in. Dust is a trigger for a lot of kids, so I make sure they have the allergy proof covers for their mattresses and their pillows, and give instructions or information on how to minimize that exposure to dust in the household. For a lot of kids getting colds in the winter triggers them, so I focus on how you put the antenna up when you see your child’s getting a cold and recognize that that it could potentially tip them over the edge.

Shari Nethersole, MD, Pediatrician