Recognizing signs and symptoms
There are overt signs and symptoms. The classic four are wheezing, coughing, shortness of breath, and complaints of chest tightness. But there are many early warning sighs that can appear long before breathing changes occur that signal parents to an impending asthma flare up. The big one that should cause a parent to react is the very first sign of a cough or a cold.

Even the most well managed, well controlled child with asthma is going to have a problem if they get sick. You can have very active kids running around but when their breathing becomes labored and their oxygen levels change, they slow way down.   The very mellow kids can often get hyper and uncharacteristically agitated when their breathing changes. You want to look at these kinds of behavior changes. Some kids, usually those with allergy related asthma, often wake up with dark circles under their eyes – a good early indicator that presents before breathing changes become noticeable, before the coughing and the wheezing kick in.

Parents, family and friends, school teachers, and after school staff all need to be able to recognize asthma early warning signs and   breathing changes in these kids and refer to the child’s Asthma Action Plan to know which medications to reach for and how to dispense them. There’s a huge misconception around the notion of an “asthma attack” – that an “attack” occurs only when asthma becomes so bad that a trip to the local ER is required or, worse, the child is hospitalized…WRONG! An “asthma attack,” “flare up,” or “exacerbation” occurs  anytime the child experiences symptoms even the most mild symptoms of cough or wheeze. That’s the point when action needs to be taken.

Amy Burack, RN, MA, AE C, Former Community Asthma Programs Manager

 

Learning what to look for
Apparent acute attacks may occur because minor symptoms that were there for a long period of time were either not recognized or ignored. Minor symptoms may be very subtle: nothing more than a little shortness of breath with exercise, a nighttime cough, a cough with laughter or maybe the child seems a little fatigued or crabby or just doesn’t feel well. Because parents are with their children all the time they might just think these things are to be expected, so sometimes it helps to have a doctor pick up on these subtle signs and advise what to watch for to try and avoid acute episodes.

Once parents learn about what to look for and once they know they can intervene, I tell them to act quickly and use the tools they have. Parents, once they realize the importance of these mild symptoms are more ready to treat asthma before it becomes acute. They are the best ones to recognize early signs of deterioration. We tell parents that the earlier they start to treat a symptom of asthma the less likely that their child will be in trouble. If they notice symptoms on a Saturday night and think, “I’ll wait until Monday to call,” it’s more likely that by Monday night things are going to be worse. If you learn how to use the medications, learn what the early signs are for your child, and go to your doctor sooner rather than later, the chance of controlling asthma is much greater.

Frank Twarog, MD, PhD, Allergist

 

Early warning signs
We emphasize early warning signs, so that treatment is started at the first signs of a problem, for example, when the child first starts coughing at night or gets a cold. We encourage parents to use their Asthma Action Plans and be in close contact with their child’s primary care provider, so that if the child’s symptoms aren’t improving or are getting worse, s/he gets seen quickly. Of course, they also need to recognize, when it is an emergency and they need to go to an Emergency Room, for example, if the Albuterol isn’t working, the parents see the child’s muscles being pulled in between the ribs, the child is having trouble speaking or is breathing hard and fast.

Susan Sommer, RNC, NP, Community Asthma Initiative

 

Stay ahead of the asthma
We have a nurse during the days and an on call person at night and weekends that answers our clinic line hourly or can be paged within a few minutes. We try to tell families to double the inhaled steroid inhaler when the adolescent first starts coughing – so many families wait days after a cough starts to change meds. As soon as the adolescent starts getting a cough, that’s when he/she needs to double the medicine dosages so they’re ahead of the asthma. If you can stay ahead of an attack, you may never need Prednisone or have to come to the hospital, or at least not as often.

Elizabeth R. Woods, MD, MPH, Division of Adolescent/Young Adult Medicine

 

Sooner rather than later
We tell parents that the earlier they start to treat asthma symptoms the less likely that their child will be in trouble. If they notice symptoms on a Saturday night and think, “I’ll wait until Monday to call,” it’s a sure thing that by Monday night things are going to be worse. If you learn how to use the medications, learn what the early signs are for your child, and go to your doctor sooner rather than later, the chance of controlling asthma is much greater.

Frank Twarog, MD, PhD, Allergist