Childhood asthma

What to do in an asthma attack

Asthma attacks vary in intensity, from mild to serious and requiring emergency treatment. Therefore, it is important to discern the severity of the attack and deal calmly with the situation.
You should also consult with your child’s doctor on how to take medication in an attack. Ask your doctor for an Action Plan Sheet (individualized asthma management plan) which tells you what to do in case of an attack.

What to observe in an asthma attack

1. Is your child acting differently than normal (play, meals, sleep)?
2. How is your child’s breathing (whistling, wheezing, chest movements while breathing, etc.)?
3. If you measure peak flow on a regular basis, the numbers may serve as an index of attack intensity.

Monitor the intensity of the attack, and observe your child for signs of severity.
If any one of the following applies, you need to take your child to the hospital immediately.

Signs of an intense attack

1. Daily activities
   • Cannot play, talk, or walk.
   • Can hardly eat.
   • Cannot lie down, cannot sleep.
2. General condition
   • Child looks pale (no pink color in lips or fingernails).
   • Child seems dazed and lethargic. Or, child is more excitable than usual and is acting out.
3. Breathing and pulse
   • Child’s wheezing is clearly audible from a distance.
   • Child’s skin tightens visibly at the throat or ribcage, or nostrils seem to flare, when breathing in.
   • Child’s pulse is very fast.

(Excerpted from the Environmental Restoration and Conservation Agency’s “Tell Me, Doctor! Children’s Asthma Handbook”)

How to deal with an attack

During regular checkups, ask your doctor for advice on dealing with attacks, how to use “rescue” medication, how to determine whether the emergency room visit is necessary, and when to go to hospital.

• Keep calm. Determine the severity level of the attack.
• Are there signs of a severe attack?
• If there are signs of a severe attack, go to the hospital immediately.
• Use “rescue” medication as necessary and as instructed by the doctor.

Remember that attacks may occur at any time, and your regular doctor may not be available. Make sure you know where to go if an attack occurs at night, on the weekend, or during holidays.

For details on what to observe and what to do during an asthma attack, please refer to the Environmental Restoration and Conservation Agency’s “Tell Me, Doctor! Children’s Asthma Handbook”

Environmental management (patient and family work together to reduce irritants and triggers from the living environment)

Each person has different triggers. It is important to identify triggers and irritants, and take steps to reduce exposure to them in daily life.

• Cigarettes, fireworks, etc.
  • Cigarette smoke can trigger attacks.
    Smoking indoors should absolutely be avoided. Even if the smoker goes outside to smoke, the cigarette components remain inside the smoker’s lungs and flow indoors together with the smoker. The components of cigarettes decrease the effectiveness of asthma medications. Family members are advised to stop smoking as much as they can.
  • Inhaling smoke from fireworks or incense can cause breathing difficulties. Move to an upwind location, or have your child cover his or her nose and mouth with a towel etc. to avoid inhaling the smoke.
• Take measures to reduce indoor allergens
  It is important to reduce allergens such as dust mites and mold in the living environment. Key points to reducing allergens are proper cleaning, bedding management, and humidity control.
  For information on reducing indoor allergens, please refer to “Allergies and Your Living Environment.”
• Pet allergens
  (people can be allergic to dogs, cats, rabbits, hamsters, etc.)
  • The allergens are pet hair or dander. It is best to avoid keeping furry pets. If you already have a pet, take steps to avoid exposure to the pet’s allergens (wash pet regularly, keep pet outdoors, etc.)
• Preventing colds and influenza
  Take measures to keep your child from catching colds or other respiratory infections, such as making sure your child washes his or her hands after going out, wears a mask when outdoors, and gets vaccinated.

Self-care (patient takes an active part in his/her treatment, acquiring the knowledge and judgment required to continue proper management)

It is important for your child to acquire the ability to monitor his or her own condition, maintain control of the asthma, take measures to prevent attacks, and deal with them appropriately should they occur. As a parent or guardian, you should provide instructions and guidance as your child grows, so that he/she can do more and more on his/her own.
Take the following steps.

Have your child learn the basics of asthma

Have your child understand the types and roles of medicines

Enable your child to monitor his or her own condition

Encourage self-care to prevent attacks. Peak flow meters and asthma diaries can be useful.

Peak flow meter

Peak flow meters are devices which can be easily used at home to measure breathing function. Peak flow refers to the speed at which you can blow air out of your lungs. After taking a deep breath, you blow as hard as you can into the peak flow meter. Peak flow is reduced when respiratory function declines, even in the absence of subjective symptoms. Using a peak flow meter lets you catch such situations early, before your condition worsens. There are many types of peak flow meters available. Consult your child’s doctor as to which type is best for your child.

Asthma diary

Keeping an asthma diary containing entries on symptoms, medication, the weather, and daily activities lets you look back on your lifestyle and symptoms. This can help you identify triggers, preliminary signs, and possible preventative steps for your attacks. Your doctor may be able to provide you with an asthma diary, or you can download one for free from various websites.

(Excerpted from the Environmental Restoration and Conservation Agency’s “Childhood Asthma Diary: My Health Notebook” brochure)

Japanese Pediatric Asthma Control Program (JPAC)

Asthma symptoms and any impairments to daily life over the past month are entered into the sheet to assess how your child’s asthma is being controlled. Show this sheet to the doctor when you go for your child’s regular checkup.
“JPAC” can be downloaded from the Environmental Restoration and Conservation Agency’s website.

Environmental management (addressing triggers and causes of attacks)

Please refer to the section on environmental management.

Addressing attacks when they occur

Ask your doctor to formulate an Action Plan (individualized asthma management plan) for your child.

Next: How to visit the hospital

How to visit the hospital

To ensure your child receives appropriate treatment, it is important to give your doctor detailed information on your child’s symptoms. To explain your child’s condition accurately when you visit the hospital.

• Jot down the points you want to convey and have them ready when you visit the hospital.
• An asthma diary or JPAC can be useful.