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NIH: Create Action Plans to Control Kids' Asthma

September is the peak month for asthma attacks that send kids to hospital emergency rooms. Experts call it the September epidemic.

"The most common precipitant of a bad attack of asthma is infection with the common cold virus," says Dr. Homer Boushey, of the University of California, San Francisco. "And what happens when kids get back together for school is they start exchanging viruses."

The National Institutes of Health has just released new guidelines to help parents prevent these flare-ups. The updated guidelines include the first distinct treatment recommendations for children ages 5 to 11 years old. They include recommendations on preferred medications, such as cortico-steroids which are used to reduce inflammation in the airways, and short-acting bronchodilators, such as Albuterol, which are used as "rescue" inhalers.

The guidelines include a new focus on self-monitoring of symptoms and urge physicians to work with their patients to develop written asthma action plans.

Asthma Action Plans

Alison Shelton, an economist in Washington, D.C., struggled with her 9-year-old son Kenneth's asthma for several years. He would start coughing at night, says Shelton, "And it would go on all night." After he was officially diagnosed, Shelton's family physician at Kaiser Permanente helped her develop a written action plan.

"It's a sheet of paper and it's got three parts or zones," Shelton says. There's a green zone, which includes instructions about which medicines to take daily.

When Kenneth starts with coughing or wheezing, or when he develops a cold, they step up to the yellow zone, which means taking higher doses of medications. Symptoms that put him in the red zone necessitate a call to the doctor for drugs they don't keep around the house.

Shelton says the written plan, and knowing when to use the medications, helps her feel a lot more confident about controlling her son's asthma.

Corticosteroids Recommended to Control Asthma

Shelton says that originally she wasn't convinced that her son needed daily medication when he didn't have any symptoms. She especially didn't like the idea of steroids.

"I thought, oh no, this can't be good," Shelton says. She associated steroids with bulked-up athletes and dangerous side effects. "But the doctor was very clear that this is not the same steroid, and that the benefits are overwhelmingly in favor of doing it."

Experts say the beauty of the inhaled cortico-steroids, which are sold under trade names such as Pulmicort and Flovent, is that they reduce inflammation in the lungs with small and targeted doses.

"We inhale tiny doses because the dose is deposited directly in the lung," Boushey explains. "And very little is absorbed into the circulation to cause systemic side effects."

Kids do grow slightly slower in the early years while using corticosteroids, but Boushey says, "Follow-up studies suggest they catch up and reach their adult height just as one would predict."

Controlling Asthma

When 39-year-old Kirstin Carlson-Dakes was a kid, there was little she could do to control her asthma. She recalls long nights in the ER, waiting for shots of adrenaline.

"I remember gasping for breath," Carlson-Dakes says. "My mom and I have talked about it and she's talked about how scared she was and how she never really knew going to the ER if I was going to make it or not."

When Carlson-Dakes was a child, there weren't effective preventive medicines, and kids didn't have inhalers. Parents had few ways of controlling symptoms, short of steaming up the bathroom. For many kids, activities such as sports and camping trips were a real challenge.

"I remember I tried to go on a Girl Scout sleepover," Carlson-Dakes says, "and my parents had to get me in the middle of the night because I had an asthma attack."

But things are very different now for her children. Although two of them suffer from asthma, they never end up in ER and don't miss out on activities.

"My daughter can go to Girl Scout camp and she can go on overnights and we don't have to worry," she says.

That's because her 9-year-old daughter has several medications to keep symptoms under control. And even on a campout, she knows exactly how much of which ones to take when she starts wheezing.

There are about 500,000 hospitalizations, and more than 2 million ER visits each year due to asthma attacks.

"Most of these could be prevented," says Boushey if more families learned to stay ahead of the symptoms.

The new guidelines urge all parents to team up with their doctors and young kids to develop a written action plan. So instead of fearing asthma, they can control it.

Copyright 2023 NPR. To see more, visit https://www.npr.org.

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Allison Aubrey is a correspondent for NPR News, where her stories can be heard on Morning Edition and All Things Considered. She's also a contributor to the PBS NewsHour and is one of the hosts of NPR's Life Kit.
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