Allergy Clinical Services

Frequently Asked Questions About Asthma

Can my child's asthma be cured?

No, asthma cannot be cured. Some children can "outgrow" wheezing and coughing; they may not have asthma to begin with. Asthma is a chronic disease that can be controlled and managed. Although you may be the most concerned when you see your child experiencing symptoms or having problems breathing, your child still has some degree of airway inflammation even when well. If your child is not experiencing symptoms, it is not because his asthma went away, but because it is under control.

Can my child catch asthma from someone?

No, asthma is not an infectious or contagious disease.

Are some children more likely to have asthma than others?

Asthma can affect anyone, young or old, male or female, people of all races and ethnic backgrounds. When one or both parents have asthma, a child has a greater chance of also having this lung disease. But many children develop asthma even though there is no family history of the disease.

I have not heard anything good about steroids. Why are steroids used to treat asthma, especially in children, if they are so "dangerous?"

Aren't all steroids the same? What about the steroids that athletes take?

There are different types of steroids. One important fact to consider is that the human body manufactures steroids, and we can't live without them. Steroids taken and abused by athletes to grow bigger and stronger are not the same as steroids used to treat asthma. Most of the bad side effects of steroids that people hear about — puffy, swollen face (especially the cheeks), high blood pressure, behavior changes, acne, skin thinning, bruising, stomach upset/ulcer, osteoporosis, cataracts, glaucoma, reduced ability to fight infections, and growth suppression come from long-term treatment (not a three- to five- day course or burst) with prednisone taken by mouth, not inhaled steroids. Prednisone is used to treat children with asthma for a short burst when they have an asthma flare or longer in some cases of severe asthma. If a child takes prednisone for a few days and develops side effects, the side effects usually resolve after finishing it. Prednisone is dosed in milligrams per kilogram of a child's body weight. Inhaled steroids are dosed in micrograms (it takes 1000 micrograms to equal 1 milligram). In other words, the dose of inhaled steroids is very small. It is delivered directly to the lungs where it is needed. It does not go through the whole body. Through research, we know that inhaled steroids are the best medicine we have to treat asthma.

Can someone die from asthma?

Yes, asthma can be fatal, but fortunately this is rare. When asthma is the cause of death, it is usually because patients didn't take their medicines properly (when and how they were supposed to), or they didn't get help in time because they didn't take their symptoms seriously.

It seems like more and more children are being diagnosed with asthma. Why is that happening?

Asthma is the most common chronic disease of childhood, and the number one reason that children miss school, go to emergency rooms, and are admitted to hospitals. About five million American children are estimated to have asthma, and the number continues to rise worldwide. We don't know why this is happening even though many asthma experts are doing research to try to find out. Some of the reasons for the increase may be that asthma is better recognized and diagnosed than in the past; increased air pollution; homes with less ventilation, more moisture, more indoor pets, and children spending more time indoors.

My child always seems to have a cold and now has been diagnosed with asthma. How do I know the difference between a cold and asthma?

A cold is an upper respiratory tract infection caused by a virus. Colds are a common asthma trigger, in fact the most common trigger in babies and toddlers. Usually when a youngster gets a cold, the cold will last a week or less. When a child with uncontrolled asthma catches a cold, the cold triggers the asthma. So although the cold itself is gone in a few days or a week, the child's cold seems to go on and on because of asthma symptoms, such as coughing and wheezing. In uncontrolled asthma, this coughing and wheezing can last for weeks. Before you know it (especially in the winter), the child gets another cold — although it seems like the last one never went away. All of us catch colds, so make sure when your child gets a cold that you follow his or her action plan to treat symptoms and keep them under control.

What is the best way to give inhaled asthma medicine?

There is no one-size-fits-all answer. Some children do well when given medicine by nebulizer machine and others by an inhaler with a spacer. There are pros and cons about each. Whichever device is prescribed, it must be used correctly to be effective. For example, if you use a nebulizer, it should be used with a facemask or mouthpiece; don't just blow the mist into the child's face. Research has shown that metered dose inhalers work well for infants if used with a spacer and facemask.

Can my child become addicted to asthma medicine?

No, asthma medicines are not addictive.

How can I tell when to replace my child's equipment: air compressor, filter, nebulizer tubing with mouthpiece or facemask?

When you get new equipment, keep the instruction booklet. If your child uses a nebulizer and air compressor, make sure you keep the phone number of the company that supplied the equipment. The manufacturers of any piece of equipment will include information about how long it should last. To replace equipment, you will need a prescription. In order for the equipment to be covered by insurance, make sure that you order from a pharmacy or equipment company that has a contract with your child's insurance provider.

You need to know if your child's nebulizer tubing and medicine cup are disposable or re-usable and how long you can use them. Follow the instructions to clean and disinfect the nebulizer. And remember: if you don't follow the manufacturer's instruction regarding maintenance and replacement of parts, it will affect the performance of the machine and the treatment your child receives.

A spacer should last at least one year and maybe longer if it is cleaned properly, is not cracked or otherwise damaged, and the one-way valve remains intact. All spacers come with instructions how to clean them properly. If they are not cleaned properly it will affect their performance.

When should my child stop playing or come out of gym or a game because of asthma symptoms?

There should be no restrictions on children's ability to play, take gym class, or compete in sports just because they have asthma. If your child has been instructed to take medicine before physical activity, however, make sure that he or she does so every time. Some parents hesitate to give medicine before exercise or sports because their child seems fine or is active and doesn't develop symptoms.

Remember: you are giving the medicine to prevent symptoms and start your child off at her best, so she can participate actively with other children. Check with your nurse practitioner or doctor first, but in general, if a child experiences symptoms while playing, she should stop and take her quick relief medicine. If she feels better and the medicine relieves the symptoms, she should be able to resume the activity. If the symptoms return, she should stop playing and you should follow the instructions in her action plan.

My child only has occasional seasonal symptoms and seems fine most of the time, so why does she need to take medicine everyday?

Many parents feel this way, but don't forget that asthma is a chronic disease. It's ongoing — it's there every day, even when the child feels fine and has no symptoms. One way to decide whether a child needs medicine daily is to go by the guidelines recommended by the National Institutes of Health. These guidelines were written by a group of experts who reviewed research about asthma and made treatment recommendations. The guidelines recommend that if a child has symptoms more than twice a week and/or three or more flares within a year, then the child should be given daily controller medicine and monitored carefully. Remember, guidelines are recommendations and each child should be viewed as an individual, so if you have questions about this, talk to your child's nurse practitioner or pediatrician.

How do I know when to refill my child's inhalers? It seems like they are all different.

Yes, different medicines are produced by different manufacturers. You just need to be familiar with your own child's medicines. The newer, dry-powder inhalers have a dose counter or indicator to let you know when they need to be refilled.

The best way to know when other inhalers are running out is to count puffs. For example, Flovent inhalers come with 120 "actuations," or puffs of medicine, because the recommended dose is two puffs twice a day, which equals four puffs a day total. If there are 120 puffs in the canister and you divide 120 by four, the inhaler will last thirty days. After thirty days you may still feel liquid in the canister and you may see liquid spray out, but the medicine is gone and the liquid is the leftover propellant and preservative — so replace it.

Most albuterol inhalers come with 200 puffs of medicine or 100 (two-puff) doses.

The usual dose of albuterol is two puffs as needed. If a child's asthma is under control, he should only be using albuterol before exercise and on as-needed basis twice a week or less often. The best way to know when your child's albuterol is running out is to count puffs. For example, if a child takes a two puff dose of albuterol once a week before gym class, another two-puff dose once a week before soccer, and two puffs twice a week for symptoms, that equals four (two-puff) doses for a total of eight puffs a week, and the albuterol inhaler should last 25 weeks (six months).

If you are unsure about how best to keep track of when to refill your child's inhalers, talk to your pharmacist who can instruct you about when to get refills.

Why does my child seem to have more asthma symptoms at night? I would have expected he'd have more coughing and wheezing when he's running around during the daytime.

The body's protective mechanisms against airway inflammation decrease between midnight and early morning because blood levels of cortisol and adrenalin, which are naturally occurring hormones, decrease at night — thereby allowing inflammation to increase. If your child has nighttime cough, wheezing, or shortness of breath, talk with your doctor or nurse practitioner about the use of anti-inflammatory corticosteroids if your child isn't already using them; if your child does take them as a controller medicine, your doctor may recommend an increased dose when necessary.

I'm trying to quit smoking, but it's difficult. I know it's not good for my child to be around cigarette smoke so I go outside to smoke, but he still seems to cough and breathe shallowly when he's around me.

A lot of parents think they're not exposing their children to second-hand smoke if they only smoke outdoors, but the smoke still sticks to your hair, clothing, and skin. So if you cuddle up with your child as you're reading him a bedtime story, don't be surprised if the smoke particles trigger asthma symptoms.

Keep trying to quit smoking for the sake of your own health as well as your child's, but if you really can't quit, at least try to wear a "smoking jacket" when you go outside to smoke and put it away when you come back indoors. Wash your hands and face after smoking, especially if you're going to be in close contact with your child. And ask other people not to smoke inside your home or around your child.

We've had some scary episodes with my child's asthma in the past, but now it's been under good control for months. The nurse is always urging me to bring my child back for a check up, though. I'm really busy with work. Are follow-up appointments really that important?

Yes, they are. When a child hasn't had a flare for a while, it's easy to assume everything is okay. But follow-up visits are important because asthma never really goes away. These appointments help you continue to learn about your child's pattern of asthma symptoms and how they might be changing. They also can determine whether lung function tests are remaining stable or improving or whether daily controller medicines might need adjusting to the lowest effective doses.

At follow-up visits, your doctor or nurse practitioner can discuss any side effects and your concerns, make sure that the medicines are taken properly, including spacer use, and identify any problems you may have with getting the care you need: insurance coverage, access to appointments, ability to get medicines, organizing the medicine schedule. So it's important to keep those follow-up appointments as part of your on-going effort to keep your child healthy.