Asthma Parent Book by Children's Hospital of The King's Daughters

Asthma

A Parentâ&#x20AC;&#x2122;s Guide To

Helping you and your child manage asthma successfully

Table of Contents What is asthma?...................................... 1 How is asthma diagnosed?..................... 2 Diagnostic tests...................................... 3 What can lead to an asthma attack?........ 4 Reducing asthma triggers at home........ 6 What are early warning signs of an asthma attack?........................................ 8 Recognizing asthma warning signs and symptoms........................................ 9 What medications treat asthma?..........10 How do I give my child asthma medicine?...............................................11 Putting it all together: your asthma action plan............................... 14 Action plan categories.......................... 15 Coping and support.............................. 16 Join your child’s team........................... 17 Parent’s role.......................................... 18 Pediatrician........................................... 19 Allergy specialist................................... 20 Pulmonologist...................................... 21

Welcome to the CHKD Asthma Team

t CHKD, our goal is to work as a team with you and your child who has asthma. You spend the most time with your child and know him or her best, so you are the captain and most important member of your child’s asthma team. In this booklet, we’ll give you the information you need to understand your child’s condition and manage it. We will also introduce you to other members of the CHKD team who are here to assist you. Your child’s regular doctor will be your primary contact. When other medical providers join your child’s asthma team, we will all share the same information so we can all work together to help your child be as healthy as possible. At CHKD, we believe that good teamwork starts with an open line of communication. If you have questions about the information in this booklet, about what your doctor tells you or about your child’s care, please tell us. Sharing information about your child’s condition with the asthma team will ensure the best possible care plan. Here’s to great teamwork! ~The CHKD Asthma Team

Emergency center staff........................ 22 Clinical social workers.......................... 23 Inpatient care....................................... 24 Asthma resources................................. 26 Glossary of asthma-related terms........ 27

The information in this booklet is provided by CHKD for general educational purposes. For specific medical advice and/or treatment, you should consult your child’s pediatrician.

What is asthma?

sthma is a condition that causes breathing problems like coughing, wheezing and shortness of breath. It can be mild, moderate or severe, depending upon how often children experience symptoms.

Asthma is a chronic illness, which means it doesn’t go away after a brief period like a cold or the flu, and it can last into adulthood. Even when children go for weeks or months without having any asthma symptoms, they still have asthma, and they still need to follow their asthma action plans. Asthma happens when children’s airways (throat and lungs) become irritated and swollen, making it very hard to breathe. Asthma often starts when a child gets a cold or breathes in something that he or she is sensitive or allergic to called an asthma trigger. Asthma episodes usually start slowly and get worse over a few hours or even days. Asthma is easiest to treat in its earliest stages. That’s why it is very important to monitor asthma symptoms every day and treat symptoms early, before they become serious.

Three things happen in an asthma episode that make it hard for your child to breathe.

1. The airways become

inflamed (red and irritated).

2. Mucus increases. 3.

The muscles around the airways tighten.

How is asthma diagnosed? Doctors diagnose asthma based on: • your child’s history of asthma or related symptoms • your family history of asthma or related symptoms

C hild’s Hist or y Famil y Hist or y P hysical Ex aminat

ion

• a physical examination of your child • medical tests Of course, children may not have asthma symptoms during their doctor’s appointments. That’s why it is very important for you to give your doctor all the information you can about your child’s symptoms. It is a great idea to write this information down before your child’s appointment and bring it with you.

During your child’s appointment, the doctor may ask you the following questions: • When did your child start having breathing problems? • What medical care has your child received for breathing problems? • If your child received treatment, did it help? • Have you noticed any pattern to your child’s breathing problems? For instance, have they usually started after your child has had a cold? Or when the weather changes? Do dust, mold or animals seem to bother your child? What about certain foods? • Do you know whether your child has allergies? • Does anyone in your family have allergies or asthma? The more information you can give your doctor, the better he or she will be able to help your child.

Learn

about asthma

Diagnostic Tests Your doctor may use any of the following tests to learn more about your child’s condition and the best way to treat it. Pulmonary function test: This test measures how well your child’s lungs are working. Your child will breathe in and out of a plastic tube that is attached to a computer. Allergy testing: In this test, a plastic device containing allergy solutions will be pressed on your child’s skin. Each device slightly scratches the skin to see if an allergic reaction occurs. If it does, allergies could be triggering your child’s asthma. X-rays: Sometimes doctors want to get pictures of your child’s lungs or sinuses to make sure that no other health conditions are playing a role in your child’s breathing problems. Lab studies: In these tests, samples of blood or urine are checked for signs of allergies or other illnesses. CHKD has labs located throughout the community where staff members are specially trained to make blood tests less frightening for children.

What can lead to an asthma attack?

nything that can start an asthma attack is called a trigger. Your child may have more than one trigger. Identifying and avoiding these triggers are important steps in managing asthma. The chart below shows common asthma triggers and ways to avoid them. Circle the triggers that bother your child. There is room at the bottom of each section of the chart to add triggers that arenâ&#x20AC;&#x2122;t listed.

Illness triggers

How to handle

The common cold

Frequent, thorough handwashing is the best way to avoid colds.

The flu

Children with asthma should get a flu vaccination every year.

Other illnesses

Ear and sinus infections can also be asthma triggers. Handwashing is the best way to avoid these illnesses too.

_________________ ______________________________________________________

Activity triggers

How to handle

Exercise

Before exercising, your child should do warm-up exercises for at least 10 minutes with a gradual increase in intensity and with a cooldown at the end of the exercise. Take medication(s) as directed on the asthma action plan.

Emotional Stress and

To help your child manage stress, make sure your child gets plenty of sleep, eats a well-balanced diet and has a reasonable schedule that includes outlets for fun and play.

_________________ ______________________________________________________ _________________ ______________________________________________________

Environmental triggers

How to handle

Weather changes

Prepare for these by watching weather reports and using medications as directed on asthma action plan.

Animal dander

Dander is dead skin cells that furry animals shed. Many children with asthma or allergies cannot keep furry pets and keep their symptoms under control.

Allergens

For tips on reducing your child’s exposure to common allergens like dust,

pollen, mildew and roaches, see pages 6-7.

Smoke

Smoke travels throughout heating and air conditioning systems and can be found on the clothing and hair of people who smoke.

Tips to avoid smoke

– Do not smoke. – Do not allow smoking in your house. – Do not allow smoking in the car. – If you smoke, change your clothes and wash your hands before being around your child. – Do not let your child stay with a caregiver who smokes. – Do not use wood stoves, kerosene heaters or wood-burning fireplaces. – Avoid barbecue grills and outdoor fire pits.

Strong odors

You can’t always avoid these, but try to reduce your child’s exposure to strong fumes from cleaning products, perfume, hair spray, room sprays, etc.

_________________ ______________________________________________________ _________________ ______________________________________________________

Reducing asthma triggers at home

any children with asthma are allergic to dust. Dust contains all sorts of different things, including tiny creatures called dust mites, pollen and sometimes even pet dander. Some things you can do to reduce allergen exposure in the bedroom include:

Reduce dust in the bedroom. • Keep windows closed in high pollen seasons.

• Dust weekly with dust-trapping cloths.

• Use air conditioning when possible.

• Wash sheets and

pillow cases every 1-2 weeks in hot water.

• Keep stuffed

animals out of the bed.

• Avoid

• Use a quality vacuum

using humidifiers.

cleaner or mop floors twice a week.

• Clean countertops. • Remember to change air conditioning and heat vent filters regularly. • Reduce room clutter.

• Cover mattress and pillows in allergen-proof dust mite covers.

Also avoid: â&#x20AC;˘ Mildew and mold. Clean places like shower stalls frequently with bleach, but not while your child is at home. Some bleach odors can also be a trigger. â&#x20AC;˘ Cockroaches. Put all food away and keep the kitchen clean. If you see roaches, use traps or call an exterminator. Cockroaches can trigger allergic asthma with their saliva, body parts and feces. Again, be sure to keep your child away from any fumes from insecticide spray or extermination. Fish make great pets for kids with asthma.

What are early warning signs of an asthma attack?

sthma often begins with mild symptoms that respond well to treatments. But if asthma isn’t treated early, symptoms often get much worse and harder to treat. Therefore, it is very important to look for early warning signs of asthma. Every child has different warning signs. Your child may have one or more of the following signs: • Headache • Feeling tired/weak • Dark circles under the eyes • Coughing • Itchy, watery eyes • Feeling tired or grumpy

Recognize your child’s symptoms

• Drop in peak flow readings • Runny/stuffy nose • Sneezing • Getting out of breath easily • Coughing and waking up in the night • Faster breathing

Recognize asthma warning signs and symptoms. Take action FAST!

t is very important to be able to recognize the asthma warning signs and symptoms that are most common for your child. Children also need to recognize asthma symptoms.

Here are the most common asthma symptoms to watch for: • Coughing: A dry, repeating cough often occurring at night or in the early morning. • Wheezing: A high-pitched whistling sound when breathing. • Shortness of breath: Sounding out of breath, like after a race, breathing much faster or gasping for air. • Chest tightness: A feeling like something heavy is sitting on the chest. • Fatigue: Refusing to play or to perform daily activities.

What medications treat asthma? There are two main types of asthma medicines: relievers and controllers.

Warning Running out of your child’s medicines may result in emergency room visits, hospitalizations or even death.

Relievers Reliever medicines help relieve symptoms once they have started. These medicines work quickly to help your child feel better by relaxing tight airway muscles and allowing your child to breathe easier. The most common reliever medicine is albuterol, often given in an inhaler or a nebulizer. Albuterol can have side effects. These include an increased heart rate, headache, trouble sleeping or a jittery feeling. These side effects usually do not last long. Controllers Controller medicines are taken every day to control asthma. These medicines fight inflammation in your child’s airways and prevent asthma episodes from starting. Your child may need to take these medicines one to two times a day to keep asthma symptoms under control. Controllers do not relieve coughing or wheezing. The most common type of controller medicines are inhaled steroids. These are not the same as muscle-building steroids. The steroids children take for asthma are safe for most children and cause few side effects. The most common side effects are a cough or hoarse voice and thrush, a harmless oral infection. In rare cases, inhaled steroids may slow a child’s growth. Your child’s provider will watch your child’s growth closely at well-asthma visits. To decrease side effects, make sure your child rinses his mouth out with water or brushes his teeth after taking this medicine.

Always

keep your child’s rescue inhaler handy!

Keep inhalers in easy-to-find places at home and other places where your child often goes such as day care or school. Inform babysitters where the inhaler is located and about the Asthma Action Plan, in the event an asthma attack occurs.

Make sure there is a firm seal between the mask and your childâ&#x20AC;&#x2122;s face when he or she is using a nebulizer.

How do I give my child asthma medicine?

sthma medicine comes in a variety of forms. Your doctor will work with you to decide which one is best for your child. Inhaling medications helps get as much medicine as possible into your childâ&#x20AC;&#x2122;s lungs. Because inhaling medications takes some skill, please take a few minutes to learn how this works.

Using a nebulizer A nebulizer is a machine that turns liquid asthma medicine into a mist that your child can inhale. Your provider or the company that supplies the nebulizer should show you in person how to use it. The machine consists of a small air compressor that has a tube running out of it. The tube has a medicine cup and either a mouthpiece or a face mask, depending upon which works better for your child. The asthma medicine is poured into the medicine cup, and the child inhales it through the tube, usually by wearing a mask. Proper technique is very important, especially with the mask. The child or parent must hold the mask so there is a firm seal between the mask and the face. This could be the perfect time of day for your childâ&#x20AC;&#x2122;s favorite book or TV show.

Cleaning Tips Clean the medicine cup often, according to the instructions that came with the nebulizer. Cleaning gets rid of germs that can make your child sick. Cleaning also prevents the nebulizer from clogging up and helps it to last longer. Rinse the cup after each use.

Using dry powder inhalers A dry powder inhaler (DPI) is a small plastic device that dispenses asthma medicine as a fine powder that the child inhales through the mouth. Your doctor will tell you how to use the DPI, and it is important to follow those directions. When used correctly, each inhalation delivers a specific amount of medicine. DPIs are usually for older children and teenagers.

Spacer

MDI

An older child can often use a spacer without a mask.

Using metered dose inhalers A metered dose inhaler (MDI) is a small device that releases a fine spray of medicine that can be inhaled. The inhaler releases a set amount of medicine with each puff. Your provider will tell you how many puffs your child should take.

Always

keep reliever medicine with your child.

It can be tricky to get the timing just right when using this kind of inhaler. Simple tools called “spacers” make these inhalers much easier for children to use correctly. Spacers also deliver more medicine directly to the lungs and help reduce the side effects of medication. We recommend that children always use spacers with metered dose inhalers.

Mask Spacer

MDI

Younger children often find it easier to use an MDI with a mask. Spacer cleaning tips: Clean the spacer with the mask at least once a week. Remove the rubber ring from spacer, but don’t remove the end with the mask. Soak in basin of clean, warm soapy water for 15 minutes. Rinse in basin of warm water and air dry. Other tips include: • If your child uses a spacer with a mask, make sure you or your child hold the mask firmly against the face so there is a tight seal. • Always wait one minute between puffs of reliever medicine. Don’t do two puffs at once. • When taking controllers and relievers at the same time, take the reliever medicine first.

Putting it all together: your asthma action plan

ou and your child’s asthma team will work together to create an asthma action plan to manage your child’s asthma.

Just like a traffic light, an asthma action plan has green, yellow and red zones. Your child’s symptoms will determine which zone your child is in, and that will determine what actions you should take. The pictures below show examples of asthma action plans. Your child’s plan will have information showing you how to take care of your child in each zone. Your child’s doctor should review this plan regularly with you. Please ask any questions you have about your child’s plan. And be sure to share this plan with everyone who cares for your child.

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Red Zone :

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_________

DANGER ! — Continu e

these:  Can’t talk, eat, or walk well  Medicine is not helping  Breathing hard and fast  Blue lips and fingernails  Tired or leth argic  Ribs show

Start/end

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breath shortness of ing due to Trouble talk nails are blue wer you Lips or finger unable to ans or ed fus Call Seems con

_________ ______ture ______ Parent’s Signa

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When _ _________ _________ Medicines cer _____ spa Controller ® ___ with r ___ ale _ Flovent inh 220mcg _________ 110mcg _________ _ 44mcg ® by nebulizer ___ __ ___ ___ ___ ___ es ® Respul ___ _________ _ __ Pulmicort _________ .5mg/2cc _________ School Div _________ sical activity phy ision: ___ __ __ .25mg/2cc ___ ore ___ Name _________ ______ _________ minutes bef 15 _________ __ _________ ___ fs ______ _________ _________ cer 2 puf _________ spa ___ _________ with ___ _________ r Date of Health Car ___ Birth _________ e Provide enex inhale _________ Xop ___ rol/ r ___ ute _________ ___ Alb _________ ) _________ (list s. Effective Provider’s ger ______ Parent/ a trig Dates Phone # Guardia Avoid asthm n l. Fax # fal / t every / to Last flu . Get a flu sho Add / ded Parent/ itional Eme shot / Guardia / rgency Con 4 hours if nee When n Phone ry / eve . to tact / ch How mu es a day, up every 4 hours if needed tim 4 Con Par : tact ent/ to Phone Guardia Asthma TAKE dicine n Email: 2 puffs es a day, up Severity: tim cer 4 spa Me er Interm Reliev x inhaler with 1 dose Contact ittent or ene e Ast Xop chin hm Ema rol/ ma a Persisten il Trig Albute ulizer t:  Mild □ Colds □ Smogers (Things that ma enex by neb  Modera _ ke (tobacco ke your Albuterol/Xop te  Sev _________ asthma □Exercise □ Acid , incense ere ) □ Pollen worse) _________ Medicine . _ reflux □ □ Dust □ Anim Controller I medicines _________ ________ Pests (rod als:______ ents, cock ing all Level ® or Pulmicort® ___ _________ roaches) _________ Green Zo t Continue tak ________ □ ven Season (circ __ ___ Flo al □ Strong odo ne: Go! le): Fall, rs □ Mold/m Add addition Winter, Spr ______ — Take th oisture □ ing, Sum _________ Stress/Emot mer □ Oth ese CONT Other: ___ er:______ ions How much

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_ DATE___ Based on Virginia Asthm NAEPP Guide ____ a Action Plan lines and modified approved with perm Departmen by the Virgin ission from t of Healt ia Asthma h, DC Contr the Coalition ol Asthma D.C. Asthma Action (VAC) 6/13 Now, and District of Plan via District of Colum Columbia bia Asthma Partn ership

Action plan categories Green “Go Play” Zone • No cough or wheeze • Play and attend school regularly • Sleep well through the night

Yellow “Not Well” Zone • Increased asthma symptoms such as wheeze, shortness of breath, cough and chest tightness • Wake up at night due to asthma • Unable to do usual activities – missing school due to symptoms, can’t run or play

Red “Emergency!” Zone • Difficulty breathing with persistent asthma symptoms like coughing and wheezing • Follow the asthma action plan closely and give reliever medication • Seek emergency care or call 911 if your child – Doesn’t improve after the use of reliever medication – Has trouble talking or walking – Develops gray or blue lips or fingernails – Has a chest or neck that pulls in with breathing

We know your child’s asthma action plan is working and his asthma is under control when the following goals are met: • Your child can attend school with no missed days for asthma. • Your child does not need emergency room care or hospital stays. • Your child has no asthma symptoms during the day or at night. • Your child has few or no side effects from medication. 15

Coping and support

our child’s medical team also includes social workers, who are available for support and resource assistance. They offer the following suggestions to help make life as normal as possible for you and your family.

• Take charge of your child’s asthma. Work closely with your child’s medical team, school and any other caregivers. Attend education programs to learn about asthma. Answer questions your child may have about asthma and its treatment honestly and in words they can understand. • Be encouraging. Focus attention on the things your child can do, not on the things he or she cannot do. Encourage normal play and activity as well as school attendance. Do not limit your child’s activities out of fear of an asthma attack – work with your child’s doctor to control exercise-induced symptoms. Allow your child an opportunity to express frustrations. Have fun with your child so that he or she develops a positive attitude towards coping with asthma on a daily basis. • Stay calm and in control when facing asthma symptoms. Try not to get rattled if you see asthma symptoms worsening. Focus on your child’s asthma action plan and involve your child in each step so that he or she understands what’s happening. • Talk to other parents of children with asthma. Send your child to “asthma camp” or find other organized activities for children with asthma. This can help your child feel less isolated and help him or her gain a better understanding of asthma and its treatment. • Make time for other children. Brothers and sisters often feel left out when a sibling becomes ill; try to find time to spend exclusively with them. It is important for parents to take the time, as soon as possible, to explain to siblings about the disease and give them an opportunity to ask questions. Make sure they understand that they were not the cause of the illness. Try not to diminish their concerns, frustrations and accomplishments.

Join

your child’s team

ust like the players on a sports team, we all have different roles and responsibilities when it comes to helping your child manage asthma. In the pages that follow, we’ll introduce you to the different members of CHKD’s asthma team and explain how they can help. Your child may not see all of these different providers, but they are all available to you if needed. But first, we’ll start with the most important person of all: you!

Parent’s role

Helpful Tips • Keep a copy of your child’s asthma action plan and a list of important phone numbers where everyone can find them (on the refrigerator, near a phone, on a bathroom mirror). • Keep a calendar to record appointments, medication refills, sporting events and school events. Refer to it frequently to ensure you are always prepared with your child’s medications. The Child’s Role Children should: • Learn how to take their medications properly. • Know what their triggers are and how to avoid them. • Understand and follow their asthma action plans. 18

ou know your child better than anyone else does. You are also the connection between home, school, day care and the doctor’s office. So there is a great deal you can do to help manage your child’s asthma. The most important things you can do are: • Learn about asthma. • Teach your child how to recognize symptoms and tell you and/or other caregivers about them as soon as they start. • Help your child avoid asthma triggers. • Make sure your child takes prescribed asthma medications. • Keep reliever medications with your child at all times. • Do not smoke or allow your child around others who smoke. • Make sure your child understands and follows his/her asthma action plan. • Take your child to regularly scheduled doctor’s appointments. • Keep up on all medication refills.

When your child goes to school or daycare It is important to share information and resources with teachers, school nurses, coaches and babysitters. Here’s a good checklist of what you should share with others who take care of your child: • Your child’s asthma action plan. • Rescue medications and how to use them. • Information on their role in caring for your child. • Duplicates of your child’s medications and spacers. • Your emergency contact information.

When you travel Use this checklist of things to bring with you: • Your child’s asthma action plan. • Enough medication (controller and reliever) for the duration of the trip. • Nebulizers and supplies, and a spacer if necessary. • Labels from medications for emergency refills. • Your doctor’s phone numbers. • Know where the local hospital or children’s hospital is.

Pediatrician

our CHKD pediatrician is your main partner in helping to manage your child’s asthma. We recommend routine asthma check-ups at least every six months and sometimes more often for patients with difficult asthma. During these visits, we will discuss an asthma action plan for your child. This plan will outline your child’s daily treatments and include detailed information for how and when to give your child controller medications as well as a plan for care when your child is ill. You should keep this plan handy and bring it to your scheduled asthma check-ups as well as any emergency or specialist visits your child has. Please call our office if your child requires treatment with reliever medication more than twice a week. We may need to adjust your child’s plan. When they follow their asthma action plans, children with asthma can be just as active and healthy as their peers. By working together as partners, we can help keep your child’s asthma controlled and prevent asthma flare-ups.

My child’s primary care provider is:

Name: __________________________________________________________ Practice location: __________________________________________________ ________________________________________________________________ Phone #: _________________________________________________________

Get

routine asthma check-ups every six months

Allergy specialist

Where can I be seen? We have offices in Virginia Beach, Chesapeake, Newport News, Norfolk and Suffolk. How do I get an appointment? Call (757) 668-8255. Schedule your appointment for the location closest to home. We have office hours Monday through Friday depending on the site of the clinic.

n allergist is a doctor specially trained and experienced in the diagnosis and treatment of allergic diseases and related conditions. These include asthma, hay fever, sinusitis, rashes, hives and certain kinds of allergic reactions to foods, insect stings and drugs. We can help determine whether exposure to specific substances such as dust or pollen is triggering your child’s asthma. If this is the case, treating the underlying allergy may improve your child’s asthma.

What can I expect at the first appointment? We will get a detailed medical history, examine your child and evaluate his or her symptoms. We may order tests (such as lung function tests or X-rays) to find out more about your child’s condition. Skin prick tests or allergy blood tests can often pinpoint the exact causes of your child’s allergic symptoms. Using all of this information, we make a diagnosis and start treatment.

What treatments do you provide? There are three types of allergy treatment: prevention, medication and immunotherapy. Immunotherapy is a process of gradually making your child less sensitive to the things he or she is allergic to.

Should I do anything special before the appointment? If possible, stop giving your child antihistamines (pills, liquid and the kind you squirt in the nose) 10 days before your appointment so they won’t interfere with the results of allergy tests that can often be done at the first visit. We will supply you with a list of medications to avoid. Please bring a list of all current medicines, medication delivery devices and any information that your doctor wants to share with us. If your child’s primary care doctor is a CHKD doctor, we will have that information in our CHKD electronic medical record system. Please be prepared to spend up to two hours at your first visit if several tests need to be done.

My child’s allergy specialist is:

Name: ______________________________________________________ Practice location: _____________________________________________ ___________________________________________________________ Phone #: ____________________________________________________

Pulmonologist

pulmonologist is a doctor who specializes in the treatment of lung and breathing conditions and diseases. Our pediatric pulmonologists provide health care services for all conditions that affect children’s breathing and the lungs, including asthma. We believe that no one knows your child as well as you. We will collaborate with you, your primary care physician and other CHKD specialists to provide a team approach to your child’s asthma care.

What can I expect at the first appointment? We will get a detailed medical history, examine your child and evaluate his or her symptoms. We may order tests (such as a lung function test or X-rays) to find out more about your child’s condition.

Should I do anything special before the appointment? If your child is not seen by a CHKD physician, please have your primary care office send us your child’s medical records. Be prepared to spend up to two hours at your first visit if several tests need to be done.

Should I bring anything with me? Please bring all of the medications your child takes and all of the devices your child uses in a bag with you. We will check to make sure that all of the devices are functioning well and that you are using them correctly.

Where can I be seen? We have locations in Norfolk, Virginia Beach, Chesapeake and Newport News. How do I get an appointment? Call (757) 668-7426 to schedule your appointment for the location closest to home. We have office hours Monday through Friday depending on the site of the clinic.

What treatments do you offer? We will work with you, your child’s pediatrician and other medical providers to develop an asthma action plan. One of the most important things we provide is education. We will teach you and your child how to identify and avoid your child’s asthma triggers, how to handle an asthma attack and how to use asthma medications.

My child’s pulmonologist is:

Emergency center staff

ven though one goal of asthma care is keeping you out of the emergency room, it is very important to know when to call 911 and seek emergency care for asthma symptoms. Your child’s asthma action plan will include specific information about when you should seek emergency care for your child. But, as a general rule of thumb, the symptoms below indicate the need for emergency help.

Seek emergency care if your child has: • No improvement after the use of reliever medication • Trouble talking or walking • Lips or fingernails that are gray or blue • Labored breathing (chest or neck pulling in with breathing).

If possible, bring the following with you: • List of all your current medicines • Medication delivery devices • Asthma action plan CHKD’s emergency department is very experienced in treatment of asthma. Our emergency asthma treatment team includes the following providers: Doctors. The doctors in CHKD’s emergency department are trained to treat children with illnesses. They will examine your child, prescribe medications and treatments and monitor your child to see how well the treatments are working. Nurses. The registered nurses (also called RNs) in the emergency room will help your child by starting breathing treatments and giving medications by mouth, IV or injection. They will monitor your child to make sure symptoms are improving and teach you and your child how to take any prescribed medications before you go home. Respiratory Therapists. These providers have special training in breathing disorders. They may assist the nurses with your child’s breathing treatments and teach your child how to use a spacer or an inhaler before discharge. Child Life Specialists. These unique providers are experts at communicating with children in ways they can understand. When needed, they can assist us in distracting your child during breathing treatments or teach you special ways to hold your child to make it easier for your child to receive breathing treatments. Social Workers. CHKD’s social workers are available to assist families in the emergency department with a variety of practical and emotional needs. Among other things, they can help you identify and access hospital and community resources available to help your child get the care he/she needs. For more information on the support our social workers provide, see page 23. 22

Clinical social workers CHKD’s clinical social workers provide support for patients and families. They can provide all of the following and more: • Needs assessments. Children’s illnesses can complicate already stressful situations. Social workers are trained to identify areas of stress and work with families to solve problems. • Resource referrals. Social workers can help you access hospital and community resources. • Adjustment to diagnosis, illness and/or hospitalization. Patients and family members may be overwhelmed by all the changes a new diagnosis creates. Social workers help families through these challenging emotional times. • Following medication and treatment plans. Many issues can get in the way of following your doctor’s orders. Social workers can help identify barriers to treatment. If you or your child is struggling to manage medications and specific treatment recommendations, social workers can help. • Advocates for patients. Your child and family are unique. Social workers respectfully work with patients and families using an understanding of the social, cultural and religious preferences that contribute to a patient’s/family’s responses to illness and use of health care. This allows your social worker to be an advocate for your child and your family’s best interests. • Crisis intervention. No one ever expects an emergency to happen, but if it does, CHKD’s social work professionals are available to support you and your family if your child becomes extremely sick. To reach CHKD’s department of social work, please call

(757) 668-7273

What do you need to know? 23

Inpatient care

hen your child’s asthma symptoms cannot be controlled at home, the doctor’s office or the emergency room, he or she may be admitted to CHKD. The table below shows the different members of our hospital asthma treatment team and explains how each one will help your child.

Asthma team member

Responsibility

Doctors (MDs, DOs)

Lead the team in managing your child’s care. Your child will likely be seen by several different doctors, including resident physicians and hospitalists. You can expect a visit at least once a day from your physicians.

Nurses (RNs)

Monitor your child’s condition by checking vital signs and how well your child is breathing. They give breathing treatments and medications and help teach you and your child about asthma and its management.

Respiratory therapists (RTs)

Work closely with nurses to monitor your child’s condition, give treatments and teach you and your child how to manage asthma at home.

Child life specialists and assistants

Help your child adjust to hospitalization and diagnosis by making sure that care is age appropriate and preparing your child for tests and treatments.

Social workers and case managers

Assist with a variety of practical and emotional challenges that can affect your child and your ability to care for him/her.

A variety of treatments are available to help your child in the hospital. The most commonly used treatments are reliever medications, steroids and supplemental oxygen. Options for monitoring your child while he/she is in the hospital include the following: • Pulse oximeter: A small device that can be slipped over your child’s finger or toe that measures how much oxygen is in the child’s blood. • Cardiorespiratory monitor: This machine measures your child’s breathing and heart rate. Small pads placed on your child’s chest gather the information, then send it through attached wires to a screen (sometimes by your child’s bed and sometimes in another location) so nurses can monitor your child.

Know

when it’s time to go to the hospital 25

Asthma resources Local • Children’s Hospital of The King’s Daughters 601 Children’s Lane Norfolk, Virginia 23507 Health Line (757) 668-7500 chkd.org • CHKD Asthma Team • Celebrating Special Children (Norfolk) • Better Breathers Club • Pediatric Asthma.org • CINCH • Your Insurance Provider

National The following organizations provide free, reliable information, which is not specifically endorsed by CHKD. • The Asthma and Allergy Foundation of America • Allergy and Asthma Network-Mothers • The Food Allergy Network • National Heart, Lung and Blood Institute • American Academy of Allergy Asthma and Immunology • The Consortium on Children’s Asthma Camps

Glossary of asthma-related terms Airways - The passageway for air to go into the lungs. Albuterol - Medication taken to relieve asthma symptoms. Allergen - Something that causes an allergic reaction. Dust is a common allergen. Allergist - A doctor who treats allergies. Allergy - Sensitivity to a substance that causes a reaction, such as a runny nose, itchy eyes, sneezing or asthma. Asthma Action Plan - Your child’s overall treatment plan for managing asthma. Asthma Episodes - Times your child is experiencing asthma symptoms. Asthma episodes usually start gradually and progress to more severe symptoms (see page1). Asthma Team - A group of physicians, family members and other caregivers who come together to provide care and management of your child’s asthma. Chronic Illness - An illness that lasts for a long time. Asthma, arthritis, sickle cell diseases and diabetes are examples of chronic illnesses. Controller Medicines - Medicines that are taken every day to control asthma. Inflammation - Redness and swelling caused by an irritant. Metered Dose Inhaler (MDI) - Delivers asthma medicine in a little puff that can be inhaled. Nebulizer - A portable air compressor that turns asthma medicine into a fine mist that can be inhaled. Primary Care Provider (PCP) - A doctor, usually a pediatrician, who provides medical care for your child to keep him healthy and treats him when he is sick. Pulmonary Function Test - A simple breathing test used to measure how well your child’s lungs are working. Reliever Medicines - Medicines that work quickly to relieve asthma symptoms. Skin Testing - A test to see if your child has allergies. Spacer (Aerochamber) - A small tube that is used with a metered dose inhaler to help your child take medicine correctly. Steroids - Controller medicines that help to prevent asthma episodes. Trigger - Anything that can start an asthma episode or make asthma worse. Warning Signs - The first symptoms that indicate an asthma episode is about to begin. Well-asthma Visit - An appointment with your child’s primary physician to discuss recent symptoms, medications, school issues and other topics related to your child’s asthma. Wheeze - This common symptom of asthma is a high-pitched whistling sound caused by air trying to move in and out of your child’s narrowed airways.

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Thanks to the patients, parents and physicians who contributed to the development of this booklet.

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