Managing Your Child’s Asthma
Edward Fishkin, M.D. is on a mission to help children with asthma. The medical director of the Woodhull Medical and Mental Health Center and North Brooklyn Health Network has been working tirelessly to ensure that no child in the New York metropolitan areas ever has to be rushed to an emergency room or miss another day of school again due to asthma. Sounds like a lofty goal, doesn’t it? But when you listen to him speak, he clearly seems intent on achieving these goals for all children in the United States and outlined extremely practical steps for physicians, parents, educators, and children to follow. He is currently working with the American Lung Association as well to help identify ways physicians can better educate parents.
“In 2006, our treatment goal—our expectations—for all children with asthma is that they will live a normal life,” says Fishkin. They will not be racing to emergency rooms. They will go to school, participate in sports, picnics and be able to do all the things other children do.”
He clearly thinks this is possible and quickly points out Olympic champions with asthma, including: Tom Dolan, who earned a gold medal for swimming; Debbie Meyer, a three- time gold medal winner for swimming and Kristi Yamaguchi, the famous gold medal figure skater.
Olympic athletes with asthma are important reminders that anyone can manage their asthma with the right treatment. Fishkin and his group of physicians are getting parents involved in their child’s treatment. “If their child is still getting symptoms or having attacks, that’s not okay—something is wrong. We encourage the parent and the physician to make a plan together with the goal that the child will live a normal life. So if the child is having any asthma symptoms while in a program of care, the physician will know to modify that care,” Fishkin explains.
But first, obviously, parents may need help determining if their children have asthma. Diagnosing asthma in children two years or younger is quite difficult. The main symptoms are coughing, wheezing, and shortness of breath—all symptoms that babies and toddlers can have at various times for other reasons such as the flu or ear infections. Because of that, experts say it is much easier to diagnose asthma in children older than two years.
Once a child is diagnosed with asthma, typically by a pediatrician, internist or allergist, Fishkin says parents often are not equipped with the proper education and tools to best manage the disease, which is not curable. Whether a child has intermittent (meaning symptoms aren’t daily), mild persistent, moderate persistent, or severe persistent asthma, physicians must closely monitor the child’s disease as it can progress and worsen.
“At least 40 percent of all asthma patients in America are under-treated,” Fishkin explains.
This isn’t a case of doctors not giving children the appropriate type of medication necessary. According to Fishkin, this proves how hard it is for children to provide an accurate picture of their health status. For instance, if your child is having monthly check- ups, he may have an appointment on a good health day, one where his peak-flow reading at the clinic is of average to normal levels. (A peak-flow reader is a device you blow into that measures your lung capacity.) However, that child might have had two full weeks during that month where he experienced shortness of breath, coughed and wheezed at school and during exercise. If the physician doesn’t know this, he can hardly determine program. For that reason, Fishkin strongly encourages parents to conduct daily peak-flow readings for their children—especially their young children with asthma. If your child doesn’t tell you what he did during his day at pre-school, you can imagine that he isn’t necessarily going to tell you every time he has asthma symptoms—especially since many children desperately want to fit in and can internalize asthma as something shameful, or something separating them from their peers.
“The peak-flow reader is what I call the weather man. If the parent can see that a child is blowing at low levels, she’ll be able to get her child treated early—before the symptoms get severe. It’s an invaluable tool.”
“Most parents want to make it better. We’re not giving enough information, or not in a way they can best understand. As physicians, we must educate the family with the sick child,” Fishkin reiterates.
And this education isn’t just about how to take medications or how to conduct daily peak- flow readings—it’s also about how to improve indoor air quality. This is especially important since at certain times of the year, children can spend up to 90 percent of their life indoors between school and home.
“We have to really explain the best way to vacuum; whether a child can have any stuffed animals in his room. There are a lot of things to discuss and it takes more than one visit with the family. That’s what I’m emphasizing with physicians,” Fishkin says.
While parents can’t control the indoor air quality at their child’s school, they can control air quality at home. For that reason, Fishkin has a program where he sends out trained nurses to do home assessments. These nurses visit the homes of children with severe asthma in New York to determine asthma triggers. Perhaps the vacuum cleaner isn’t of the best quality. Perhaps the cleaning supplies have harsh chemicals or the neighbor’s long-haired cat shouldn’t make as many visits?
If you’d like a home assessment, check with your physician, especially if you are in a HMO. Otherwise, check with your local chapter of the American Lung Association.
Fishkin outlined the six main triggers for Asthma:
1. Allergens: Pollen, hay fever and other allergies such as pet dander and dust mites trigger asthma symptoms or attacks. In fact, 40 percent of people who get hay fever also have asthma.
2. Irritants: Things such as diesel exhaust, tobacco smoke, cleaning solvents, and strong perfumes can irritate asthmatics.
3. Respiratory infections: Viral or bacterial infections or bouts of the flu can spark an asthma episode. Another reason to get your flu shot!
4. Change in the weather: Whether from good to bad weather or vice versa—these seasonal changes can exacerbate asthma symptoms.
5. Exercise: That’s not to say asthmatics shouldn’t exercise! But if you notice your asthma worsening when you exercise, perhaps you need to discuss your treatment options with your physician.
6. Stress: When someone says, “It’s all in your head” well, that’s absolutely true. “Emotional stress is as powerful a trigger for asthma as anything else,” says Fishkin.