Timothy C. Horton, MD


So your doctor told you that your child has asthma. Well, you're in good company. In some areas of California, up to 20 percent of children have been diagnosed with asthma. So what can you do about it? This article will focus on some practical strategies to increase your control over asthma, increase your ability to communicate with your doctor, and finally how to determine when things are worse than you can handle at home and medical attention is necessary.

Controlling the Triggers

We know asthma is a problem that starts when your child is exposed to a trigger. Identifying the triggers that affect your child the most is a crucial part of home treatment. Try to identify what sets off your child's attacks and let your doctor know. No one can do this better than you. Sometimes the trigger will be obvious. Sometimes it will take some detective work. If the triggers aren't obvious, keep a log of your child's attacks and review it with your doctor. Where was your child when the attack started? (In smoking grandma's house.) What was your child doing when the attack started? (Playing with the neighbor's cat.) A very small detail might be the key.

The most common triggers that affect children and their asthma include colds, exposure to smoking, weather changes, and allergies (to dust, molds, cats, dogs, birds—in that order). Some of these we can't control, but some we can, often with very little effort.

Colds: They may be unavoidable, but there are some things that help. Teach your child good hygiene. Good hand-washing goes along way. Set a good example by washing your hands, too!

  • Your child should get the flu (influenza) shot annually. It's the one cold we can prevent.
  • Discuss the pneumococcal vaccine with your doctor also.

Exposure to Smoking: Probably the most important preventable trigger.
Try to quit. Easier said than done, but it is the single biggest way that you can affect your child's asthma.
Get help! Very few people can do it alone and there is lots of help available. Some of the money from tobacco settlements is for just helping people quit.
If you can't quit, cut down. Smoking outside helps a little, but the smoke sticks to your hair and clothes, and then you bring it inside.
Weather changes: Not too much you can do, but be realistic about where you live. Sometimes a move to a different part of the country can make the world of difference—for better or for worse.
Visit where you are going to move in a couple of different seasons, if possible.
Talk to people with asthmatic children in the area to see how they do.
Avoid areas with heavy pollution or heavy pollen counts if at all possible.
Dust: Dust mites are the hidden enemy. Some techniques for fighting dust can get costly, but start at the cheap things and move up, depending on the severity of your child's asthma.
Try to make the rooms where you spend the most time as dust free as possible. Most people sleep eight to 12 hours a day, so work on the bedroom first.
Keep the bedrooms especially free of clutter (stuffed animals, decorations, trophies, etc.) that can accumulate dust and can be hard to clean.
Mattress covers and pillow covers are cheap and very effective.
HEPA air filters and HEPA vacuum bags can get a little pricey, but can work very well, too.
Change the heating and air conditioner filters every one to three months. They are cheap and easy to change.
If you have carpeted floors, consider changing to tile or hard wood. This can be pricey, but the change can make a big difference.
Pets: We love them, but they can wreak havoc on our asthmatic love ones.
Try to keep them out of the bedrooms and off the beds.

It is much easier to choose not to bring a pet in to the household than to remove it once it's there. Choose your pets wisely.

The Red, Yellow, and Green Plan

Now your child is having an attack. How do you know how bad the attack is? Should you head right in to your doctor's office or tough it out for a while? A great way to gauge the severity of your child's asthma attack is with a peak-flow meter. A peak-flow meter is a small tube-shaped instrument that measures how hard your child can blow into it. Most children six years old and older can use them, and I have even seen some three-year-olds who can do it pretty well. It will give you and your doctor an important measurement of the severity of the attack. You can get a peak-flow meter from your doctor or pharmacist. Have your pharmacist or doctor show you how to use the peak-flow meter properly.

Measuring your child's peak flow: The red, yellow, and green plan is based on your child's peak-flow maximum, or best all-time measurement.

Choose a week when your child is feeling well.
Measure your child's peak flows three times a day over one to two weeks.
Record your child's peak flows in a log and determine the highest number.
This is your child's peak flow max (PFmax).
If your child gets a higher number, this is your new peak flow max. The number usually will go higher as your child grows in height.
Developing a red, yellow, and green plan: This is best done together with your doctor. The purpose is to develop a plan for each range of your child's peak flow.
The green zone: The green zone is defined as 100 percent of the PFmax to 80 percent of the PFmax. For example, if your child's peak flow is 400, his green zone is 400 to 320. Set a plan with your doctor for this range.

The green zone is usually smooth sailing, so I usually have my patients use occasional albuterol treatments (inhalers) and any prevention medicines that they use regularly. The plan will differ depending on the severity of the child's asthma, so discuss the plan with your doctor.
The yellow zone: This is the caution zone and is probably the most important zone. It is defined as 80 to 50 percent of the PFmax.
Using our example above, the yellow zone is 200 to 320.
Set a careful plan with your doctor. How often should you do the albuterol treatments? Should you increase your maintenance/prevention medicines? Are there other medicines you should start? How long should you wait to come in? When should you call your doctor?
You can also let your doctor know that your child is in the yellow zone and how he responds to the treatments that you give him. For example, "My child has been in the yellow zone for two days, but improves to the green zone after his albuterol treatment."
The red zone: This zone means trouble. The red zone is defined as less than 50 percent of the PFmax.
Using our example, the red zone is less than 200.
Take your child to the doctor as soon as possible. Contact your doctor or go to an emergency room. Discuss this plan with your doctor before it happens, so you know what to do. Don't panic! Just take action!
To save yourself a trip, make sure that your child is doing the peak flow properly.

When You've Done the Best You Can

The unfortunate thing about asthma is that sometimes, even if you do everything right, the asthma still gets bad and you need to seek medical help. Here are some signs to watch for:

Your child is having trouble breathing and is not getting better with the medicines you have. This is respiratory distress.
Children breathing greater than 50 breathes a minute. (Ask your doctor about this, because each age group is different.) Get out your stopwatch or second-hand watch and count the breaths in a one-minute time span.
Children will heave when they breathe. You only need to see this once to never forget it. Have your doctor demonstrate, if needed.
Children will look and feel uncomfortable. They will have difficulty talking without taking many breaths.
If your child's skin changes color, for example, turns blue, go to an emergency room immediately or call 911.

If you use the red, yellow, and green plan, set the length of time with your doctor that it is okay to be in each zone. Usually I tell my patients, if they don't see signs of distress (see above), I like to see them after two to three days in the yellow zone, especially if the child is not improving. Any moment in the red zone is too long and needs to be treated right away.

Asthma can be a frustrating problem for you and your child, but the more that you understand about how it affects your child, the better you can control it. Learn your child's triggers. Learn the medicines that your child needs and how your child should respond to these medicines. Most of all, learn how to talk with your doctor about your child's asthma in a way that both of you are comfortable. Set a treatment plan together for your child's attacks. Take the time, while your child is healthy, to prepare for the time that he or she is not.

Timothy C. Horton, MD