Breathing Easy: Keeping Kids Asthma-Free

Asthma attacks can escalate quickly, but they are also quite predictable. With a little help, one asthmatic family learns to expect the unexpected.

By Elissa Sonnenberg

Kim Miller has had enough of ER. Nothing against Noah Wylie, but after two emergency room trips in the past two years with her asthmatic 5-year-old daughter, Miller has faced enough drama to last a lifetime.

"It's scary," says Miller, a teacher, as she describes the late-night wheezing and coughing sessions that led to the hospital runs. "She starts to wheeze badly and she can't breathe."

Breathing easy in the hospital is one thing, but the Millers wanted their daughter to breathe just as freely at home. So, with the help of her pediatrician and pediatric allergist, they pinpointed Mara's primary asthma triggers — cats, dust, tree pollen and peanuts. The family now has an action plan to keep Mara's asthma at bay.

Some elements of the plan are environmental — Mara stays away from furry, four-legged friends, and her parents dust often to maintain an irritant-free house. They also pore over food labels like detectives in search of clues.

Other parts of the plan stress plain old common sense. For example, Mara takes a preventive breathing treatment when tree pollen counts are high, if she's struggling with a cold, or before heading to houses where cats live. Despite precautions, when an attack strikes Mara can be kept calm by taking a dose of steroids and using her nebulizer.

The Millers' action plan is exactly the sort of practical approach to childhood asthma that many doctors recommend. Specific plans give parents and children simple steps to follow to avoid or alleviate symptoms, which allows them to live with more freedom and, more likely, better health.

The startling rise in asthma cases, deemed by many doctors to be an environmental epidemic, is nothing to sneeze at.

The Pew Environmental Health Commission at the Johns Hopkins School of Public Health predicts asthma cases in America will double by the year 2020. Since triggers vary from one person to the next, that translates into 29 million distinct cases for which generalized strategies just aren't enough.

That's why renowned pediatrician T. Berry Brazelton, M.D., clinical professor of pediatrics emeritus at Harvard Medical School, and Terrold Butler, M.D., a pediatrician with Comprehensive Health Services in Chicago, are taking a different route.

"I think that parents have to be aware of what asthma is and find a pediatrician or family doctor who will make them part of a team approach," says Butler.

Butler worked closely with Brazelton to implement the Touchpoints Asthma Management Program in his South Side Chicago practice. As a result, he's seen a dramatic decrease in hospitalizations, late-night calls and office visits from asthmatic patients – all after he began to show them how to take control of their disease.

Brazelton geared the program toward asthmatics because of the critical "touchpoint" of vulnerability that asthma attacks can quickly become. He defines "touchpoints" as predictable periods of regression in a child's development, often surrounding major milestones or turning points, like when babies learn to sleep through the night, begin to crawl or take their first steps.

"The main thing that my patients got from me was the assurance that I was right there with them in every crisis," explains Brazelton, whose asthma patients rarely needed to be hospitalized. "Our relationship was at the base of our successes."

Butler found that working with asthmatic patients and their families to develop strategic action plans increased their confidence in themselves because he trusted their abilities.

One example was the seven-year-old patient who began to have symptoms of asthma at his grandmother's house, while his mother was at work. The boy called his mother, who calmly told him what he needed to do and reinforced that she knew he could do it himself.

Without any help, the young boy set himself up with his nebulizer, put a cool cloth on his forehead and laid down to rest. Twenty minutes later, when his mother called to check up on him, he was fine, breathing clearly and playing with his Gameboy.

When children and families learn to recognize symptoms before an attack becomes severe, they can avoid serious crises and handle the rest with confidence.

"The action plan means a lot to my patients," Butler says. "It made me feel good to know how much this little boy could do."

Once parents have become active partners in their child's health, the doctors say, it's easier for them to take concrete steps to lessen their children's asthma symptoms.

Brazelton stresses that parents need to know that they play an essential role in the day-to-day management of their children's asthma.

While parents feel more secure with an action plan to follow, Dr. Brazelton encourages them to allow their children to be actively involved in process as much as possible, from pouring medicine into a cup to turning on nebulizers. Giving every member of the management team a piece of the action strengthens their commitment and contributes to their success.

"We're giving mastery back to the parent and child," he says, "not holding it as if it were some kind of magic we had in our hands. It isn't that kind of disease."

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