Asthma in children: Creating an asthma action plan

Maintaining good day-to-day asthma control is the key to keeping symptoms at bay and preventing asthma attacks. With a written asthma action plan, it's easier for you to measure whether your child's asthma is under control — and it lets you know exactly what steps to take when it isn't.

Using an asthma action plan is especially important if your child has moderate to severe asthma or has had a serious asthma attack in the past. Here's how to get started.

Creating an asthma action plan

Because people experience asthma differently, you'll need to work with the doctor to make a customized plan for your child. Children who are old enough to understand why you're setting up the plan may be able to help create it. An action plan can help you and your child:

• Track symptoms. The plan will help you keep tabs on signs and symptoms such as coughing, wheezing and shortness of breath. You can also note when symptoms interfere with school, play, exercise or sleep. You'll also need to track how often your child uses a quick-relief inhaler, such as albuterol (ProAir HFA, Proventil HFA, others), to ease symptoms.
• Record peak flow readings. If your child is old enough to use one, he or she may have a peak flow meter. This simple hand-held device tests how well the lungs are working day to day. Low measurements indicate that the lungs aren't working as well as they should be. This is often the first sign that asthma's getting worse.

• Judge asthma control. The action plan will give you a system for making sense of the information you record. Many asthma plans use a "traffic light" system of green, yellow and red zones that correspond to worsening symptoms. This system can help you quickly determine asthma severity and identify signs of an asthma attack.

  Some asthma plans use a symptoms questionnaire called the Asthma Control Test (ACT) to measure asthma severity over the past month.

• Adjust medications. Your child's plan should say when you need to make medication adjustments based on the severity of symptoms. Asthma medications usually include long-term-control medications such as inhaled corticosteroids, along with as-needed, quick-relief medications such as inhaled albuterol. Make sure you understand what medications to use when, how long to use them and what to expect.
• Recognize and treat an asthma attack. Tracking symptoms daily and adjusting treatment accordingly improves asthma control and reduces the risk of having an asthma attack. But if symptoms do start to get worse quickly, follow the action plan's instructions for using quick-relief medications or other steps to get your child's symptoms under control.
• Know when to seek emergency care. Some asthma attacks can't be managed at home. Use the action plan to recognize the signs of rapidly worsening asthma, such as trouble speaking, use of abdominal muscles to breathe or wide nostrils when breathing in. If your child uses a peak flow meter, the action plan will also tell you when low peak flow readings signal that your child's asthma attack has become an emergency.
• Help your child avoid asthma triggers. The action plan may have a place for you to list your child's asthma triggers and keep notes on how to avoid them. Asthma triggers vary from person to person — examples include cold air, pollen, dust mites, mold, pet dander, smoke and respiratory infections.

Make sure caregivers know how to use the action plan

Once you and your child's doctor have developed an asthma action plan, keep it close at hand. Make sure children and caregivers — including grandparents and baby sitters — know where to find it and what to do in case asthma symptoms get worse.

Give a copy of the plan to the school nurse and your child's teachers and coaches. Keep another copy in your wallet or purse, in case an asthma attack occurs away from home. As children get older, they can take more responsibility for using the plan to track and manage asthma.

Meet regularly with your child's doctor

Work with the doctor to adjust your child's asthma action plan on a regular basis. Asthma changes with age, so your child's treatment plan will need to change too.

• Make sure your child goes to every scheduled appointment. Review your child's asthma action plan at every doctor visit. Tell the doctor about any problems your child is having sticking with the plan. These checkups are also a good time to double-check that you're tracking symptoms accurately and that your child is using asthma medications properly.
• If asthma isn't under control, see the doctor. If your child is following the action plan but symptoms still aren't under control, a treatment change may be needed. On the other hand, if your child's asthma is well controlled, the doctor may be able to reduce the amount of medication your child takes.
• Call the doctor if you have concerns. If you have any questions or you're concerned about your child's signs and symptoms, call your child's doctor or schedule an appointment.

Having asthma shouldn't mean that your child will miss school, be short of breath during sports or play, or wake up coughing at night. By carefully following a written plan, you and your child can control asthma and minimize the disruptions it causes.