Asthma Information for Children and Families
Monica Federico, MD, Director of Outpatient
Asthma at Children's Hospital Colorado, evaluates
a patient using a metered dose inhaler.
What is asthma?
Signs and symptoms
Asthma triggers
Children's Hospital Colorado Asthma Program
Frequently used medications
Frequently used asthma terms
Things to remember
Tips for organizing care
Resources for patients and families
Resources for health care professionals
What is Asthma?
Asthma is a chronic respiratory disease commonly identified during childhood. It affects all airways of the lungs and occurs from:
- Inflammation
- Bronchospasm
- Increased Mucous Production
Symptoms occur when airways are irritated from asthma triggers. More than 14 million school days and 14.5 million work days are missed annually due to asthma. Asthma can be controlled in the majority of children if properly treated. It is important to visit your doctor if your child has been diagnosed with asthma and they cough or wheeze regularly. It is often helpful to track these symptoms. A monthly asthma tracking sheet is helpful to sit down and discuss with your physician at the time of a visit. Also, download an asthma action plan (.pdf). Available in Spanish (.pdf)
Signs and Symptoms
Signs and symptoms of asthma include the following:
- Persistent cough
- Wheezing
- Difficulty breathing with exercise
- Cough during the night
- Shortness of breath or difficulty breathing
If you have any of these symptoms on a regular basis, you should meet with your doctor.
Triggers for Asthma
Common asthma triggers include:
- Tobacco Smoke (major contributor)
- Respiratory Viral Infections
- Exercise (links to American Thoracic Society information)
- Strong Odors
- Perfumes or Cleaning Agents
- Environmental Allergens
- Dust
- Mold or Mildew
- Cold Air
Triggers are specific to each child, but smoking and second-hand smoke have been found to have a strong negative effect on children’s asthma. Protect your child from second-hand smoke by keeping your home and cars smoke free. If you or someone you know is a smoker and is considering quitting, try visiting Colorado QuitLine for ideas or assistance. For more information about kids and smoking, please visit www.raisesmokefreekids.com. Other triggers include natural things found in our environment such as molds, trees, grasses, weeds and common pets. If the child is old enough, skin-testing for these environmental allergens can be performed.
Children's Hospital Colorado Asthma Program
Our asthma program provides comprehensive education, trigger identification (allergen skin-testing if age-appropriate), and evaluation including lung function testing before and after Albuterol, and a possible chest X-ray. Some things to expect during a visit to the pulmonary clinic for asthma include:
- Filling out an asthma control test
- Completing an asthma questionnaire
- Discussing previous health history, medications, and family history with a nurse
- Meeting with a physician to determine the best course of treatment that will suit the patient/family
- Plan for what to do if the child’s asthma worsens
- Family will receive an asthma action plan specific to the child to guide the family through treating an acute asthma episode
- There will be a comprehensive teaching session on asthma
Please try to arrive at least 15 minutes prior to your appointment to allow for check-in time and lung function testing. Please also bring any medications and/or devices that your child has been given in the past to your visit so that the asthma team can ensure the device is working properly and can answer any specific questions you have about that device.
Frequently Used Medications 
Our asthma education series of videos can help you and your child learn how to use common medications and devices.
- Quick relief medication is used for fast relief of asthma symptoms like cough, wheeze, or difficulty breathing. Examples include Albuterol, Xopenex and Maxair.
- Controller medication is used on a daily basis to prevent asthma symptoms. This is usually an inhaled corticosteroid. Examples include Pulmicort, Flovent, Qvar, Asmanex, etc. One type of controller medication is combination therapy. This is when two or more medications are combined to help control asthma symptoms. These include Advair and Symbicort. A controller medication will not provide quick relief for asthma symptoms and should not be taken to relieve asthma symptoms.
- Steroid burst is a course of oral steroids that is usually prescribed for a few days when a patient is having an asthma exacerbation to help relieve airway inflammation. Examples include Orapred, Prednisolone and Prednisone.
Frequently Used Asthma Terms
Here are some asthma terms you may hear during a visit:
- Asthma exacerbation – This refers to a period in time where asthma symptoms were occurring frequently during the day and night, and a quick relief medication was needed at least every four hours. Another name for this is asthma flare-up.
- Bronchospasm – Tightening of the muscles around the airways, which makes them narrower and more difficult to get air into and out of the lungs.
- Inflammation – irritation, redness, and swelling of the airways.
- Peak Flow Meter Readings – A peak flow meter is a small device which indicates how well a child is able to force air out of the lungs. The child exhales into the device forcefully and quickly to move the meter to a certain point on a scale. Readings are specific to each child, and indicate how the child’s asthma is on a day-to-day basis when compared with normal readings for that child.
- Triggers – Anything that causes your child to have asthma symptoms.
- Zones – This term refers to the patient’s asthma action plan and consists of green, yellow and red zones which are categorized by symptoms and peak flow readings. This information helps your provider determine how bad the child’s asthma is at that time.
Things to Remember about Asthma
- Valved-holding Chamber (or Spacer) Use: Children's Hospital Colorado recommends that all children using a metered-dose inhaler (MDI) for either a controller medication or quick relief use a valved-holding chamber with the MDI to improve medication delivery technique, decrease the amount of medication deposited in the mouth, and increase the amount of medication to the lungs. During a visit to the pulmonary department for asthma, the patient will be given a Valved-holding chamber if they do not already have one.
- Exercise: Asthmatics should remember to treat themselves with quick-relief medication 15 minutes prior to exercise to help reduce asthma symptoms.
- Tracking Medication Doses: It is important to keep track of how many doses of asthma medication remains in the device, whether it is a quick relief medication or controller medication. Many medication devices will spray propellant after medication is empty, which looks and sounds like medication has been dispensed. This can make you think you still have medication, when in actuality you are spraying propellant into your lungs which may irritate them. To help with tracking medication use, some devices have a counter with remaining doses such as the discus (Advair or Serevent), but other devices require the user to track doses on their own such as most metered-dose inhalers (Albuterol, Flovent, Qvar, etc). Try placing a piece of masking tape on the boot, and marking with a pen each time the medication has been dispensed. Refer to your medication insert as to the total number of medication doses available in each device.
- Cleaning equipment: Asthma equipment should be cleaned at least once a week to ensure its effectiveness.
- Prevention of the Flu: It is important for all asthmatics to receive a flu vaccine every fall. The flu, which is also called Influenza, can make an asthmatic very sick because the virus attacks the lungs and can cause breathing problems, making asthma worse. Since the flu shot only works for one year a new shot is needed each fall to protect the child from catching the flu.
- Vacation Planning: It is important for an asthmatic to always have their quick relief medication available to them in the case that they start to have difficulty breathing, wheezing, or persistent coughing. When planning for a vacation, remember to check that you will have enough controller medication to last throughout the trip, and that quick-relief medication (example: Albuterol) is easily accessible during travel. If a controller medication is stopped for more than a few days, the level of medication in the lungs will quickly decrease, and it will take about two weeks after restarting the medication to return to a therapeutic level. Also, it is important to consider location and environment for the asthmatic when traveling on vacation. If the vacation is planned for outdoors, you may consider speaking to your physician about bringing an allergy medication with you for any allergies that the child may be exposed to in his/her new environment to prevent an asthma exacerbation.
- School/Camp Information: Remember to provide the school or camp health official with a copy of the asthma action plan that you receive during your visit. This will help guide the health official if your child is having problems with his/her asthma. In addition, many schools have forms that must be completed by a physician in order for the child to be able to keep quick-relief medication with them at all times. If your child is a patient in the pulmonary clinic, you can fax the school forms to the office and our nurses will complete the forms and send them to the school. If your child is not a patient in the pulmonary department, these forms can be filled out by the child’s primary care physician.
Tips For Organizing Asthma Care
- Provide school with an asthma action plan in case symptoms occur at school.
- Place home-copy of an asthma action plan in a visible place in the house where it can be easily read such as a refrigerator.
- Store all asthma medications and devices in one place, such as a duffle-bag or plastic container. Make this storage container easily accessible for the child and parent.
- Place handout for cleaning devices in a commonly-used area such as on the refrigerator to help remind you about cleaning the devices on a regular basis.
- Coordinate taking controller medications prior to teeth-brushing in the morning and at night to reduce the chance of forgetting to take the medicine and decrease the possibility of thrush in and around the mouth.
Resources for Patients and Families
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