A guide to helping your child stay healthy

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Contents p4 What is asthma? p6 Diagnosing asthma p8 What are asthma triggers? p12 Asthma medicines and how to take them p22 Living with asthma

It was very scary when Llahnie was diagnosed with asthma. But we found that the more information we had, the more it helped us. Asthma UK’s website really helped us understand a lot more about severe asthma and was a great source of information. Caron Whitlock, mother of Llahnie Mae, seven

p24 How can I stay on top of my child’s asthma? Finding out that your child has asthma can be a time of worry and confusion. Your doctor or nurse may have explained what asthma is and how it can be treated. But no doubt there are other questions on your mind, such as: • How will asthma affect my child on a day-to-day basis? • What can I do to help? • Is there a cure? • What are the long-term effects of asthma?

p26 How do I know if my child’s asthma is getting worse? p27 What to do in an asthma attack

If you have any further questions, please call the Asthma UK Adviceline 0800 121 62 44 or visit www.asthma.org.uk

We hope that after reading this booklet you’ll understand the basics of asthma, feel reassured about your child’s health and know where to go for help if you have other worries.

children in the UK has asthma Asthma and my child

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What is asthma?

What are the symptoms of asthma?

Asthma is a long-term condition that affects the airways – the small tubes that carry air in and out of the lungs. If your child has asthma their airways are almost always sensitive and inflamed (swollen), even when there are no obvious signs of asthma.

The usual symptoms of asthma in children are: • wheezing, or a whistling noise in the chest • getting short of breath • coughing, particularly at night and after exercise • feeling tight in the chest – sometimes children will describe this as their chest hurting or even a tummy ache.

When your child comes into contact with something that irritates their airways (an asthma trigger), the lining of their airways becomes inflamed; the muscles around the walls of their airways start to tighten; and sometimes the mucus that cleans and protects the lining of their airways builds up and gets in the way of the air that’s trying to reach their lungs.

Coughs, colds and chest infections are the big triggers for Eisa. I know we need to prevent him from having attacks, so we use his preventer inhaler every day, not just when his asthma gets worse. Eisa’s very happy to take his medicine – he sees his nan and mum taking ours so he loves to copy us. Zara Sheikh, mother of Eisa, two

Asthma and my child

Asthma symptoms may not be present all the time and may come and go. With the right medicines, taken properly and as prescribed, your child should be able to lead a full life without symptoms. However, asthma is a serious condition, and if not treated properly can lead to life-threatening asthma attacks.

All of these reactions mean that your child’s airways will become narrower, making it more difficult for them to breathe. This leads to the symptoms of asthma.

Healthy airways

Airways of a person with asthma

There’s an average of two children with asthma in every

classroom School Bus

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Diagnosing asthma There isn’t a single test your child can take to tell if they have asthma. To help make a diagnosis, your doctor or nurse will do a number of things. They will ask about your child’s symptoms, and might ask you to keep a record of them along with what seems to make them better or worse. The doctor or nurse may also listen to your child’s chest to find out if there are any wheezy sounds. If your child is old enough, they may use a peak flow meter to measure how well their lungs are working (see page 25 for more information). Asthma is more likely to be diagnosed if your child has more than one of the typical symptoms (coughing, wheezing, difficulty breathing, chest tightness), particularly if these are: • frequent • worse at night or early in the morning • in response to a trigger (see page 8) • when your child doesn’t have a cold.

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Children under the age of two

Why did my child get asthma?

If your child is under the age of two it’s difficult to tell if they have asthma because: • nearly one-third of very young children will have wheezing at some point. Over time, most of them will stop wheezing as their airways grow; however for others early wheezing can be a sign they will get asthma in later childhood or adult life. • it isn’t easy to measure how well a young child’s lungs are working. A peak flow meter is used for older children, but is unsuitable for children under the age of six.

It’s difficult to say for sure what causes asthma. What we do know is that: • asthma is not infectious • if one or both parents have an allergic condition – such as asthma, hay fever or eczema – their child is more likely to develop asthma • a child is more likely to develop asthma if they already have an allergic condition such as eczema, hay fever or a food allergy • many aspects of modern lifestyles – such as changes in housing and diet and a more hygienic environment – may have contributed to the rise in asthma over the past few decades • smoking during pregnancy or exposing your child to cigarette smoke early in life will increase their risk of asthma.

The best way you can help your child is to make sure that they take their

Asthma is a long-term condition that affects people differently. Some children lose their symptoms during their teenage years and others find that their symptoms get milder. However, recent research shows that the underlying condition doesn’t go away and it’s possible that symptoms may return in later life. If your child has more severe asthma symptoms their asthma is more likely to continue or return in later life.

What can I do to help? Whatever the severity of your child’s asthma, the best way you can help them is to make sure that they take their medicines and learn how to manage their triggers. Your doctor or asthma nurse will help you to understand what triggers your child’s asthma and what medicines are most effective for them. Getting a My Asthma pack (see page 24) can really help you and your child get to grips with their asthma.

medicines and learn how to manage their triggers

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What are asthma triggers? A trigger is anything that can make a person’s asthma worse by irritating their airways. Everyone’s asthma is different and you’ll probably find your child has several triggers.

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When your child has asthma symptoms, try keeping a note of anything that might have caused them: think about where they were and what they were doing at the time. You may be able to notice patterns and identify what’s triggering their asthma. If you know your child’s triggers, tell your doctor as there may be things you can do to reduce the impact on your child’s asthma. To help reduce the effect of triggers and the risk of your child having an asthma attack it’s important that they: • take their preventer inhaler every day as prescribed even when they’re feeling well • always have their reliever inhaler with them just in case they need it.

Common asthma triggers Colds and viral infections Zac’s asthma can go downhill in winter, as his main trigger is cold weather. So I make sure he’s had his flu jab and stays on top of his medicines, taking what he needs before leaving the house and having his inhalers on him when he’s out. Hayley Kuta, mother of Zak, seven

Asthma and my child

Colds and viral infections are a very common trigger in children. It’s important that your child has an annual flu vaccination every autumn – speak to your doctor or asthma nurse to find out more. A good diet high in fresh fruit and vegetables may also help by making sure they have a healthy immune system.

House-dust mites House-dust mites are tiny creatures that live in our beds, carpets, soft furnishings and soft toys. It’s almost impossible to get rid of all the house-dust mites in your home, but there are things you can do to reduce their numbers. See www.asthma.org. uk/house-dust-mites for more details.

Furry or feathery animals Some children with asthma are allergic to furry animals and occasionally birds. The allergens are found in their saliva, flakes of skin and urine. Think seriously before buying a pet if there is a family history of allergies or your child has asthma, and try to keep any pets out of your child’s bedroom.

To help to manage this trigger: • where necessary, give your child their reliever inhaler, one to two puffs just before they start exercising or playing • if your child starts to have symptoms when they exercise, get them to stop, take their reliever inhaler and wait for their symptoms to go away before starting again • if exercise triggers their asthma regularly, speak to their doctor or asthma nurse, as it’s a sign that their asthma might not be as well controlled as it could be. For more information on exercise and asthma go to www.asthma.org.uk/exercise

Exercise and excitement Exercise, laughing and excitement can all trigger asthma in children but it’s important for them to keep fit by exercising and having fun playing with their friends. There’s also evidence to show that regular exercise can help improve asthma symptoms. Asthma shouldn’t hold your child back, and as long as they’re taking their medicines, exercise shouldn’t be a problem.

exercise Regular

can help improve asthma symptoms www.asthma.org.uk

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Food

Weather

Pollen

A sudden change in temperature, cold air, windy days, poor air quality and hot, humid days can all be triggers for asthma. This doesn’t mean that your child shouldn’t go outside, but make sure that they’re taking their preventer inhaler regularly and they take their reliever with them when going out.

Pollen is produced by certain types of trees, grasses, weeds and flowers. To help reduce the effects of this common trigger, review your child’s medicines with the doctor or asthma nurse before the hay fever season starts.

Thunderstorms Thunderstorms have been associated with an increase in asthma attacks, possibly as a result of pollen and mould spores being swept up into the air and broken into small pieces that can be breathed in. As thunderstorms can trigger severe asthma attacks, it’s important to know how to best prepare for them. Please see www.asthma.org.uk/weather

Asthma and my child

See www.pollen.co.uk or www.allergyuk.org for more details.

Mould Moulds release tiny spores into the air, which can trigger asthma symptoms in some children. They are found in any damp place, from piles of autumn leaves and woody areas to bathrooms and kitchens and even damp clothes. By keeping your house well ventilated and treating mould and damp quickly you can reduce the risk of this triggering your child’s asthma.

Some children can develop allergies to certain foods. The most common foods known to cause allergies include milk, eggs, wheat, peanuts, tree nuts, fish and shellfish, although other foods can too. If your child has a known food allergy and asthma it’s very important to make sure your doctor or nurse knows about both so they can help make sure they’re being well managed. This is because children with both conditions are at a greater risk of having a potentially life-threatening asthma attack. If you think your child’s asthma is triggered by a specific food: • let your doctor or asthma nurse know as soon as possible: if your child’s symptoms are severe they’ll be referred to a consultant • keep a food diary, recording what they were eating, what the symptoms were and when these started after eating the food • make sure you know what to do if your child has an asthma attack, so get them an asthma action plan (see page 24) • and they’ve been given an adrenaline (epinephrine) auto injector pen (for example anapen, epipen or jext) to use in an emergency, it’s also important that you see the doctor or nurse regularly to go through the emergency

procedure together. As your child gets older and more independent they’ll need to know how to manage both their asthma and food allergy.

Cigarette smoke One of the best ways to help your child’s asthma is not to smoke. Cigarette smoke triggers asthma attacks and is especially harmful to growing lungs, causing long-term damage. It’s better for your child if you can keep your home smoke free, so if you do smoke, do it outside.

Air pollutants The air we breathe contains a range of particles that can trigger asthma symptoms. Air pollutants such as cigarette smoke and car exhaust fumes contain gases and particles which can irritate the airways.

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Asthma medicines and how to take them Managing asthma in steps – ages 5 to 12 years old

Your doctor’s choice of treatment for your child’s asthma will be based on a nationally agreed ‘stepwise’ approach taken from the British Guideline on the Management of Asthma. When your child’s asthma has been well controlled for many months, their doctor may recommend moving down a step – this is called ‘stepping down’. The aim of the ‘stepwise’ approach is for your child to be on as little medicine as possible to control their asthma. There are five steps – step 1 involves just one medicine that’s used occasionally and each further step involves either adjusting dosages or adding other medicines to your child’s treatment. Your child will be moved up the steps until they are on the right level of treatment that controls their asthma. Before they’re moved up a step the doctor or asthma nurse will check to make sure they’ve been using their inhalers properly and managing their triggers.

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Step 1 Everyone with asthma should have a reliever inhaler. These are used when your child feels their asthma symptoms coming on, for example when they start to cough or wheeze. Relievers work by relaxing the muscles that surround the airways, allowing the air to flow in and out more easily. The effect lasts for about four hours. Reliever inhalers are usually blue. If your child is using their reliever inhaler more than three times a week they should be on step 2.

Step 2 In addition to their reliever inhaler, your child will be given a preventer inhaler to take every day. Preventer inhalers contain small doses of corticosteroids, which work by reducing swelling, soreness and irritation in the airways, making them less sensitive to triggers. The effects of preventer medicine build up over a period of time and your child will only start to feel some benefits after about a week. Preventer inhalers need to be taken every day even when your child is feeling well. They have a protective role and reduce the risk of asthma attacks and long-term damage to your child’s lungs.

Step 3 If your child is using their preventer inhaler correctly and regularly and is still experiencing asthma symptoms, the doctor may ‘add-on’ a long-acting reliever inhaler before increasing the dose of your child’s preventer medicine. As the name suggests, long-acting relievers work in a similar way to reliever inhalers but the effects last for longer – around 12 hours instead of four. They open up the airways by relaxing the muscles that surround them and are taken twice a day. They must be taken with a preventer inhaler. If the long-acting reliever inhaler helps but your child is still getting asthma symptoms, the doctor may keep them on it and increase the dose of their preventer inhaler up to 400mcgs per day. If the long-acting reliever isn’t helping, the doctor may take your child off it and increase the dose of their preventer inhaler up to 400mcgs per day.

The doctor may ‘add-on’ any of the medicines mentioned on page 14 if your child’s asthma is still troubling them.

Step 4 If your child’s asthma symptoms are still not controlled despite using medicines regularly and correctly, their doctor may increase the strength of their preventer inhaler medicine to up to 800mcgs per day.

Step 5 If your child’s symptoms are still difficult to get under control, they’ll be started on daily steroid tablets in addition to the medicines they’re already taking. Steroid tablets contain corticosteroids at a higher dose than found in preventer inhalers. They work by reducing swelling, soreness and irritation in the airways, making them less sensitive to triggers. Your child will also be referred to an asthma specialist who will take over their care.

ntrol nder co u a m h t their as to keep s p e t s etween move b n a c d il Your ch

STEP 1

STEP 2

STEP 3 STEP 4

STEP 5

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‘Add-on’ treatments Your child’s doctor has the option of trying either of the following two add-on treatments at step 3. Your child will be started on them one at a time on a trial basis. If the medicine doesn’t help, the doctor will stop it before starting your child on the other one. If the ‘add-on’ treatment helps, your child will be kept on it even if they’re ‘stepped up’ onto step 4 or 5.

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Preventer tablets – leukotriene receptor antagonist Preventer tablets work by blocking one of the reactions in the lungs that causes the airways to flare up when your child comes into contact with an asthma trigger. They may be particularly effective if your child’s asthma is triggered by exercise or allergies. They’re taken once a day even when your child is feeling well and come as chewable tablets.

Theophylline Theophylline relaxes the airways in your child’s lungs to make breathing easier and help prevent asthma attacks. It may also help to reduce inflammation in the lungs. Theophylline comes as syrup, tablets (which mustn’t be crushed or chewed) or capsules (which can be opened and the contents sprinkled onto a spoonful of soft food, eg yoghurt, and swallowed without chewing). The theophylline is slowly released into the bloodstream. It must be taken regularly twice daily and the dose may need to be adjusted according to the levels in your child’s blood. If your child is changed to a different brand of theophylline their dose will need adjusting.

Asthma and my child

Steroid tablets

Combination inhalers

Regardless of which step of treatment your child is on, if their asthma symptoms flare up, your doctor or asthma nurse may give them a short ‘rescue’ course (a minimum of three days) of steroid tablets to quickly get their asthma back under control, in addition to their usual medicines.

These inhalers contain both preventer and long-acting reliever medicines in one device. This is a more convenient way of taking two medicines and makes it less likely that your child will forget to take them both. They should be taken regularly, every day as prescribed, even when your child is feeling well.

Steroid tablets are powerful and quickly reduce the inflammation (redness, soreness and swelling) in the lungs that causes your child to cough, wheeze, get short of breath or have chest tightness. Steroids are hormones that occur naturally in our bodies. Steroid medicines are man-made but are similar to our natural hormones. The type of steroids used to treat asthma are called corticosteroids. They’re different to the anabolic steroids which some athletes and bodybuilders use. A short course of steroids usually causes no long-term side effects. These are more likely to occur if your child needs longer courses, or takes short courses repeatedly.

It’s important you and your child see the doctor or asthma nurse for an asthma review every 12 months to ensure they’re on the right medicines. This means that they’ll be able make sure your child is on the lowest dose of medicines possible to manage their symptoms.

Can complementary medicine help? Some people find that complementary therapies seem to improve their asthma symptoms. However, there is little scientific evidence that complementary therapies alone are effective. If you want to try one of the many complementary therapies available, talk to your child’s doctor and make sure your child continues to take their normal asthma medicine as well.

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For children younger than five years there are four steps...

1

Step

Everyone should have a reliever inhaler. These are used when your child’s asthma symptoms come on, for example when they start to cough, wheeze or are breathless. Relievers work by relaxing the muscles that surround the airways, allowing the air to flow in and out more easily. The effect lasts for about four hours. Reliever inhalers are usually blue. If your child is using their reliever inhaler more than three times a week they should be on step 2.

Asthma and my child

2

Step

In addition to their reliever inhaler, your child will be given a preventer inhaler to take every day. This contains small doses of corticosteroids, which work by reducing swelling, soreness and irritation in the airways, making them less sensitive to triggers and reducing the risk of an asthma attack and long-term damage to their lungs. The effects of preventer medicine build up over a period of time and your child will only start to feel some benefits after about a week. Preventer inhalers need to be taken every day even when your child is feeling well. Your child will be started at the lowest dose needed to get their asthma under control. If your child is unable to use a preventer inhaler effectively, your doctor might prescribe preventer tablets – called leukotriene receptor antagonists. These work by blocking one of the reactions in your child’s lungs that causes their airways to flare up when they come into contact with an asthma trigger. They’re taken once a day even when your child is feeling well, and come as chewable tablets or granules, which can be swallowed whole or mixed with cold soft food.

3

Step

If your child was given a preventer inhaler at step 2 and they’re still having asthma symptoms, your doctor will check that they’re using their inhaler correctly before considering giving them a preventer tablet (a leukotriene receptor antagonist) as well.

4

Step

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If your child’s asthma is still not controlled despite the correct use of the medicines mentioned in steps 1-3, your doctor will refer them to a respiratory paediatrician.

If they were taking a preventer tablet at step 2, and are still having asthma symptoms, your doctor will consider giving them a preventer inhaler as well.

Managing asthma in steps –

under 5s www.asthma.org.uk

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Stepping up and stepping down

Things to remember about your child’s medicines:

If your child has an asthma action plan, you’ll have discussed with their doctor or asthma nurse when they need to step up or step down, which will give them greater control over their asthma. However, if they don’t have a plan it’s important that you don’t move them up or down the steps without talking to your doctor or asthma nurse first. See page 24 for more information on asthma plans.

• Your child should be on the lowest dose of medicine to manage their asthma. • Once the medicines have reduced your child’s asthma symptoms, the doctor may consider ‘stepping down’ their medicines. • It’s important that the doctor or asthma nurse reviews your child’s symptoms after their medicines have been ‘stepped down’ to see what effect this has had. • Make sure your child always has their reliever inhaler with them.

How does my child take their medicines? Inhalers

Most asthma medicines come as inhalers (sometimes called a puffer) so that the medicine can be breathed into the lungs and goes straight to the airways where it’s needed. Inhalers can be in aerosol form, or for children aged around seven or older they can be in dry powder form. It’s a good idea to encourage your child to start taking their medicine by themselves (with your support) as early as possible. That way it will become part of their routine and something that they’ll continue to manage through adolescence and adulthood.

I make sure Mya takes her brown inhaler in the morning and at night, and she’s mostly good as gold. She mainly gets asthma when she’s running around or has a cold. That’s when she needs her inhalers more. Tanya Pierce, mother of Mya, six

17 minutes Every

a child is admitted to hospital because of their asthma

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Spacers

How do I use the spacer?

If your child has an aerosol inhaler, using a spacer device with their inhaler is the most effective way to take their medicine.

Read through the instructions that come with the spacer and keep them for future reference. Your doctor or asthma nurse should show you how to give your child their inhaler with the spacer.

If you find it difficult to use the spacer with very young children, don’t worry – you’re not alone! But do keep trying. Getting your child to take inhaled medicine is the most important way to reduce their asthma symptoms and the risk of an asthma attack.

Remember:

Tips for children over two

• Only put one puff of medicine into the spacer at a time. • Spacers need to be washed on a regular basis and replaced after a time – please check your manufacturer’s instructions.

As your child gets older (usually between the ages of three and four) they’ll be able to learn to use the spacer with a mouthpiece rather than a mask. • Show your child how to use the inhaler and spacer first without putting medicine into it. • Turn the spacer into a toy – decorate it with coloured stickers. • Make a counting game. Count aloud as your child takes a deep breath. • Have a routine – set a time of day to give preventer medicine (best before brushing teeth). • Praise your child when they use their spacer correctly or use a daily chart with stickers to reward them.

A spacer is a plastic container with a mouthpiece or face mask at one end and a hole for the inhaler at the other. Spacers are only used with an aerosol inhaler. Spacers with face masks can be used with babies or younger children (up to around three years old) and are better than giving the medicine in syrup form. Children over three can usually be taught how to use a spacer with a mouthpiece. Speak to your doctor or asthma nurse if your child doesn’t have a spacer or if you think they have the wrong one for their age.

Spacers are very important because: • they make aerosol inhalers easier to use • your child gets more medicine into their lungs than when just using the inhaler on its own • they stop the medicine from sticking to the back of your child’s mouth, reducing the risks of thrush (a fungal infection that can occur in the mouth) and a sore mouth • in an emergency situation, an inhaler and spacer are now recommended as an alternative to a nebuliser.

spacer Using a

with an inhaler makes it more effective

Asthma and my child

Tips for using a spacer and mask with babies • Cuddle your baby on your knee or cradle them in your arms. Gently tuck their arms out of the way with one hand if they try to knock the mask away. • Be positive and smile! Your baby will be aware if you are anxious. • Gently stroke your baby’s cheek with the mask so that they get used to the feel of it. • Reassure your baby by pretending to take the medicine yourself or giving it to a favourite toy. • Distraction with music or videos can also be useful. • Use them when your baby is asleep. • Wipe your baby’s face after using a preventer.

Go to www.asthma.org.uk/usingyour-inhalers for demonstrations of how to use an inhaler and spacer.

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Living with asthma

Managing asthma

Coping with childcare

School life

With the right medicine, taken properly, your child should be symptom free and able to lead a full life. It’s important to take steps to manage their asthma as soon as possible, to prevent the possibility of long-term lung damage and reduce the risk of asthma attacks.

The doctor or asthma nurse may talk to you about how you and your child can ‘control’ or ‘manage’ their asthma. This is their way of talking about how to treat asthma.

Finding the right childcare can be difficult, especially for parents of children with asthma. Whatever sort of childcare you arrange, it’s important to make sure the childcare worker understands your child’s asthma. Think about the following: • Are there any pets around? • Will anyone be smoking around your child? • Will their carers give them medicine if necessary? If so, have they been taught how and when to use it? • Do they know how to recognise and deal with an emergency? • Can they contact you quickly at all times? • Are they properly registered with the local authority?

Asthma affects on average two children in every classroom throughout the UK, and teachers are now more aware of how to deal with asthma at school. However, the following tips will help your child to make the most of their school days: • Make sure their teacher knows that they have asthma, what medicines they’re on and what triggers their asthma. A School Asthma Card is a useful way to record this information. Go to www.asthma. org.uk/shop to download one. • Clearly mark your child’s medicines with their name. • Check that they’re allowed to carry their medicines, or that these are easily accessible. • Leave a spare reliever inhaler and spacer, with the expiry date and your child’s name marked on it, with their teacher or school nurse – just in case your child loses theirs. • If your child has a food allergy and asthma it’s very important that your school knows this and that the school nurse is informed.

Your child’s asthma is under control if they: • are on the right medicines • are taking their medicines properly • have no symptoms day or night • rarely need to use their reliever inhaler • are able to do all their usual activities, including exercise • don’t have asthma attacks or flare ups.

Your child’s asthma is not under control if:

James’ medicines have allowed him to lead a normal life and take part in sport, which he loves! His nurse knew his asthma well enough to suggest changing his inhaler when he was seven, which dramatically improved James’ health and meant his asthma no longer impacted his life. Sarah Harrison, mother of James, 13

Asthma and my child

• they’re having asthma symptoms • they’re using their reliever inhaler more than three times a week • they’re waking at night due to their asthma • their asthma is getting in the way of school or exercise, or stopping them from doing any activity that they want to do.

Make sure you leave clear written instructions with carers, and give them a medicines postcard. This will show them which medicines your child needs to take, when to give them and what to do in an emergency (see back cover for details of how to order).

The doctor or asthma nurse should work with you and your child to help them achieve ‘good control’ to reduce the risk of an asthma attack. It may take a few visits to get this right.

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How can I stay on top of my child’s asthma?

5. Monitor your child’s asthma symptoms

6. Know what triggers your child’s asthma

Here are some key actions that you can take to make sure your child’s asthma is looked after.

If you keep note of your child’s asthma symptoms every day, it will help you to notice when they’re getting worse and understand their triggers, so you can take steps to avoid them. The My Asthma calendar and stickers are a fun way for children to monitor their asthma symptoms.

If you know what their triggers are, you can support your child to manage or avoid them, where possible.

1. Have a My Asthma Action Plan Your doctor or asthma nurse should help you to complete an asthma action plan, which is a written guide telling you what to do if your child’s asthma gets worse. The plan will contain all the information you need to manage their asthma, including details about their asthma medicines, how to tell when their symptoms are getting worse and what to do if they have an asthma attack. My Asthma My Asthma is a resource to help children aged 6–11 to understand and manage their asthma. This includes a personal asthma action plan, a wall chart with stickers to help your child monitor their asthma and a medicine card to give to people who look after them. We also offer Your Asthma for those over 12 and an under 5s action plan, which can be downloaded at www.asthma. org.uk/advice-child-action-plan

Asthma and my child

2. Understand your child’s medicines and when to take them Talking to your child’s doctor, asthma nurse or pharmacist will help you with this. They can also help you fill out the action plan, which will contain all of this information.

3. Get your child’s inhaler technique checked This should be checked every time your child has an asthma review, and you can ask to have it checked at any time by your doctor, asthma nurse or pharmacist.

4. Make sure your child is taking their preventer as prescribed

Peak flow meters If your child is over the age of six, they can use a peak flow meter to help monitor their asthma. This is a small plastic tube that the doctor will ask them to blow into, showing how well their lungs are working by measuring how quickly they can blow air out. Peak flow meters can be prescribed by the doctor or asthma nurse. Small changes in your child’s peak flow readings are quite normal but if they vary daily by large amounts it may be an early warning sign that their asthma is getting worse.

7. Have an asthma review every 6 to 12 months Asthma is a long-term condition that needs to be treated on an individual basis. It’s important that your child has regular review appointments with their doctor or asthma nurse to monitor their asthma symptoms, medicines and any side effects. You might need to see the doctor or nurse more regularly just after your child has been diagnosed.

8. Know what steps to take in an asthma attack. Please see page 27 for this information.

Even when your child is feeling well, taking their preventer is important. It will reduce their risk of an asthma attack if they come into contact with a trigger.

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How do I know if my child’s asthma is getting worse? Asthma attacks don’t usually come out of the blue but are the result of gradually worsening symptoms. Watch out for signs that your child’s asthma is getting worse including: • wheezing and/or coughing first thing in the morning • increased wheezing and/or coughing after exercise, or doing less exercise • waking at night with a cough or wheeze • needing more and more reliever medicine with less and less effect. If your child’s asthma symptoms are getting worse don’t ignore them. Often, using their reliever is all that is needed when they start having an asthma attack. At other times, symptoms are more severe and urgent action is needed. If you notice any worsening symptoms, follow your child’s asthma action plan and let the doctor or asthma nurse know. This should help your child to reduce their symptoms and get back on track. You might want to look at their medicines, triggers and lifestyle to see if anything can be changed.

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Signs of an asthma attack No matter how careful you are in making sure that your child takes their asthma medicines and avoids their triggers, your child may still have an asthma attack. They are having an asthma attack if any of the following happen: • their reliever doesn’t help their symptoms • their symptoms are getting worse (cough, shortness of breath, wheeze or tightness in the chest) • they’re too breathless to speak, eat or sleep.

What to do in an asthma attack 1. Give your child one to two puffs of their reliever inhaler (usually blue). 2. Sit them up and tell them to take slow steady breaths. 3. If there is no immediate improvement, continue to give them two puffs of reliever inhaler (one puff at a time) every two minutes. They can take up to ten puffs. 4. If your child doesn’t feel better after taking their inhaler as above, or if you’re worried at any time, call 999 for an ambulance. 5. If an ambulance doesn’t arrive within ten minutes, repeat step 3. Don’t be afraid of causing a fuss, even at night. If your child has to go to hospital, take details of their medicines with you. You can order a free, pocket size What to do in an asthma attack card (see back cover).

After an asthma attack 1. Make an appointment with the doctor or asthma nurse for an asthma review within 48 hours of your child’s asthma attack. This is so that they can: • try to find out what made your child’s asthma worse • check their inhaler technique • check their asthma symptoms and peak flow to make sure that everything is settling down again • check that your child is on the right medicines to reduce the risk of having another asthma attack • make sure you know what to do if they have another asthma attack. 2. Your child will also need another review with the doctor or asthma nurse within one to two weeks of their asthma attack to make absolutely sure their symptoms are back under control and less likely to flare up again.

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Or visit our website www.asthma.org.uk