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Managing asthma in children
A booklet for parents and carers   December 2011
                                       Evidence
Cover photograph: Asthma UK




                    © Scottish Intercollegiate Guidelines Network
                                ISBN 978 1 905813 79 7
                           First published December 2011

SIGN consents to the photocopying of this booklet for the purpose of implementation in
                                   NHSScotland
Contents
What is this booklet about?                                        2

What is asthma?                                                    3

Diagnosing asthma in children and young people                     5

Who will help me to look after my child’s asthma?                  9

What medicines can help control my child’s asthma?                 11

What can I do to help to control my child’s asthma?                20

What happens during an asthma attack and how will it be treated?   25

Can I prevent my child from developing asthma?                     30

Asthma in young people                                             31

Where can I find out more information about asthma?                35

What is SIGN?                                                      38




                                                                        1
What is this booklet about?

    This booklet is for the parents and carers of children who have or might have
    asthma. It aims to make parents and carers aware of the treatment and care
    they should expect their children to receive. It will also help you to understand
    the latest research evidence so you can manage your child’s condition better.

    The booklet is based on guidance from the British guideline on managing
    asthma which was developed by the British Thoracic Society and the Scottish
    Intercollegiate Guidelines Network (SIGN). Your child’s doctor or asthma nurse
    should be following this guidance when looking after your child’s asthma.

    The booklet covers:

     diagnosis;
    ~~
    ~~ will be involved in looking after your child’s asthma;
     who
     medicines;
    ~~
    ~~ you can help control your child’s asthma;
     how
     asthma attacks;
    ~~
     asthma in young people; and
    ~~
     where to find out more about asthma.
    ~~

    If you would like to see a full version of this guidance, please visit
    www.sign.ac.uk/pdf/sign101.pdf




2
What is asthma?

Asthma is a condition that affects your child’s airways (the small tubes that
carry air in and out of your child’s lungs). Asthma can start at any age and there
are many different causes.

If your child has asthma you may find that they sometimes have asthma
symptoms. Asthma symptoms could be:

 wheezing (a noisy whistling sound coming from your child’s chest);
~~
 coughing a lot (especially after exercise or at night); or
~~
~~ tight feeling in your child’s chest.
 a

Asthma symptoms may come and go. You might find your child has symptoms
at different times of the day or even different times of the year.

                                                                                     3
Some things can make your child’s asthma worse. They are called asthma
    triggers. Examples of common asthma triggers are dust, pets, pollen, cigarette
    smoke and changes in the weather. Everyone has different asthma triggers and
    most people have more than one trigger.

    When your child breathes in something that irritates their airways (asthma
    triggers) their asthma symptoms may start.

    ~~ muscles around their airways tighten.
     The
    ~~ lining of their airways becomes swollen and inflamed.
     The
    ~~ of mucus is produced.
     Lots

    All of this makes your child’s airways narrower and they may get some or all of
    the symptoms described above.




4
Diagnosing asthma in children and young people
How will my child’s doctor and I know if my child has asthma?

You will need to see your child’s doctor to find out if your child has asthma.
Unfortunately, asthma can be difficult to diagnose, particularly in young
children. Your child might not have symptoms when they see their doctor
but may have symptoms at other times. On page 3 there is a list of asthma
symptoms they might have.

Your child’s doctor might ask:

 what asthma symptoms your child is having;
~~
~~ often and when they get asthma symptoms;
 how
~~ their asthma symptoms are worse at night or in the early morning (or
 if
 both);
~~ their asthma symptoms come on after they exercise or play;
 if
 what you think triggers your child’s asthma symptoms; and
~~
~~ you child only gets asthma symptoms when they have a cold or at certain
 if
 other times.

Some conditions such as eczema and allergies go hand in hand with asthma so
your doctor might also:

~~ you if your child has a history of other conditions such as eczema or
 ask
 hayfever or other allergies;
~~ if anyone else in your family has a history of asthma or a history of other
 ask
 allergic conditions such as hayfever, eczema, food allergy;
~~ and listen to your child’s chest; and
 look
~~ your child is old enough, do some breathing tests with them to see how
 if
 well their lungs are working. These are also called lung function tests.
What if my doctor thinks my child has asthma?

If your child’s doctor thinks that your child has asthma, they will give your child
asthma medicines to try. This is known as a treatment trial. This is likely to be

                                                                                      5
an inhaler. The asthma medicines your child is given will depend on how often
    they have asthma symptoms and how serious these symptoms are. You can
    read about the different types of medicine on page 12. Your child will be asked
    to see their doctor regularly while they are taking asthma medicines to talk
    about whether they are still working.

    If the treatment helps your child’s asthma symptoms, their doctor should treat
    them for asthma and arrange an asthma review. You can read more about
    asthma reviews on page 9.

    If the treatment is not helping your child, their doctor should:

    ~~ their asthma medicines;
     stop
     consider doing more tests;
    ~~
     consider testing them for other conditions they might have; and
    ~~
     consider referring your child to a specialist doctor for their opinion.
    ~~
    What if the doctor is not sure whether my child has asthma?

    If the doctor is not sure whether your child has asthma, they may give your
    child medicine for a number of weeks to see if it works (a trial of treatment).
    They may suggest a reversibility test if your child is old enough (school age).
    They may offer both a treatment trial and a reversibility test.

    A reversibility test involves testing your child’s breathing before and after they
    take their asthma medicines. These breathing tests are called lung function
    tests. Lung function tests include the following.

     Peak expiratory flow measurement. The doctor will use a small device called
    ~~
     a peak flowmeter to test how fast your child can blow air out of their lungs.
     Spirometry. The doctor will use a machine called a spirometer to measure
    ~~
     the amount of air your child can blow out and how fast they can blow it out.

    The photograph on page 7 shows a child having a peak flow test. It is likely that
    your child has asthma if their readings on the spirometer or peak flowmeter are
    lower than expected and improve after they take asthma medicines.

6
7
Although spirometry is recommended in children over five, it can still be
    difficult for some children of this age (and older) to take the test. It may take
    some time for your child to learn to blow out air and the results may not be
    reliable until they have mastered this. If your child cannot do this test then your
    doctor will give them a treatment trial.

    Medicines that can be used for reversibility testing include the following.

    A reliever inhaler - your child will be asked to do a breathing test immediately
    before being given a dose of reliever medicine. About 20 minutes later your
    child will be asked to do another breathing test.

    A preventer inhaler - your child may be asked to do a breathing test at the
    doctor’s surgery then they will be given a preventer inhaler to take at home,
    twice a day, for about six to eight weeks. Your child will then have to go back to
    see their doctor and have another breathing test.

    You can read more about these medicines on page 12.

    If there is an improvement in the results of your child’s peak flow or spirometry
    test results after they take the reversibility test or if the medicines are helping
    your child, their doctor will treat them for asthma. Asthma comes and goes so
    normal readings do not always mean that your child does not have asthma. If
    there is no improvement in your child’s test results after the reversibility test or
    if a trial of treatment is not helping, the doctor may consider testing your child
    for other conditions.

    Other tests might include more detailed breathing tests, blood tests and skin
    tests for allergies. The doctor may refer your child to a hospital specialist for an
    expert opinion.




8
Who will help me to look after my child’s asthma?

Your child’s doctor or asthma nurse will help to look after your child’s asthma.

You will need to take your child to their doctor to have an asthma review at
least once a year. In an asthma review your child’s doctor or asthma nurse will
ask you a set of questions about your child’s asthma to make sure that their
asthma is controlled and that they are on the right medicines for them. Here is
an example set of questions recommended by the Royal College of Physicians.

~~ your child had difficulty sleeping because of their asthma symptoms
 Has
 (including cough)?
~~ your child had their usual asthma symptoms during the day (coughing,
 Has
 wheezing, chest tightness or breathlessness)?
~~ your child’s asthma prevented them from doing their usual activities (for
 Has
 example, going to school)?

The doctor or asthma nurse should also ask your child specific questions such
as ‘How often do you use your blue inhaler?’.

Your child’s doctor or asthma nurse should also check and record the following.

 Whether your child has had an asthma attack since their last review and if so
~~
 how many.
 How many courses of steroid tablets your child has had since their last
~~
 review.
 Whether your child has had any time off school or nursery because of their
~~
 asthma since their last review.
 How many inhalers and medicines your child has been prescribed since
~~
 their last review.
 Whether your child has a personal asthma action plan and, if so, that you
~~
 know how to use it. There is more information about this on page 21.
 Whether your child is or has been exposed to tobacco smoke.
~~
 Your child’s height and weight.
~~


                                                                                   9
The doctor or asthma nurse may also watch your child take their inhaler to
     check they are taking it properly.




     The doctor or asthma nurse may also ask your child to take the Asthma Control
     Test (ACT) which asks questions about asthma control. You can read more
     about this by visiting www.chchealth.org/GetFile.aspx?FileID=251


        If you feel your child’s asthma is not well controlled, you should not be
        afraid to ask for an asthma review at any time. You don’t have to wait for
        their regular asthma review.


10
What medicines can help control my child’s asthma?

Your child’s doctor or asthma nurse will give you medicines to help you control
your child’s asthma. If their asthma is controlled well, they should:

 have no asthma symptoms during the day;
~~
~~ be woken up at night because of their asthma;
 not
~~ need to take their reliever inhaler; and
 not
~~ have asthma attacks.
 not

Having the right medicines will also mean their asthma will not interfere with
their daily life (including exercise) and their breathing tests (peak flow and
spirometry) will be normal.

It can take time to find the best asthma medicines to suit your child.




                                                                                  11
What medicines will be used to help my child’s asthma?

                                          Asthma medicines
     Type of medicine                When it should be used            How it helps
     Reliever inhaler (usually       y   When your child feels         y   It helps relieve
     blue)                               their asthma symptoms             your child’s asthma
                                         start for example, when           symptoms for a few
     This is also sometimes called
                                         they start to cough or            hours.
     a short-acting reliever.
                                         wheeze.
                                                                       y   Reliever inhalers don’t
     Everyone with asthma
                                     y   Your child should only            reduce the inflammation
     should be given a reliever
                                         take their reliever inhaler       in your child’s airways.
     inhaler.
                                         when they get their               Instead they temporarily
                                         asthma symptoms.                  open up your child’s
                                                                           airways by relaxing the
                                                                           muscles that surround
                                                                           them, allowing them to
                                                                           breathe more easily.

     Preventer inhaler (usually a Your child should be given a         Preventer inhalers are the
     brown, red or orange inhaler preventer inhaler if they:           main treatment for asthma.
     containing steroids)                                              They can take some time
                                  y have had an asthma
                                                                       to work. They reduce the
     If your child has a             attack in the last two
                                                                       inflammation in your child’s
     preventer inhaler they          years;
                                                                       airways and prevent future
     should take it every day,
                                  y use their reliever inhaler         asthma symptoms.
     even when they feel well,
                                     three times a week or
     to keep their airways
                                     more;
     healthy.
                                  y have asthma symptoms
                                     three times a week or
                                     more; and
                                     y   wake up at least one
                                         night a week because of
                                         their asthma.
                                     Your child should take their
                                     preventer inhaler twice a
                                     day.
     Combination inhaler (one        Your child should take their      Combination inhalers
     inhaler that acts as both       preventer inhaler twice a         can be used to relieve
     preventer and reliever)         day and when they get their       symptoms as well as reduce
                                     asthma symptoms.                  the inflammation in your
                                                                       child’s airways.




12
Your child’s doctor or asthma nurse may consider trying your child on other
medicines to help control their asthma. These may include some of the
medicines in the table below.

                                  Other asthma medicines
Medicine                                         How it helps
Long-acting reliever inhaler                     Long-acting reliever inhalers open up your
                                                 child’s airways by relaxing the muscles that
It contains a reliever medicine that lasts for
                                                 surround them.
12 hours. It does not contain steroids but
your child should always take it with a
preventer inhaler.
Leukotriene receptor antagonists                 These work by blocking one of the
                                                 chemicals that is released when your child
These are preventer tablets. They do not
                                                 comes into contact with an asthma trigger.
contain steroids.
Theophylline                                     Theophylline works by relaxing the muscles
                                                 that surround your child’s airways. This
This medicine is available as tablets, syrup
                                                 makes it easier for them to breathe.
and injection. It does not contain steroids.
Steroid tablets                                  Steroid tablets work by reducing the
                                                 inflammation in your child’s airways.


How will the doctor or asthma nurse decide which medicines my child needs?

When your child’s doctor or asthma nurse decides what medicines to give
your child, they use a ‘stepwise’ approach. There are five main steps (treatment
levels) and you can record the medicines you get at each step on the diagram
on page 14.




                                                                                                13
Your child should start treatment at the step most appropriate
       to help them get their symptoms under control.                                                                      EEDED
                                                                                                                  L AS N
                                                                                                         CONTRO
                                                                                                   PROVE
                                                                                        UP   TO IM
                                                                                   MOVE
                                                                               P
                                                                          G STE
                                                                     OLLIN
                                                               C ONTR
                                                          WEST
                                                    AIN LO
                                               MAINT
                                    D AND
                              TO FIN
                     DOWN
              MOVE
                                                                                                                                   STEP 5
                                                                                                  STEP 4
                                                                    STEP 3
                                        STEP 2
  STEP 1




                                                                                                                                            14
The doctor or asthma nurse will assess your child’s asthma and start at the most
appropriate step for them. If that doesn’t work they will move up to the next
step.

Stepping up your child’s medicines

Before giving your child more asthma inhalers and medicines, the doctor
should always check they are not having any problems with the medicines they
are currently using. This includes:

 checking that your child is taking their current asthma medicine correctly;
~~
 checking that your child is using their inhaler and spacer correctly; and
~~
 discussing your child’s asthma triggers, and how to avoid them, with you
~~
 and your child.
Stepping down your child’s medicines

Once your child’s asthma is well controlled, it is important that they still see
their doctor or asthma nurse regularly for an asthma review. It may be possible
that their medicines can be reduced (stepped down). When deciding which
medicine to step down, you and your child’s doctor must consider:

~~ well controlled your child’s asthma has been on their current
 how
 medicines;
~~ long your child has been taking their current medicines;
 how
~~ side effects of current treatment; and
 the
~~ you feel about the medicines your child is on.
 how

When your child’s asthma medicines are stepped down, this should be done
gradually.




                                                                                   15
16
How should my child take their asthma medicines?

It is important that your child follows their treatment plan. When they are first
given inhalers, their doctor or asthma nurse should show them how to use
them. They should then regularly check how your child is taking them to make
sure they are doing it correctly. Your local pharmacist will also be able to show
your child how to use their inhaler correctly. You can watch a demonstration of
how to use an inhaler and spacer on Asthma UK’s website at www.asthma.org.
uk/inhalerdemo.

Spacers and inhalers

Your child may be given a spacer to use with their inhaler. Spacers help to
deliver the medicine to your child’s airways and make the inhaler easier for your
child to use. They are plastic or metal containers with a mouthpiece or mask at
one end and a hole for the inhaler at the other. Using a spacer with an inhaler
makes no difference to how well the medicine works.

What are the side effects of my child’s asthma medicines?

Reliever medicine

Reliever inhalers have very few side effects but they can temporarily increase
your child’s heartbeat or give them mild muscle shakes (tremor). These effects
are more common if your child is taking a high dose. They wear off within a few
minutes or a few hours at the most.

Preventer inhalers

Preventer inhalers have been tested on groups of patients and the benefits of
good asthma control outweigh the risk of having side effects.




                                                                                    17
The possibility of your child having side effects from taking their preventer
     medicine is low, but there is a small risk of side effects including:

     ~~ tongue;
      sore
     ~~ throat;
      sore
      hoarse voice; and
     ~~
      mouth infection (oral thrush).
     ~~

     For a small number of children, high doses of inhaled steroids may be linked
     with side effects such as problems with growth. Although these side effects are
     rare, your child’s height and weight should be monitored every year by their
     doctor, especially if they are on a high dose of steroids. If your child is on high
     doses of preventer inhaler, their doctor should refer them to hospital to see a
     children’s specialist doctor.

     Steroid tablets

     Although there are side effects associated with taking steroid tablets over a long
     period of time, these are outweighed by the benefit of good asthma control.




     Your child’s doctor will only give your child steroid tablets if their asthma is
     going through a particularly bad patch, and at these times it is much safer to
     have the steroids than to try to manage without them. Your child will be given
     a short course of steroid tablets. There is a low risk of side effects but some
     parents notice their child has mood swings and is hungrier than usual.

18
Possible effects of taking steroid tablets for long periods of time include:

 feeling depressed or having mood swings;
~~
 feeling hungry and wanting to eat more;
~~
~~ fatter face;
 a
 feeling overactive and finding it difficult to sleep;
~~
 heartburn and indigestion;
~~
 bruising easily;
~~
 brittle bones;
~~
~~ of having diabetes; and
 risk
~~ of having cataracts.
 risk

Children taking steroid tablets should have their growth and weight monitored
every year and may be screened for cataracts (eye problems) through
community eye-care services. Your child’s doctor or asthma nurse should
discuss this with you and should monitor your child’s:

 blood pressure;
~~
 bone mineral density (how thick and strong your child’s bones are);
~~
 urine or blood sugar to check for diabetes; and
~~
 cholesterol levels.
~~

If your child takes steroid tablets over long periods of time, their adrenal gland
might stop producing its own natural steroid and so they should not stop
taking their steroid tablets suddenly. If your child is on steroid tablets, their
doctor or asthma nurse should give them a steroid card to carry with them to
tell other healthcare professionals what medication they are on.

What medicines will my child be given if exercise brings on their asthma?

Exercise can trigger asthma symptoms in some children. If this happens to your
child, their doctor might suggest that they take two puffs of a reliever inhaler
before exercising. If this is an ongoing problem, the doctor might consider
increasing your child’s preventer treatments following the ‘stepwise’ guidance
(see page 14).
                                                                                     19
What can I do to help to control my child’s asthma?

     It is important that you keep good control of your child’s asthma. Having good
     control of their asthma means they:

      have no asthma symptoms during the day;
     ~~
     ~~ not woken up at night because of their asthma;
      are
     ~~ not need to take their reliever inhaler; and
      do
     ~~ not have asthma attacks.
      do

     It also means that:

      their asthma will not interfere with their daily life including exercise and
     ~~
      going to school; and
      their breathing tests will be normal for example, peak flow, spirometry.
     ~~

     To have good control of their asthma it’s important that your child takes their
     asthma inhalers and medicines and, if possible, tries to stay away from things
     that make their asthma worse (their asthma triggers such as pollen, pets,
     cigarette smoke and so on).

     Having good asthma control reduces the risk of them having asthma attacks.
     You can read more about asthma attacks on page 25.




20
Personal asthma action plan


   Children who have a personal asthma action plan are more likely to have
   better control over their asthma. This means that they have fewer asthma
   symptoms, are less likely to have an asthma attack and are less likely to
   have to go to hospital because of their asthma.


A personal asthma action plan (PAAP) is
written information provided by your child’s
doctor or nurse to help you understand more
about your child’s asthma and how to control
it. It is sometimes called a self-management
plan and the doctor or nurse will draw it up
with you and your child.

Your child’s personal asthma action plan
should contain information on:

~~ child’s medicines (for example, what
 your
 they take and when);
~~ to recognise when their asthma is
 how
 getting worse;
 what to do when their asthma is getting
~~
 worse; and
 what to do if your child has an asthma
~~
 attack.




                                                                               21
When should my child receive their personal asthma action plan?

     Your child’s doctor or asthma nurse should draw up the plan with you and your
     child when your child is diagnosed as having asthma, and it should include
     your and your child’s preferences and opinions.You will be able to discuss it
     with them at your child’s asthma review.

     It is important that you understand and agree with the action plan. Your child’s
     doctor or asthma nurse should also go through it with you and your child at
     other times when discussing your child’s asthma with you.

     If your child has to go into hospital because of their asthma, their personal
     asthma action plan should be reviewed before they leave.

     It is very important for your child to have a personal asthma action plan. You
     should speak to your child’s doctor or asthma nurse if your child doesn’t have
     one. You can also order a personal asthma action plan from Asthma UK by
     visiting www.asthma.org.uk/myasthma




22
The table below explains some ways you and your child can help to control
their asthma.

       What can I do to help control                              How can this help?
            my child’s asthma?
Make sure your child takes their asthma             For good asthma control it is important
medicines when they should.                         that your child takes their medicines, even
                                                    when they feel well. Many children live with
Learn about your child’s asthma from their
                                                    troublesome asthma symptoms (coughing,
doctor or asthma nurse. It is important
                                                    wheezing and so on) and think this is normal.
that they give you all the information you
need. They should ask you if you have any           Good asthma control means your child has no
worries and you should tell them if you             asthma symptoms day or night. If they have
have any concerns. To help you control your         asthma symptoms quite often, it is serious and
child’s asthma they should give you simple          it can lead to an asthma attack and long-term
information (face-to-face or written (or            lung damage.
both)), especially about your child’s asthma
medicines.
Make sure they stay away from cigarette             Smoking or being around cigarette smoke
smoke.                                              will definitely make your child’s asthma
                                                    worse. If you smoke, you should try to stop. If
                                                    you would like to stop, your doctor, asthma
                                                    nurse or pharmacist can offer you advice and
                                                    support to help you. You should not smoke in
                                                    front of your child and you should encourage
                                                    other people not to smoke near them.
Consider taking action to reduce the number         If your child is allergic to house dust mites,
of house dust mites in your home. House dust        it can make their asthma worse. It is very
mites are small creatures that live in mattresses   difficult to reduce the number of house dust
and fabric around the home.                         mites enough to stop your child’s asthma
                                                    symptoms. If your child is allergic to them you
However, most of the evidence suggests that
                                                    could try:
it is not possible to make a big difference to
asthma control in this way.                         y   using special covers for their mattress,
                                                        duvet and pillows;
                                                    y   removing the carpets in your home;
                                                    y   removing soft toys from their bed;
                                                    y   washing their bed linen on a hot wash (50
                                                        degrees);
                                                    y   using products that kill dust mites on areas
                                                        such as bedding and curtains; and
                                                    y   making sure your home is well ventilated.
Encourage them to lose weight if necessary.         If your child is overweight, your doctor or
                                                    asthma nurse will encourage them to lose
                                                    weight. Losing weight will help improve your
                                                    child’s asthma control.
                                                                                                       23
Children should have all of the recommended vaccines including the flu jab as
     the benefits of these outweigh the risks of triggering an asthma attack. If they
     are on high-dose steroids for their asthma, the vaccines may not be as effective
     so you need to speak to your child’s doctor about this.




24
What happens during an asthma attack and how will it be
treated?

Although asthma can usually be controlled with medicines, sometimes triggers
can lead to asthma attacks which can occasionally be serious.

An asthma attack is when your child’s airways become swollen and the muscles
around the airways become very tight which makes it harder to breathe.
Asthma attacks do not usually come out of the blue, and most are triggered by
viral infections. Your child will probably feel their asthma getting worse over a
few days before the attack (for example, they may be coughing and wheezing
more, their chest may start to feel tight or they may become lethargic).

How will I know that my child is having an asthma attack?

Your child is having an asthma attack if any of the following happen.

 Their asthma is getting worse (for example, they are coughing or wheezing
~~
 more than usual or they feel more breathless or their chest feels tight)
 They cannot breathe easily and it is hard for them to talk, eat or sleep
~~
 They have to use their reliever inhaler more often than usual
~~
 Their reliever inhaler does not help
~~




                                                                                    25
IF YOUR CHILD IS HAVING AN ASTHMA ATTACK
               THEY SHOULD DO THE FOLLOWING.

     1. Take one to two puffs of their reliever inhaler immediately. (This is
        usually a blue inhaler.)
     2. Sit up and try to take slow steady breaths.
     3. If they do not start to feel better, your child should continue to take two
        puffs (one at a time) of their reliever inhaler every two minutes. They can
        take up to 10 puffs.
     4. If they do not feel better after taking their inhaler as described above, or if
        you are worried, call 999. If an ambulance does not arrive within
        10 minutes and they are still not feeling any better, repeat step 3 above.

     Do not be afraid of causing a fuss, even at night. If their asthma gets
     better and you do not need to call 999, they still need to see a doctor or
     asthma nurse that day. Check your child’s asthma action plan and follow
     the advice you have been given.

     Make sure your child carries an asthma attack card with them. This has
     been designed to inform or remind people with asthma, and their family
     and friends, what to do in an asthma attack. You can get a card from
     Asthma UK by visiting www.asthma.org.uk/order_your_free_asth.html




26
Will my child need to go to hospital if they have an asthma attack?

Your child will not always have to go to hospital if they have an asthma attack.
A lot of the time children only need to go into hospital if their asthma attack
was caused by a viral infection. Sometimes an asthma attack can be so bad that
your child can die from it. This is very rare, but if they do show signs of serious
life-threatening asthma, they should be looked after by a hospital specialist.

What treatment will my child be given if they have an asthma attack?

The table below describes the medicines used to treat asthma attacks and how
they help.

Treatment         How the medicine is given
Oxygen            Your child’s oxygen levels should be checked with
                  an oxygen saturation meter. If they are low, they
                  will be given oxygen through a mask.




Reliever          You child will be given a high dose of reliever
medicine          medicine either through an inhaler and spacer
                  or through a nebuliser. A nebuliser creates a mist
                  of medicine which your child breathes through a
                  mask.
                  Occasionally in hospital your child may be given
                  reliever medicine through a drip or given a
                  nebuliser very often.
                  Your child may be given another reliever medicine
                  in the nebuliser if the attack is severe or is not
                  responding to the first reliever medicine alone.

Steroid tablets   They may be given steroid tablets for up to five
                  days or until they have recovered from their
                  asthma attack.
Magnesium         Your child may be given this through a drip if they
sulphate          have very severe asthma.
Aminophylline     In hospital, your child’s specialist may give them a
                  medicine called aminophylline through a drip.



                                                                                      27
Treatment of asthma attacks in children aged two and over

     If your child is having an asthma attack at home, they should be given their
     reliever inhaler through a spacer. You can read more about this on page 27.

     Your child can be given two puffs of their reliever inhaler through a spacer
     every two minutes (up to 10 puffs).

     If your child’s symptoms have not improved after 10 puffs of their reliever
     inhaler, ring 999 and ask for an ambulance.

     While your child is waiting to go to hospital the ambulance staff may give them
     more doses of reliever inhaler and start them on a course of steroid tablets
     to stop the attack. It is important that your child is taken to hospital in an
     ambulance. This is because the ambulance staff can give them more oxygen
     and reliever medicine on the way to the hospital if they need it.

     Once at hospital, your child should be treated with one or more of the
     medicines shown in the table on page 27.

     Treating asthma attacks in children under two years

     If your child is under two and has an asthma attack at home, they should be
     given a reliever inhaler through a spacer with a face mask. If your child needs to
     go to hospital because of an asthma attack, they may be given one or more of
     the medicines shown in the table on page 27 although children under two are
     not given magnesium sulphate or aminophylline.

     Your child should have appointments with a hospital specialist for a least a year
     if their asthma attack was so severe that they had to go into hospital.




28
Before your child leaves hospital

To help decide when your child is well enough to leave hospital, their hospital
doctor will check their breathing regularly with a peak flowmeter frequently to
see if it improves. They will also discuss with you how to look after your child’s
asthma. This will include helping you to monitor your child’s asthma using a
peak flowmeter or keeping a diary to monitor their symptoms.

Staff at the hospital should also watch your child take their inhaler to make
sure they are taking it properly and, most importantly, should give them a new
personal asthma action plan.

You can read more about personal asthma action plans on page 21.

The hospital will tell your child’s GP about their treatment in hospital and they
should arrange a follow-up appointment for your child in an appropriate clinic
for children with asthma.

You should also make an appointment with your GP within 48 hours of leaving
hospital.




                                                                                     29
Can I prevent my child from developing asthma?
     Breastfeeding

     All women are encouraged to breastfeed their babies as breast milk can reduce
     the chances of a child developing asthma.

     Smoking during pregnancy

     If you smoke while you are pregnant this can increase the chance of your child
     developing asthma and wheezing. If you smoke, your doctor will offer you
     support to give up.

     Diet

     There is not enough evidence to suggest that avoiding certain foods or using
     dietary supplements while you are pregnant can prevent your child developing
     asthma.

     Immunisations

     Immunisations are the vaccinations your child will be given by a doctor
     or nurse as they are growing up. There is no evidence that having these
     immunisations increases the risk of your child developing asthma.

     It is important that your child has vaccinations to help protect them against
     infectious diseases.




30
Asthma in young people

This section has been written for teenagers to read with their parents or carers.

Adolescence is the time when you are moving from childhood into adulthood.
During this time you are becoming more independent but it can be a
challenging time for you. You may think that having asthma can make things
more difficult for you and it is quite normal if you feel anxious or depressed.
If you do feel anxious or depressed you should speak to your GP or asthma
nurse. You can also find information from Asthma UK at www.youtube.com/
watch?v=QYK5e2y_G6k and www.asthma.org.uk/all_about_asthma/
asthma_young_adults/depression.html

As you get older, your doctor will encourage you to take more responsibility
for your asthma by seeing you on your own, without your parents or carers, for
part of the time. Your written asthma plan developed between you and your
doctor allows you to take control of your asthma by taking on responsibility
and making some choices for yourself.

Some of the questions below will help you and your doctor know that you are
able to look after your asthma.

~~ you tell what things make your asthma worse?
 Can
 What medicines do you take for it?
~~
~~ you know what each medicine does to help you?
 Do
 How easy is it to remember to take your medicine?
~~
~~ your doctor or asthma nurse asks you questions about your asthma, how
 If
 do you describe it?
 When you need to go and see your doctor or asthma nurse, how do you
~~
 make arrangements to do this?
~~ you find you are unable to keep an appointment you have made with your
 If
 doctor or asthma nurse, do you know how to cancel it?
 How do you make sure you arrange new prescriptions before your medicine
~~
 runs out?

                                                                                    31
Your doctor will discuss your treatment preferences with you (for example,
     which inhaler suits you best). Your doctor should also ask you if you find it easy
     to use your inhaler in places you might need to use it such as school or if you
     are out with friends.

     Your doctor should teach you how to use your inhaler and check that you are
     using it correctly. If you need to use a spacer with your reliever inhaler when
     you’re at home, your doctor should consider giving you a different reliever
     inhaler device that’s easier for you to carry around and use when you are out
     and about.

     When your doctor is giving you advice on controlling your asthma, they should
     take account of your own needs. This means:

      offering help and advice for coping with feelings;
     ~~
      teaching you what you need to know in a respectful and encouraging way;
     ~~
      discussing information that is personal to you and offering you written
     ~~
      copies of this; and
      teaching you in an appropriate place.
     ~~

     Your school should work with you to help control your asthma. It is important
     that you keep your school up to date with changes in your medication, for
     example what you take and how much.

     There might be other children in your school who you could share information
     about asthma with. This is known as peer support and if your school doesn’t
     currently offer it, Asthma UK can help support your school. Ask your teacher to
     visit www.asthma.org.uk/how_we_help/schools_early_years

     Smoking and cigarette smoke

     You are at a time in your life where you should be making choices and learning
     from your mistakes. Never feel pressurised to smoke just because your friends
     do it. It is important to know about the effects smoking has on your asthma
     and the rest of your health.


32
For example, smoking:

 increases the risk of asthma attacks;
~~
 permanently damaging your airways; and
~~
 reduces the benefits of your asthma medicines.
~~

If you do smoke, your doctor or asthma nurse should offer you advice and
support to help you stop.

Living with someone who smokes may also affect your condition. If your
parents or carers smoke, they should also be encouraged to stop so you don’t
have to breathe in their cigarette smoke.

Don’t be afraid to discuss with your doctor, asthma nurse or parents about how
you feel if any of the above issues concern you.

Complementary therapies

Some people like to consider complementary therapies as a way to treat
medical conditions such as asthma. You should never use them instead of the
treatments your doctor or asthma nurse has recommended.

Always tell your doctor or asthma nurse if you are using any complementary
therapies.

What should happen as I get older?

If you are under the care of a specialist, as you get older, you will need health
services that are designed to look after people in your age group. You will
become more involved in managing your asthma. To make this easier, there
should be a clear plan about what should happen. In most cases, looking after
your asthma will involve your local GP. Only a few young people need to go to
hospital.

You, your family and other people who help manage your asthma should
be involved in the decisions about how and when you will move from child
services to adult services.

                                                                                    33
Will having asthma affect my career choice?

     Your doctor or asthma nurse should discuss future career choices with you and
     tell you which jobs might increase your risk of work-related asthma symptoms.
     This is known as ‘occupational asthma’.

     Occupational asthma is caused by substances such as wood dust, dust from
     flour and grain, latex and dust from insects and animals.

     Examples of jobs which can cause occupational asthma include joinery, spray
     painting, laboratory work or any job which involves using latex gloves such as
     nursing or dentistry.




34
Where can I find out more information about asthma?
National organisations for people who have asthma

Asthma UK
Summit House, 70 Wilson Street
London EC2A 2DB
Phone: 020 7786 4900
Asthma UK Adviceline - speak to an asthma nurse specialist: 0800 121 62 44
Website: www.asthma.org.uk

Asthma UK is the charity dedicated to improving the health and well-being
of people who are affected by asthma. They offer a range of information on
asthma including fact sheets and booklets.

British Lung Foundation
73-75 Goswell Road
London EC1V 7ER
Helpline: 08458 50 50 20
Phone: 020 7688 5555
Fax: 020 7688 5556
Website: www.lunguk.org

The British Lung Foundation aims to help people understand and live with lung
disease. They run the Breathe Easy support network which offers information,
support and friendship to anyone affected by lung disease.




                                                                                35
Other organisations

     Allergy UK
     Planwell House, Lefa Business Park
     Edgington Way, Sidcup
     Kent DA14 5BH
     Helpline: 01322 619898
     Fax: 01322 470 330
     Website: www.allergyuk.org

     Allergy UK is a charity which aims to increase understanding and awareness of
     allergies, and helps people manage their allergies.

     ASH (Action on smoking and health)
     First Floor, 144-145 Shoreditch High Street
     London E1 6JE
     Phone: 020 7739 5902
     Fax: 020 7729 4732
     Website: www.ash.org.uk

     ASH is the leading voluntary organisation campaigning for effective tobacco-
     control legislation and providing an expert information service.

     NHS Direct
     Phone: 0845 4647 (24 hours)
     Website: www.nhsdirect.nhs.uk

     This is a 24-hour helpline for people in England and Wales. It is led by nurses
     who provide confidential health-care advice and information 24 hours, 365
     days a year.




36
NHS 24
Phone: 0854 24 24 24
Website: ww.nhs24.com

This is a 24-hour helpline for people in Scotland. It is led by nurses who provide
confidential health-care advice and information 24 hours, 365 days a year.

Useful publications

Guide to good asthma care for adults and children with asthma
Website: www.asthma.org.uk/scotland/guide.html

Useful websites

Department for Work and Pensions (DWP)
Website: www.dwp.gov.uk

The website can give you details of state benefits you may be entitled to.

Healthtalkonline
Website: www.healthtalkonline.org

Healthtalkonline lets you share in other people’s experiences of health and
illness. You can watch or listen to videos of interviews, read about people’s
experiences and find reliable information about conditions, treatment
choices and support.




                                                                                     37
What is SIGN?

     The Scottish Intercollegiate Guidelines Network (SIGN) writes guidelines which
     give advice to health-care professionals, patients and carers about the best
     treatments that are available.

     We write these guidelines by working with health-care professionals, other NHS
     staff, patients, carers and members of the public.

     The guidelines are based on the most up-to-date scientific evidence. You can
     read more about us by visiting www.sign.ac.uk

     Other formats

     If you would like a copy of this booklet in another language or another format,
     such as in large print, please phone Karen Graham, Patient Involvement Officer
     on 0131 623 4740, or e-mail karen.graham2@nhs.net




38
IF YOU ARE HAVING AN ASTHMA ATTACK
                     YOU SHOULD DO THE FOLLOWING.

        1. Take one to two puffs of your reliever inhaler immediately. (This is
           usually a blue inhaler.)

        2. Sit up and try to take slow steady breaths.

        3. If you do not start to feel better, continue to take two puffs (one
           at a time) of your reliever inhaler every two minutes. You can take
           up to 10 puffs.

        4. If you do not feel better after taking your inhaler as described
           above, or if you are worried, call 999. If an ambulance does not
           arrive within 10 minutes and you are still not feeling any better,
           repeat step 3 above.

        Do not be afraid of causing a fuss, even at night. If your asthma feels
        better and you do not need to call 999, you still need to see a doctor
        or asthma nurse that day. Check your asthma action plan and follow
        the advice you have been given.




www.healthcareimprovementscotland.org

Edinburgh Office | Elliott House | 8-10 Hillside Crescent | Edinburgh | EH7 5EA
Telephone 0131 623 4300 Fax 0131 623 4299

Glasgow Office | Delta House | 50 West Nile Street | Glasgow | G1 2NP
Telephone 0141 225 6999 Fax 0141 248 3776

The Healthcare Environment Inspectorate, the Scottish Health Council, the Scottish Health Technologies Group, the Scottish
Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium are key components of our organisation.




www.sign.ac.uk

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Managing asthma in children - A booklet for parents and carers

  • 1. Managing asthma in children A booklet for parents and carers December 2011 Evidence
  • 2. Cover photograph: Asthma UK © Scottish Intercollegiate Guidelines Network ISBN 978 1 905813 79 7 First published December 2011 SIGN consents to the photocopying of this booklet for the purpose of implementation in NHSScotland
  • 3. Contents What is this booklet about? 2 What is asthma? 3 Diagnosing asthma in children and young people 5 Who will help me to look after my child’s asthma? 9 What medicines can help control my child’s asthma? 11 What can I do to help to control my child’s asthma? 20 What happens during an asthma attack and how will it be treated? 25 Can I prevent my child from developing asthma? 30 Asthma in young people 31 Where can I find out more information about asthma? 35 What is SIGN? 38 1
  • 4. What is this booklet about? This booklet is for the parents and carers of children who have or might have asthma. It aims to make parents and carers aware of the treatment and care they should expect their children to receive. It will also help you to understand the latest research evidence so you can manage your child’s condition better. The booklet is based on guidance from the British guideline on managing asthma which was developed by the British Thoracic Society and the Scottish Intercollegiate Guidelines Network (SIGN). Your child’s doctor or asthma nurse should be following this guidance when looking after your child’s asthma. The booklet covers: diagnosis; ~~ ~~ will be involved in looking after your child’s asthma; who medicines; ~~ ~~ you can help control your child’s asthma; how asthma attacks; ~~ asthma in young people; and ~~ where to find out more about asthma. ~~ If you would like to see a full version of this guidance, please visit www.sign.ac.uk/pdf/sign101.pdf 2
  • 5. What is asthma? Asthma is a condition that affects your child’s airways (the small tubes that carry air in and out of your child’s lungs). Asthma can start at any age and there are many different causes. If your child has asthma you may find that they sometimes have asthma symptoms. Asthma symptoms could be: wheezing (a noisy whistling sound coming from your child’s chest); ~~ coughing a lot (especially after exercise or at night); or ~~ ~~ tight feeling in your child’s chest. a Asthma symptoms may come and go. You might find your child has symptoms at different times of the day or even different times of the year. 3
  • 6. Some things can make your child’s asthma worse. They are called asthma triggers. Examples of common asthma triggers are dust, pets, pollen, cigarette smoke and changes in the weather. Everyone has different asthma triggers and most people have more than one trigger. When your child breathes in something that irritates their airways (asthma triggers) their asthma symptoms may start. ~~ muscles around their airways tighten. The ~~ lining of their airways becomes swollen and inflamed. The ~~ of mucus is produced. Lots All of this makes your child’s airways narrower and they may get some or all of the symptoms described above. 4
  • 7. Diagnosing asthma in children and young people How will my child’s doctor and I know if my child has asthma? You will need to see your child’s doctor to find out if your child has asthma. Unfortunately, asthma can be difficult to diagnose, particularly in young children. Your child might not have symptoms when they see their doctor but may have symptoms at other times. On page 3 there is a list of asthma symptoms they might have. Your child’s doctor might ask: what asthma symptoms your child is having; ~~ ~~ often and when they get asthma symptoms; how ~~ their asthma symptoms are worse at night or in the early morning (or if both); ~~ their asthma symptoms come on after they exercise or play; if what you think triggers your child’s asthma symptoms; and ~~ ~~ you child only gets asthma symptoms when they have a cold or at certain if other times. Some conditions such as eczema and allergies go hand in hand with asthma so your doctor might also: ~~ you if your child has a history of other conditions such as eczema or ask hayfever or other allergies; ~~ if anyone else in your family has a history of asthma or a history of other ask allergic conditions such as hayfever, eczema, food allergy; ~~ and listen to your child’s chest; and look ~~ your child is old enough, do some breathing tests with them to see how if well their lungs are working. These are also called lung function tests. What if my doctor thinks my child has asthma? If your child’s doctor thinks that your child has asthma, they will give your child asthma medicines to try. This is known as a treatment trial. This is likely to be 5
  • 8. an inhaler. The asthma medicines your child is given will depend on how often they have asthma symptoms and how serious these symptoms are. You can read about the different types of medicine on page 12. Your child will be asked to see their doctor regularly while they are taking asthma medicines to talk about whether they are still working. If the treatment helps your child’s asthma symptoms, their doctor should treat them for asthma and arrange an asthma review. You can read more about asthma reviews on page 9. If the treatment is not helping your child, their doctor should: ~~ their asthma medicines; stop consider doing more tests; ~~ consider testing them for other conditions they might have; and ~~ consider referring your child to a specialist doctor for their opinion. ~~ What if the doctor is not sure whether my child has asthma? If the doctor is not sure whether your child has asthma, they may give your child medicine for a number of weeks to see if it works (a trial of treatment). They may suggest a reversibility test if your child is old enough (school age). They may offer both a treatment trial and a reversibility test. A reversibility test involves testing your child’s breathing before and after they take their asthma medicines. These breathing tests are called lung function tests. Lung function tests include the following. Peak expiratory flow measurement. The doctor will use a small device called ~~ a peak flowmeter to test how fast your child can blow air out of their lungs. Spirometry. The doctor will use a machine called a spirometer to measure ~~ the amount of air your child can blow out and how fast they can blow it out. The photograph on page 7 shows a child having a peak flow test. It is likely that your child has asthma if their readings on the spirometer or peak flowmeter are lower than expected and improve after they take asthma medicines. 6
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  • 10. Although spirometry is recommended in children over five, it can still be difficult for some children of this age (and older) to take the test. It may take some time for your child to learn to blow out air and the results may not be reliable until they have mastered this. If your child cannot do this test then your doctor will give them a treatment trial. Medicines that can be used for reversibility testing include the following. A reliever inhaler - your child will be asked to do a breathing test immediately before being given a dose of reliever medicine. About 20 minutes later your child will be asked to do another breathing test. A preventer inhaler - your child may be asked to do a breathing test at the doctor’s surgery then they will be given a preventer inhaler to take at home, twice a day, for about six to eight weeks. Your child will then have to go back to see their doctor and have another breathing test. You can read more about these medicines on page 12. If there is an improvement in the results of your child’s peak flow or spirometry test results after they take the reversibility test or if the medicines are helping your child, their doctor will treat them for asthma. Asthma comes and goes so normal readings do not always mean that your child does not have asthma. If there is no improvement in your child’s test results after the reversibility test or if a trial of treatment is not helping, the doctor may consider testing your child for other conditions. Other tests might include more detailed breathing tests, blood tests and skin tests for allergies. The doctor may refer your child to a hospital specialist for an expert opinion. 8
  • 11. Who will help me to look after my child’s asthma? Your child’s doctor or asthma nurse will help to look after your child’s asthma. You will need to take your child to their doctor to have an asthma review at least once a year. In an asthma review your child’s doctor or asthma nurse will ask you a set of questions about your child’s asthma to make sure that their asthma is controlled and that they are on the right medicines for them. Here is an example set of questions recommended by the Royal College of Physicians. ~~ your child had difficulty sleeping because of their asthma symptoms Has (including cough)? ~~ your child had their usual asthma symptoms during the day (coughing, Has wheezing, chest tightness or breathlessness)? ~~ your child’s asthma prevented them from doing their usual activities (for Has example, going to school)? The doctor or asthma nurse should also ask your child specific questions such as ‘How often do you use your blue inhaler?’. Your child’s doctor or asthma nurse should also check and record the following. Whether your child has had an asthma attack since their last review and if so ~~ how many. How many courses of steroid tablets your child has had since their last ~~ review. Whether your child has had any time off school or nursery because of their ~~ asthma since their last review. How many inhalers and medicines your child has been prescribed since ~~ their last review. Whether your child has a personal asthma action plan and, if so, that you ~~ know how to use it. There is more information about this on page 21. Whether your child is or has been exposed to tobacco smoke. ~~ Your child’s height and weight. ~~ 9
  • 12. The doctor or asthma nurse may also watch your child take their inhaler to check they are taking it properly. The doctor or asthma nurse may also ask your child to take the Asthma Control Test (ACT) which asks questions about asthma control. You can read more about this by visiting www.chchealth.org/GetFile.aspx?FileID=251 If you feel your child’s asthma is not well controlled, you should not be afraid to ask for an asthma review at any time. You don’t have to wait for their regular asthma review. 10
  • 13. What medicines can help control my child’s asthma? Your child’s doctor or asthma nurse will give you medicines to help you control your child’s asthma. If their asthma is controlled well, they should: have no asthma symptoms during the day; ~~ ~~ be woken up at night because of their asthma; not ~~ need to take their reliever inhaler; and not ~~ have asthma attacks. not Having the right medicines will also mean their asthma will not interfere with their daily life (including exercise) and their breathing tests (peak flow and spirometry) will be normal. It can take time to find the best asthma medicines to suit your child. 11
  • 14. What medicines will be used to help my child’s asthma? Asthma medicines Type of medicine When it should be used How it helps Reliever inhaler (usually y When your child feels y It helps relieve blue) their asthma symptoms your child’s asthma start for example, when symptoms for a few This is also sometimes called they start to cough or hours. a short-acting reliever. wheeze. y Reliever inhalers don’t Everyone with asthma y Your child should only reduce the inflammation should be given a reliever take their reliever inhaler in your child’s airways. inhaler. when they get their Instead they temporarily asthma symptoms. open up your child’s airways by relaxing the muscles that surround them, allowing them to breathe more easily. Preventer inhaler (usually a Your child should be given a Preventer inhalers are the brown, red or orange inhaler preventer inhaler if they: main treatment for asthma. containing steroids) They can take some time y have had an asthma to work. They reduce the If your child has a attack in the last two inflammation in your child’s preventer inhaler they years; airways and prevent future should take it every day, y use their reliever inhaler asthma symptoms. even when they feel well, three times a week or to keep their airways more; healthy. y have asthma symptoms three times a week or more; and y wake up at least one night a week because of their asthma. Your child should take their preventer inhaler twice a day. Combination inhaler (one Your child should take their Combination inhalers inhaler that acts as both preventer inhaler twice a can be used to relieve preventer and reliever) day and when they get their symptoms as well as reduce asthma symptoms. the inflammation in your child’s airways. 12
  • 15. Your child’s doctor or asthma nurse may consider trying your child on other medicines to help control their asthma. These may include some of the medicines in the table below. Other asthma medicines Medicine How it helps Long-acting reliever inhaler Long-acting reliever inhalers open up your child’s airways by relaxing the muscles that It contains a reliever medicine that lasts for surround them. 12 hours. It does not contain steroids but your child should always take it with a preventer inhaler. Leukotriene receptor antagonists These work by blocking one of the chemicals that is released when your child These are preventer tablets. They do not comes into contact with an asthma trigger. contain steroids. Theophylline Theophylline works by relaxing the muscles that surround your child’s airways. This This medicine is available as tablets, syrup makes it easier for them to breathe. and injection. It does not contain steroids. Steroid tablets Steroid tablets work by reducing the inflammation in your child’s airways. How will the doctor or asthma nurse decide which medicines my child needs? When your child’s doctor or asthma nurse decides what medicines to give your child, they use a ‘stepwise’ approach. There are five main steps (treatment levels) and you can record the medicines you get at each step on the diagram on page 14. 13
  • 16. Your child should start treatment at the step most appropriate to help them get their symptoms under control. EEDED L AS N CONTRO PROVE UP TO IM MOVE P G STE OLLIN C ONTR WEST AIN LO MAINT D AND TO FIN DOWN MOVE STEP 5 STEP 4 STEP 3 STEP 2 STEP 1 14
  • 17. The doctor or asthma nurse will assess your child’s asthma and start at the most appropriate step for them. If that doesn’t work they will move up to the next step. Stepping up your child’s medicines Before giving your child more asthma inhalers and medicines, the doctor should always check they are not having any problems with the medicines they are currently using. This includes: checking that your child is taking their current asthma medicine correctly; ~~ checking that your child is using their inhaler and spacer correctly; and ~~ discussing your child’s asthma triggers, and how to avoid them, with you ~~ and your child. Stepping down your child’s medicines Once your child’s asthma is well controlled, it is important that they still see their doctor or asthma nurse regularly for an asthma review. It may be possible that their medicines can be reduced (stepped down). When deciding which medicine to step down, you and your child’s doctor must consider: ~~ well controlled your child’s asthma has been on their current how medicines; ~~ long your child has been taking their current medicines; how ~~ side effects of current treatment; and the ~~ you feel about the medicines your child is on. how When your child’s asthma medicines are stepped down, this should be done gradually. 15
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  • 19. How should my child take their asthma medicines? It is important that your child follows their treatment plan. When they are first given inhalers, their doctor or asthma nurse should show them how to use them. They should then regularly check how your child is taking them to make sure they are doing it correctly. Your local pharmacist will also be able to show your child how to use their inhaler correctly. You can watch a demonstration of how to use an inhaler and spacer on Asthma UK’s website at www.asthma.org. uk/inhalerdemo. Spacers and inhalers Your child may be given a spacer to use with their inhaler. Spacers help to deliver the medicine to your child’s airways and make the inhaler easier for your child to use. They are plastic or metal containers with a mouthpiece or mask at one end and a hole for the inhaler at the other. Using a spacer with an inhaler makes no difference to how well the medicine works. What are the side effects of my child’s asthma medicines? Reliever medicine Reliever inhalers have very few side effects but they can temporarily increase your child’s heartbeat or give them mild muscle shakes (tremor). These effects are more common if your child is taking a high dose. They wear off within a few minutes or a few hours at the most. Preventer inhalers Preventer inhalers have been tested on groups of patients and the benefits of good asthma control outweigh the risk of having side effects. 17
  • 20. The possibility of your child having side effects from taking their preventer medicine is low, but there is a small risk of side effects including: ~~ tongue; sore ~~ throat; sore hoarse voice; and ~~ mouth infection (oral thrush). ~~ For a small number of children, high doses of inhaled steroids may be linked with side effects such as problems with growth. Although these side effects are rare, your child’s height and weight should be monitored every year by their doctor, especially if they are on a high dose of steroids. If your child is on high doses of preventer inhaler, their doctor should refer them to hospital to see a children’s specialist doctor. Steroid tablets Although there are side effects associated with taking steroid tablets over a long period of time, these are outweighed by the benefit of good asthma control. Your child’s doctor will only give your child steroid tablets if their asthma is going through a particularly bad patch, and at these times it is much safer to have the steroids than to try to manage without them. Your child will be given a short course of steroid tablets. There is a low risk of side effects but some parents notice their child has mood swings and is hungrier than usual. 18
  • 21. Possible effects of taking steroid tablets for long periods of time include: feeling depressed or having mood swings; ~~ feeling hungry and wanting to eat more; ~~ ~~ fatter face; a feeling overactive and finding it difficult to sleep; ~~ heartburn and indigestion; ~~ bruising easily; ~~ brittle bones; ~~ ~~ of having diabetes; and risk ~~ of having cataracts. risk Children taking steroid tablets should have their growth and weight monitored every year and may be screened for cataracts (eye problems) through community eye-care services. Your child’s doctor or asthma nurse should discuss this with you and should monitor your child’s: blood pressure; ~~ bone mineral density (how thick and strong your child’s bones are); ~~ urine or blood sugar to check for diabetes; and ~~ cholesterol levels. ~~ If your child takes steroid tablets over long periods of time, their adrenal gland might stop producing its own natural steroid and so they should not stop taking their steroid tablets suddenly. If your child is on steroid tablets, their doctor or asthma nurse should give them a steroid card to carry with them to tell other healthcare professionals what medication they are on. What medicines will my child be given if exercise brings on their asthma? Exercise can trigger asthma symptoms in some children. If this happens to your child, their doctor might suggest that they take two puffs of a reliever inhaler before exercising. If this is an ongoing problem, the doctor might consider increasing your child’s preventer treatments following the ‘stepwise’ guidance (see page 14). 19
  • 22. What can I do to help to control my child’s asthma? It is important that you keep good control of your child’s asthma. Having good control of their asthma means they: have no asthma symptoms during the day; ~~ ~~ not woken up at night because of their asthma; are ~~ not need to take their reliever inhaler; and do ~~ not have asthma attacks. do It also means that: their asthma will not interfere with their daily life including exercise and ~~ going to school; and their breathing tests will be normal for example, peak flow, spirometry. ~~ To have good control of their asthma it’s important that your child takes their asthma inhalers and medicines and, if possible, tries to stay away from things that make their asthma worse (their asthma triggers such as pollen, pets, cigarette smoke and so on). Having good asthma control reduces the risk of them having asthma attacks. You can read more about asthma attacks on page 25. 20
  • 23. Personal asthma action plan Children who have a personal asthma action plan are more likely to have better control over their asthma. This means that they have fewer asthma symptoms, are less likely to have an asthma attack and are less likely to have to go to hospital because of their asthma. A personal asthma action plan (PAAP) is written information provided by your child’s doctor or nurse to help you understand more about your child’s asthma and how to control it. It is sometimes called a self-management plan and the doctor or nurse will draw it up with you and your child. Your child’s personal asthma action plan should contain information on: ~~ child’s medicines (for example, what your they take and when); ~~ to recognise when their asthma is how getting worse; what to do when their asthma is getting ~~ worse; and what to do if your child has an asthma ~~ attack. 21
  • 24. When should my child receive their personal asthma action plan? Your child’s doctor or asthma nurse should draw up the plan with you and your child when your child is diagnosed as having asthma, and it should include your and your child’s preferences and opinions.You will be able to discuss it with them at your child’s asthma review. It is important that you understand and agree with the action plan. Your child’s doctor or asthma nurse should also go through it with you and your child at other times when discussing your child’s asthma with you. If your child has to go into hospital because of their asthma, their personal asthma action plan should be reviewed before they leave. It is very important for your child to have a personal asthma action plan. You should speak to your child’s doctor or asthma nurse if your child doesn’t have one. You can also order a personal asthma action plan from Asthma UK by visiting www.asthma.org.uk/myasthma 22
  • 25. The table below explains some ways you and your child can help to control their asthma. What can I do to help control How can this help? my child’s asthma? Make sure your child takes their asthma For good asthma control it is important medicines when they should. that your child takes their medicines, even when they feel well. Many children live with Learn about your child’s asthma from their troublesome asthma symptoms (coughing, doctor or asthma nurse. It is important wheezing and so on) and think this is normal. that they give you all the information you need. They should ask you if you have any Good asthma control means your child has no worries and you should tell them if you asthma symptoms day or night. If they have have any concerns. To help you control your asthma symptoms quite often, it is serious and child’s asthma they should give you simple it can lead to an asthma attack and long-term information (face-to-face or written (or lung damage. both)), especially about your child’s asthma medicines. Make sure they stay away from cigarette Smoking or being around cigarette smoke smoke. will definitely make your child’s asthma worse. If you smoke, you should try to stop. If you would like to stop, your doctor, asthma nurse or pharmacist can offer you advice and support to help you. You should not smoke in front of your child and you should encourage other people not to smoke near them. Consider taking action to reduce the number If your child is allergic to house dust mites, of house dust mites in your home. House dust it can make their asthma worse. It is very mites are small creatures that live in mattresses difficult to reduce the number of house dust and fabric around the home. mites enough to stop your child’s asthma symptoms. If your child is allergic to them you However, most of the evidence suggests that could try: it is not possible to make a big difference to asthma control in this way. y using special covers for their mattress, duvet and pillows; y removing the carpets in your home; y removing soft toys from their bed; y washing their bed linen on a hot wash (50 degrees); y using products that kill dust mites on areas such as bedding and curtains; and y making sure your home is well ventilated. Encourage them to lose weight if necessary. If your child is overweight, your doctor or asthma nurse will encourage them to lose weight. Losing weight will help improve your child’s asthma control. 23
  • 26. Children should have all of the recommended vaccines including the flu jab as the benefits of these outweigh the risks of triggering an asthma attack. If they are on high-dose steroids for their asthma, the vaccines may not be as effective so you need to speak to your child’s doctor about this. 24
  • 27. What happens during an asthma attack and how will it be treated? Although asthma can usually be controlled with medicines, sometimes triggers can lead to asthma attacks which can occasionally be serious. An asthma attack is when your child’s airways become swollen and the muscles around the airways become very tight which makes it harder to breathe. Asthma attacks do not usually come out of the blue, and most are triggered by viral infections. Your child will probably feel their asthma getting worse over a few days before the attack (for example, they may be coughing and wheezing more, their chest may start to feel tight or they may become lethargic). How will I know that my child is having an asthma attack? Your child is having an asthma attack if any of the following happen. Their asthma is getting worse (for example, they are coughing or wheezing ~~ more than usual or they feel more breathless or their chest feels tight) They cannot breathe easily and it is hard for them to talk, eat or sleep ~~ They have to use their reliever inhaler more often than usual ~~ Their reliever inhaler does not help ~~ 25
  • 28. IF YOUR CHILD IS HAVING AN ASTHMA ATTACK THEY SHOULD DO THE FOLLOWING. 1. Take one to two puffs of their reliever inhaler immediately. (This is usually a blue inhaler.) 2. Sit up and try to take slow steady breaths. 3. If they do not start to feel better, your child should continue to take two puffs (one at a time) of their reliever inhaler every two minutes. They can take up to 10 puffs. 4. If they do not feel better after taking their inhaler as described above, or if you are worried, call 999. If an ambulance does not arrive within 10 minutes and they are still not feeling any better, repeat step 3 above. Do not be afraid of causing a fuss, even at night. If their asthma gets better and you do not need to call 999, they still need to see a doctor or asthma nurse that day. Check your child’s asthma action plan and follow the advice you have been given. Make sure your child carries an asthma attack card with them. This has been designed to inform or remind people with asthma, and their family and friends, what to do in an asthma attack. You can get a card from Asthma UK by visiting www.asthma.org.uk/order_your_free_asth.html 26
  • 29. Will my child need to go to hospital if they have an asthma attack? Your child will not always have to go to hospital if they have an asthma attack. A lot of the time children only need to go into hospital if their asthma attack was caused by a viral infection. Sometimes an asthma attack can be so bad that your child can die from it. This is very rare, but if they do show signs of serious life-threatening asthma, they should be looked after by a hospital specialist. What treatment will my child be given if they have an asthma attack? The table below describes the medicines used to treat asthma attacks and how they help. Treatment How the medicine is given Oxygen Your child’s oxygen levels should be checked with an oxygen saturation meter. If they are low, they will be given oxygen through a mask. Reliever You child will be given a high dose of reliever medicine medicine either through an inhaler and spacer or through a nebuliser. A nebuliser creates a mist of medicine which your child breathes through a mask. Occasionally in hospital your child may be given reliever medicine through a drip or given a nebuliser very often. Your child may be given another reliever medicine in the nebuliser if the attack is severe or is not responding to the first reliever medicine alone. Steroid tablets They may be given steroid tablets for up to five days or until they have recovered from their asthma attack. Magnesium Your child may be given this through a drip if they sulphate have very severe asthma. Aminophylline In hospital, your child’s specialist may give them a medicine called aminophylline through a drip. 27
  • 30. Treatment of asthma attacks in children aged two and over If your child is having an asthma attack at home, they should be given their reliever inhaler through a spacer. You can read more about this on page 27. Your child can be given two puffs of their reliever inhaler through a spacer every two minutes (up to 10 puffs). If your child’s symptoms have not improved after 10 puffs of their reliever inhaler, ring 999 and ask for an ambulance. While your child is waiting to go to hospital the ambulance staff may give them more doses of reliever inhaler and start them on a course of steroid tablets to stop the attack. It is important that your child is taken to hospital in an ambulance. This is because the ambulance staff can give them more oxygen and reliever medicine on the way to the hospital if they need it. Once at hospital, your child should be treated with one or more of the medicines shown in the table on page 27. Treating asthma attacks in children under two years If your child is under two and has an asthma attack at home, they should be given a reliever inhaler through a spacer with a face mask. If your child needs to go to hospital because of an asthma attack, they may be given one or more of the medicines shown in the table on page 27 although children under two are not given magnesium sulphate or aminophylline. Your child should have appointments with a hospital specialist for a least a year if their asthma attack was so severe that they had to go into hospital. 28
  • 31. Before your child leaves hospital To help decide when your child is well enough to leave hospital, their hospital doctor will check their breathing regularly with a peak flowmeter frequently to see if it improves. They will also discuss with you how to look after your child’s asthma. This will include helping you to monitor your child’s asthma using a peak flowmeter or keeping a diary to monitor their symptoms. Staff at the hospital should also watch your child take their inhaler to make sure they are taking it properly and, most importantly, should give them a new personal asthma action plan. You can read more about personal asthma action plans on page 21. The hospital will tell your child’s GP about their treatment in hospital and they should arrange a follow-up appointment for your child in an appropriate clinic for children with asthma. You should also make an appointment with your GP within 48 hours of leaving hospital. 29
  • 32. Can I prevent my child from developing asthma? Breastfeeding All women are encouraged to breastfeed their babies as breast milk can reduce the chances of a child developing asthma. Smoking during pregnancy If you smoke while you are pregnant this can increase the chance of your child developing asthma and wheezing. If you smoke, your doctor will offer you support to give up. Diet There is not enough evidence to suggest that avoiding certain foods or using dietary supplements while you are pregnant can prevent your child developing asthma. Immunisations Immunisations are the vaccinations your child will be given by a doctor or nurse as they are growing up. There is no evidence that having these immunisations increases the risk of your child developing asthma. It is important that your child has vaccinations to help protect them against infectious diseases. 30
  • 33. Asthma in young people This section has been written for teenagers to read with their parents or carers. Adolescence is the time when you are moving from childhood into adulthood. During this time you are becoming more independent but it can be a challenging time for you. You may think that having asthma can make things more difficult for you and it is quite normal if you feel anxious or depressed. If you do feel anxious or depressed you should speak to your GP or asthma nurse. You can also find information from Asthma UK at www.youtube.com/ watch?v=QYK5e2y_G6k and www.asthma.org.uk/all_about_asthma/ asthma_young_adults/depression.html As you get older, your doctor will encourage you to take more responsibility for your asthma by seeing you on your own, without your parents or carers, for part of the time. Your written asthma plan developed between you and your doctor allows you to take control of your asthma by taking on responsibility and making some choices for yourself. Some of the questions below will help you and your doctor know that you are able to look after your asthma. ~~ you tell what things make your asthma worse? Can What medicines do you take for it? ~~ ~~ you know what each medicine does to help you? Do How easy is it to remember to take your medicine? ~~ ~~ your doctor or asthma nurse asks you questions about your asthma, how If do you describe it? When you need to go and see your doctor or asthma nurse, how do you ~~ make arrangements to do this? ~~ you find you are unable to keep an appointment you have made with your If doctor or asthma nurse, do you know how to cancel it? How do you make sure you arrange new prescriptions before your medicine ~~ runs out? 31
  • 34. Your doctor will discuss your treatment preferences with you (for example, which inhaler suits you best). Your doctor should also ask you if you find it easy to use your inhaler in places you might need to use it such as school or if you are out with friends. Your doctor should teach you how to use your inhaler and check that you are using it correctly. If you need to use a spacer with your reliever inhaler when you’re at home, your doctor should consider giving you a different reliever inhaler device that’s easier for you to carry around and use when you are out and about. When your doctor is giving you advice on controlling your asthma, they should take account of your own needs. This means: offering help and advice for coping with feelings; ~~ teaching you what you need to know in a respectful and encouraging way; ~~ discussing information that is personal to you and offering you written ~~ copies of this; and teaching you in an appropriate place. ~~ Your school should work with you to help control your asthma. It is important that you keep your school up to date with changes in your medication, for example what you take and how much. There might be other children in your school who you could share information about asthma with. This is known as peer support and if your school doesn’t currently offer it, Asthma UK can help support your school. Ask your teacher to visit www.asthma.org.uk/how_we_help/schools_early_years Smoking and cigarette smoke You are at a time in your life where you should be making choices and learning from your mistakes. Never feel pressurised to smoke just because your friends do it. It is important to know about the effects smoking has on your asthma and the rest of your health. 32
  • 35. For example, smoking: increases the risk of asthma attacks; ~~ permanently damaging your airways; and ~~ reduces the benefits of your asthma medicines. ~~ If you do smoke, your doctor or asthma nurse should offer you advice and support to help you stop. Living with someone who smokes may also affect your condition. If your parents or carers smoke, they should also be encouraged to stop so you don’t have to breathe in their cigarette smoke. Don’t be afraid to discuss with your doctor, asthma nurse or parents about how you feel if any of the above issues concern you. Complementary therapies Some people like to consider complementary therapies as a way to treat medical conditions such as asthma. You should never use them instead of the treatments your doctor or asthma nurse has recommended. Always tell your doctor or asthma nurse if you are using any complementary therapies. What should happen as I get older? If you are under the care of a specialist, as you get older, you will need health services that are designed to look after people in your age group. You will become more involved in managing your asthma. To make this easier, there should be a clear plan about what should happen. In most cases, looking after your asthma will involve your local GP. Only a few young people need to go to hospital. You, your family and other people who help manage your asthma should be involved in the decisions about how and when you will move from child services to adult services. 33
  • 36. Will having asthma affect my career choice? Your doctor or asthma nurse should discuss future career choices with you and tell you which jobs might increase your risk of work-related asthma symptoms. This is known as ‘occupational asthma’. Occupational asthma is caused by substances such as wood dust, dust from flour and grain, latex and dust from insects and animals. Examples of jobs which can cause occupational asthma include joinery, spray painting, laboratory work or any job which involves using latex gloves such as nursing or dentistry. 34
  • 37. Where can I find out more information about asthma? National organisations for people who have asthma Asthma UK Summit House, 70 Wilson Street London EC2A 2DB Phone: 020 7786 4900 Asthma UK Adviceline - speak to an asthma nurse specialist: 0800 121 62 44 Website: www.asthma.org.uk Asthma UK is the charity dedicated to improving the health and well-being of people who are affected by asthma. They offer a range of information on asthma including fact sheets and booklets. British Lung Foundation 73-75 Goswell Road London EC1V 7ER Helpline: 08458 50 50 20 Phone: 020 7688 5555 Fax: 020 7688 5556 Website: www.lunguk.org The British Lung Foundation aims to help people understand and live with lung disease. They run the Breathe Easy support network which offers information, support and friendship to anyone affected by lung disease. 35
  • 38. Other organisations Allergy UK Planwell House, Lefa Business Park Edgington Way, Sidcup Kent DA14 5BH Helpline: 01322 619898 Fax: 01322 470 330 Website: www.allergyuk.org Allergy UK is a charity which aims to increase understanding and awareness of allergies, and helps people manage their allergies. ASH (Action on smoking and health) First Floor, 144-145 Shoreditch High Street London E1 6JE Phone: 020 7739 5902 Fax: 020 7729 4732 Website: www.ash.org.uk ASH is the leading voluntary organisation campaigning for effective tobacco- control legislation and providing an expert information service. NHS Direct Phone: 0845 4647 (24 hours) Website: www.nhsdirect.nhs.uk This is a 24-hour helpline for people in England and Wales. It is led by nurses who provide confidential health-care advice and information 24 hours, 365 days a year. 36
  • 39. NHS 24 Phone: 0854 24 24 24 Website: ww.nhs24.com This is a 24-hour helpline for people in Scotland. It is led by nurses who provide confidential health-care advice and information 24 hours, 365 days a year. Useful publications Guide to good asthma care for adults and children with asthma Website: www.asthma.org.uk/scotland/guide.html Useful websites Department for Work and Pensions (DWP) Website: www.dwp.gov.uk The website can give you details of state benefits you may be entitled to. Healthtalkonline Website: www.healthtalkonline.org Healthtalkonline lets you share in other people’s experiences of health and illness. You can watch or listen to videos of interviews, read about people’s experiences and find reliable information about conditions, treatment choices and support. 37
  • 40. What is SIGN? The Scottish Intercollegiate Guidelines Network (SIGN) writes guidelines which give advice to health-care professionals, patients and carers about the best treatments that are available. We write these guidelines by working with health-care professionals, other NHS staff, patients, carers and members of the public. The guidelines are based on the most up-to-date scientific evidence. You can read more about us by visiting www.sign.ac.uk Other formats If you would like a copy of this booklet in another language or another format, such as in large print, please phone Karen Graham, Patient Involvement Officer on 0131 623 4740, or e-mail karen.graham2@nhs.net 38
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  • 44. IF YOU ARE HAVING AN ASTHMA ATTACK YOU SHOULD DO THE FOLLOWING. 1. Take one to two puffs of your reliever inhaler immediately. (This is usually a blue inhaler.) 2. Sit up and try to take slow steady breaths. 3. If you do not start to feel better, continue to take two puffs (one at a time) of your reliever inhaler every two minutes. You can take up to 10 puffs. 4. If you do not feel better after taking your inhaler as described above, or if you are worried, call 999. If an ambulance does not arrive within 10 minutes and you are still not feeling any better, repeat step 3 above. Do not be afraid of causing a fuss, even at night. If your asthma feels better and you do not need to call 999, you still need to see a doctor or asthma nurse that day. Check your asthma action plan and follow the advice you have been given. www.healthcareimprovementscotland.org Edinburgh Office | Elliott House | 8-10 Hillside Crescent | Edinburgh | EH7 5EA Telephone 0131 623 4300 Fax 0131 623 4299 Glasgow Office | Delta House | 50 West Nile Street | Glasgow | G1 2NP Telephone 0141 225 6999 Fax 0141 248 3776 The Healthcare Environment Inspectorate, the Scottish Health Council, the Scottish Health Technologies Group, the Scottish Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium are key components of our organisation. www.sign.ac.uk