Asthma

Asthma is one of the “allergic triad” of associated conditions: eczema (also known as “atopic dermatitis”); wheezing or asthma; and “hay fever” (or “allergic rhinitis”). These conditions often occur at different times in the same individual, or if you have one condition, a family member (such as your child) may have another of them, at some point.

Amongst the allergic triad disorders, asthma has the potential to be the most serious condition. Thus, there is some stigma in calling it by its name. Common euphemisms for asthma include “bronchitis” (which actually is a too-general term), “wheezy bronchitis”, “asthmatic bronchitis” and “reactive airways disease”.

One false preconception that scares many parents—and doctors—and prevents people from calling it like it is, is the image of an asthmatic as a sickly individual. In general, an undiagnosed, or undertreated asthmatic child has a recurrent cough, may not like sports, and may have more school absences (or may not), but the child looks pretty much like his/her classmates otherwise.

The truth is that asthma is understandable, treatable, and should not interfere with you or your child’s activities most of the time.

Unfortunately, there are barriers to control of asthma, including a misunderstanding of asthma and its treatments. I hope to provide useful information to you on this website, and in the office, to help counter these barriers.

Peak flow monitoring is a tool to diagnose and manage asthma in school-aged children (as well as adults). I have chosen this topic as the first to include in this section about asthma.

Peak Flow Monitoring

Checking and documenting peak flows can help you or your child know whether or not the child has asthma, and if so how well it’s under control. Sometimes a four year old can blow a reliable peak flow, and usually a six year old can learn to do it well.

A non-asthmatic without other lung disease will have a peak flow close to that predicted for height or age and sex, and it won’t vary regardless of whether the person gets a cold, has allergies, or has just been running in cold weather. However those circumstances are all possible “triggers” for asthma in an asthmatic. Whether or not the peak flow goes down, and how much, is an indicator of asthma control.

If peak flows vary more than 20% from best to worse, the person probably has asthma. If the asthmatic is taking asthma preventative medications and peak flows still vary a lot, a review in the office is indicated. If the asthmatic has recently made a change in usual management, for example changing antihistamines or stopping a daily inhaler, and peak flows vary more than 20% from best to worst over a few days to a week or so, then you can see that the change is causing a problem.

Peak flows can be documented many ways. You can use the paper that comes with your meter, if you like it. A small notebook, a page of graph paper, or a hand-held computer—there are new ones for ~$100—can also be used.

Watch your child and help with his/her technique. S/he should blow hard and fast with the mouthpiece inside the mouth and lips tight on it. Have her/him blow 3 times and if the numbers are similar her/his technique is probably good.

Always write down the best value. Then write down other information to help interpret the number.

For example, in a notebook you might write:
“160 before breakfast, has a cold”;
“350 before albuterol” and “380 10 minutes after albuterol”;
“240, sneezing a lot today”.

Please bring this record to doctor’s office appointments, and also bring all your “asthma devices”: the meter, any inhalers or spacers. Everything except the nebuliser machine!

Another source of information:

One Minute Asthma by Thomas Plaut, Jr, MD—available from the office at a discount from the usual retail price of $5.