Tips for Parents About Asthma Management
- Wednesday, September 9, 2009, 23:08
- Asthma
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- Andrew:
- Now let’s talk about education and break it down for different ages. First of all, how can parents play a role in helping their kids understand the importance of using the combined medication or the two important medications apart? What tips would you give parents?
“It’s important to realize that compliance means the act of conforming to whatever is recommended.”
- Dr. Nathan:
- Let me first talk about compliance in general. It’s important to realize that compliance means the act of conforming to whatever is recommended. Adherence is really the extent to which a patient’s behavior coincides with the medical advice that’s given. So there’s a difference, but most of us use these two terms interchangeably. Again, if somebody takes their medications as recommended, the goals of asthma management are easily achievable. You may ask, “What are the goals?” Basically, the goal is to feel good, meaning you don’t have any symptoms day or night, and that you do all the activities you want to do without having chest symptoms. We’re trying to prevent exacerbations – trying to keep people out of the emergency room, out of the hospital. With medications, we don’t want to cause any adverse effects. But more importantly, we’re trying to maximize lung function. The goals are the same whether we’re talking about kids, adolescents, or the elderly. I don’t think it’s any different when we’re dealing with a child than it is when we’re dealing with an adult, although when we’re dealing with a child, even though we want the child to be responsible for taking the medication, you may have to have the parent involved as well.
- Andrew:
- Maybe you could give us some strategies. There are activities at school that you’d like your child to be able to participate in. There may be hesitancy, or, if the asthma is not under control, a real inability to participate. For parents who really want their kid to participate, what are some suggestions you would make?
“If children take their medications regularly, they’ll be able to do everything that a non-asthmatic can do.”
- Dr. Nathan:
- If children take their medications regularly, they’ll be able to do everything that a non-asthmatic can do. Aerobic activities may require extra medication. Albuterol, the same medication we use to relieve symptoms, can be used 15 minutes before you do aerobic activities, and in most cases, it will block exercise-induced asthma. So that may be an add-on drug that children have to take during the day, and we don’t count that as being out of control. In other words, if you have to use albuterol more than two to three times a week, you’re considered poorly controlled. But that excludes having to use it for exercise prevention.
We do have some other drugs for kids, and for adults, that may help to improve exercise tolerance. Serevent, the long-acting bronchodilator I talked about, also will prevent exercise-induced asthma for up to 12 hours. That’s a good drug for kids to use before they go off to school because they’ll have gym or recess. They may have aerobic activities multiple times throughout the day, and we prefer they not grab their short-acting bronchodilators or rescue inhaler frequently.
If that’s not effective, then one of the leukotriene antagonists also has been shown to help prevent exercise-induced asthma. Sometimes you have to use combination therapy. But first, you want to make sure that they are using their controller drug – their anti-inflammatory medication.
- Andrew:
- Dr. Nathan, if you had a little boy in your office and you were trying to help him understand the importance of getting with the program, what would you say to him?
“Advair, a combination inhaled steroid and bronchodilator, is simplifying everybody’s approach, because all you have to take is one puff in the morning and one puff in the evening.”
- Dr. Nathan:
- I always explain this in simple terms. Asthma is a chronic disease. It’s no different than any other chronic disease, and a chronic disease requires chronic medication. I’m going to give you the least amount of medication to try to keep you symptom-free. Advair, a combination inhaled steroid and bronchodilator, is simplifying everybody’s approach, because all you have to take is one puff in the morning and one puff in the evening. That’s what I would tell this youngster. You don’t have to take this medication to school; you leave it at home.
- Andrew:
- Let’s role-play for a different group, and that is teenagers. Some teenagers may think they know it all and they’re impervious to the effects of asthma getting out of hand. You’ve probably seen that at the emergency room. What do you tell that group?
“Teenagers don’t want to use their inhaler in front of their friends. They don’t want the stigma of having asthma or having any kind of chronic problem.”
- Dr. Nathan:
- That group has some other issues such as peer pressure. Teenagers don’t want to use their inhaler in front of their friends. They don’t want the stigma of having asthma or having any kind of chronic problem. But it’s the same issue as with younger kids. If they can understand that there are medications that don’t have to be used at school – that are used before they go to school and after they go to school – then most of the time they won’t have a problem; they won’t have to use their inhaler. If exercise is a big component, teenagers may have to use their rescue inhalers or their preventative inhalers prior to doing activities. But drugs like Serevent and Singular, which are used prior to going to school, often will negate the need to use the short-acting bronchodilators before they exercise.
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