Managing Asthma: Have a Plan

May is National Asthma Awareness Month. Asthma is a serious, but common lung condition that affects 1 in 13 people, including adults and children. CDC’s National Asthma Control Program works to help Americans with asthma achieve better health and improved quality of life. Learn more.

Now 17 months old, Zachary was 10 months when he began exhibiting what I learned were asthmatic tendencies. A third episode of wheezing, coughing, and breathlessness in as many months led doctors to re-classify his symptoms as asthma.

Asthma is a serious, but common lung condition, and one of the most common long-term diseases of children. Symptoms of an asthma attack are chest tightness, coughing, shortness of breath, and wheezing. Parents of and people with asthma are on alert all of the time, not just in the event of an episode or when disaster looms.

It can be hard to tell if someone, especially a child under age 5, has asthma. An asthma diagnosis in a child under the age of two is rare, but are sometimes given by a doctor if a child endures repeated episodes in a short period of time. Three episodes in three months was a sign that Zachary was experiencing more than just a bad cold and flu season.

As a parent, it’s a very helpless feeling when you don’t know what to do next. And the idea that patience is a virtue is of no consolation even though the reality is that it takes time and—at least in the beginning—some educated guesswork to learn how to control asthma. A caregiver can’t begin to manage a young child’s asthma until the caregiver knows the warning signs of an asthma attack, identifies the triggers, and strategizes—with the child’s doctor—ways to manage the child’s condition.

On the advice of his doctors, we began treating Zachary with an inhaled steroid controller medicine given once daily through a nebulizer. For a short time, we thought we had his asthma under control. But about a month later, he had a fourth and much more serious episode. Several failed attempts to control his symptoms at home, an emergency call to 9-1-1, more ineffective treatments, and many anxious hours later, he was admitted to the Pediatric Intensive Care Unit (PICU) at the local children’s hospital.

Asthma Action Planning

After four days in the PICU we were discharged and returned home with two inhalers, oral steroids, and an Asthma Action Plan. An Asthma Action Plan is written with a medical professional; it describes how to manage asthma on a day-to-day basis and during an episode. The best plans are personalized and based on what you know about asthma and the facts of your child’s case.

An asthma trigger is something in the environment that causes an asthma attack. Triggers are different for everyone, and can change for a person over time. Tobacco smoke, mold, air pollution, and wood smoke caused by wildfire are a few of the more common ones. Severe weather, such as drastic increases and decreases in temperature and humidity like that caused by thunderstorms and hurricanes, and hyperventilation caused by strong emotions can also cause an asthma attack.

Since our discharge from the PICU, our family has become hypersensitive to any cold or virus Zachary picks up because we know that these are triggers. But we are also more confident in our ability to identify his triggers and treat the symptoms.

The Different Levels of an Asthma Action Plan

Zachary’s reaction to a trigger develops over time. Prior to an asthma episode, we notice minor changes in his well-being and behavior. These changes are “early warning signs,” and for Zachary they include coughing or wheezing, shortness of breath, and tiredness or irritability. These symptoms are also a sign to review the Asthma Action Plan.

Asthma Action Plans have three levels or zones (Green, Yellow, and Red) that are prescribed by a medical professional, such as a pulmonologist.

Each zone is customized to your child’s asthma and individual needs. In Zachary’s case, the Green Zone means that he is taking his controller medicines daily, breathing well, is not coughing or wheezing, can attend school and participate in his normal activities, and is able to sleep peacefully.

If Zachary starts to display “early warning signs,” he graduates from the Green Zone to the Yellow Zone. In the Yellow Zone, Zachary receives his rescue medication every 4 hours as needed. If the need exceeds every 4 hours, than we move from the Yellow Zone to the Red Zone.

The Red Zone is the most serious. Symptoms can include increased breathing rate, decreased alertness, severe breathing problems, pale skin, severe chest tightness, and a continual cough. When these symptoms present, the rescue medication is given every 20 minutes for up to 60 minutes.

Zachary’s pulmonologist advises calling 9-1-1 at this time. It is important not to transport yourself or your child to the hospital because additional life threatening conditions are possible. As advised, always call 9-1-1.

Prepare Your Health

It’s important to know that unmanaged asthma can lead to life-threatening respiratory failure. Fortunately, for Zachary this was not the case. Our family is very grateful for the knowledge our pediatric team has, their ability to respond quickly and appropriately, and their constant support in advocating for what works best for Zachary.

Asthma can be controlled by knowing the warning signs of an attack, avoiding triggers, and following the advice of a doctor or other medical professional. An Asthma Action Plan is part and parcel of asthma self-management, and an important part of your personal health preparedness:

• Talk with the doctor to determine when the Asthma Action Plan needs to be reviewed and possibly updated.
• Parents, give copies of the Asthma Action Plan to individuals who may be with you or your child during an asthma episode, such as a school nurse.
• Save an electronic copy of the Asthma Action Plan—along with copies of other important paperwork—to a flash or external hard drive or a secure cloud-based service.
• Keep a copy of the Asthma Action Plan with your family’s Emergency Action Plan in case of a disaster.
• In addition to the Asthma Action Plan, anyone providing you or your child with care must have access to a list of prescriptions, know when those medications were last taken, know where they are kept, and know how to properly administer the medications to an adult versus a child. Be sure to have an adequate supply of prescriptions on-hand in case of emergency.

Related Resources

• Tools for Asthma Control (CDC)
• Learn how to control asthma (CDC)
• Asthma Care Before, During, and After a Hurricane or Other Tropical Storm (CDC)
• Know How to Use Your Asthma Inhaler (CDC)
• Helping Children Cope with Emergencies (CDC)

Thanks in advance for your questions and comments on this Public Health Matters post. Please note that the CDC does not give personal medical advice. If you are concerned you have a disease or condition, talk to your doctor. 

Have a question for CDC? CDC-INFO (http://www.cdc.gov/cdc-info/index.html) offers live agents by phone and email to help you find the latest, reliable, and science-based health information on more than 750 health topics.