Dr. Troy’s Asthma Primer

Asthma is often called reactive airway disease because the airways are reacting to something that irritates them—viruses (such as those that cause colds, sore throats, and the flu), cigarette smoke, other pollutants, and allergens (e.g. grasses, pollen, cat dander). When the airways react, they constrict, making it difficult to breathe.

When someone is having an asthma attack they may have a sensation of tightness or pain in the chest or feel that they are having trouble breathing—which they are! They may have retractions or pulling in of the skin between the ribs, above the collarbones, or of the upper abdomen and they may be breathing faster than normal. They may be pale and their lips won’t be as pink as usual. They may also be wheezing i.e. making a whistling sound when they breathe out (you can sometimes hear this if you place your ear to their back). Sometimes asthma presents as coughing. A cough that is moist or increases as soon as someone lies down is usually upper airway and is helped by cough syrup with codeine. A cough that comes on with exercise, wakes someone up after they’ve been sleeping for a few hours, or is not helped by codeine, is likely to be asthmatic.

When someone is having an Acute Asthmatic Attack, use the medicine that begins with A, Albuterol. Albuterol should be used only as needed, hopefully not several times a day or even daily (except when someone is recovering from an acute asthmatic attack).

When someone has asthma their airways become inflamed—they are swollen and secrete more mucus—and are more likely to react (constrict) with the least little provocation. To Protect the lungs and Prevent asthma, we often use medicine that starts with a P: Prednisone, Prednisolone, Pulmicort (some of these medicines, also called controllers, start with other letters e.g. Flovent). They should be used on a regular basis to prevent asthma—even if someone isn’t having asthma symptoms. Some people get asthma every time they get a cold and we tell them to use their controllers as soon as their nose starts to run (or even as soon as someone else at home gets a cold). Whenever asthma symptoms increase, a controller should be used. If they are already on a controller, the dose should be increased—and they should probably see their doctor!

For older children and adults, we often prescribe peak flow meters. These are helpful to help gauge how someone is breathing and, thus, direct treatment. We have them check their peak flow three times and record the best value twice a day for two weeks, then use these numbers to draw up an Asthma Management Plan.

Asthma is very individual. Some people just need occasional albuterol; others may take four or five medicines a day. There is an art to living with asthma and minimizing its impact. Working together, we can figure out what is best for your child.