Here\u2019s a scary statistic: One in three life-threatening asthma attacks happens in people with mild asthma.\u00a0<\/p>\n
\u201cYou\u2019re just caught in that terrible moment where you\u2019re sick and there\u2019s wildfire smoke and somebody just asked you to pat their cat and you went for a run,\u201d describes Dr. Anne Hicks<\/a>, associate professor of pediatric respiratory medicine and Canada Research Chair<\/a> in Children\u2019s Lung Health. \u201cIt can all add up and send you in the wrong direction.\u201d<\/p>\n That statistic is why Hicks recommends that everyone who has asthma \u2014 one in 10 children in Canada and 6.1 million kids worldwide \u2014 should have an \u201casthma action plan\u201d so they\u2019re ready for that no good, very bad day when it happens.<\/p>\n \u201cAsthma is a condition of loss,\u201d Hicks explains. \u201cYou can\u2019t go outside for recess, you\u2019re not picked for sports teams, you miss being in the school play.\u201d\u00a0<\/p>\n Hicks, who is clinical lead for the Children\u2019s Environmental Health Clinic<\/a> and also runs her own Children\u2019s Lung Health Lab<\/a>, aims to help children have safe play experiences, participate in sports and go on summer vacation without a crisis.\u00a0<\/p>\n \u201cHow do we get people prepared so they can control their asthma and live just like somebody with no asthma?\u201d\u00a0<\/p>\n In honour of Asthma Awareness Month in Canada<\/a>, Hicks shares some expert advice on how parents can keep their children safe and healthy every day of the year.\u00a0<\/p>\n Find an asthma educator<\/p>\n As soon as your child is diagnosed with asthma, Hicks says the first step to preventative care is finding a certified asthma educator<\/a> \u2014 a specially trained nurse, respiratory therapist or pharmacist \u2014 who can teach you all about the disease and how it affects your child.\u00a0<\/p>\n Hicks\u2019 recent study<\/a> of a Calgary asthma education program looked at 3,589 children with mild asthma from 2016 to 2019. Their risk of asthma attacks was reduced by 15 per cent in the two years following the education session, and they also saw a reduction in emergency department visits.\u00a0<\/p>\n \u201cA certified asthma educator works with a family for 60 to 90 minutes, teaching them about asthma and their medications and how to read their own body, what they should expect from their medicine and how long it\u2019ll take to work,\u201d Hicks explains.\u00a0<\/p>\n \u201cThis supports parents and children to make informed decisions about how to control what\u2019s happening in their body.\u201d<\/p>\n An asthma education session may include taking a clinical history, spirometry (for children\u2009age five and up), a prescription review, and teaching on how to use asthma devices such as inhalers.\u00a0<\/p>\n Each patient should come away with a personalized asthma action plan that outlines preventive actions, control medications and exacerbation management, Hicks says, so you can stay on top of the disease and avoid a serious attack.<\/p>\n Know your child\u2019s triggers<\/p>\n Asthma is a chronic inflammatory disease triggered by external factors like smoke, infections or allergens, causing symptoms such as shortness of breath, chest tightness, coughing and wheezing, according to Asthma Canada<\/a>.<\/p>\n \u201cBasically asthma is an obstruction of air flow in the small airways because they are swollen and the muscles become tight,\u201d says Hicks. \u201cBut it\u2019s a waxing and waning disease. Everybody\u2019s asthma is different. It belongs to them.\u201d\u00a0<\/p>\n \u201cInflammatory triggers\u201d such as dust mites, animal dander, moulds and pollen set off an allergic reaction that causes inflammation. \u201cSymptom triggers\u201d such as smoke, exercise, cold air or perfume are not allergic, but they can provoke symptoms all the same.<\/p>\n In about one in 20 children with asthma, it is severe or difficult to control, with a different disease process in the body, according to Hicks, who is a member of the Women and Children\u2019s Health Research Institute<\/a>.<\/p>\n Hicks says people with asthma are much like the proverbial canaries in the coal mine when it comes to environmental pollutants, providing an early warning of danger.<\/p>\n \u201cWhen we\u2019re exposed to a respiratory irritant like wildfire smoke, everyone will eventually get sick,\u201d she points out. \u201cBut people with asthma know about it before others.\u201d<\/p>\n Know what good control looks and feels like\u00a0<\/p>\n The good news is that people with mild to moderate asthma can plan for these challenges by taking regular medications and staying on top of their disease.\u00a0<\/p>\n \u201cPeople want to take medicine and get better and have it go away,\u201d she says. \u201cThat\u2019s not how asthma works, but it\u2019s incredibly frustrating to take medication when you feel well.\u201d\u00a0<\/p>\n She says accepting that asthma is a chronic illness that means taking medication every day is the first step to good control. Think of it like wearing glasses for poor vision.<\/p>\n \u201cWhen you have the right asthma medicines in your body, your lungs work beautifully and you can run and play. You can even catch a cold and it feels crummy, but you\u2019re not sitting in the emergency department needing medications to get you out of an asthma attack,\u201d Hicks explains.<\/p>\n Every person\u2019s asthma will require different treatment, but most people will have two kinds of medication: The first is a controller medicine, taken daily, that will take two to four weeks to start working. Much like your skin after a scab comes off, it takes up to three months for inflamed and irritated lung tissue to completely return to normal after a severe attack.\u00a0<\/p>\n Then there are reliever medicines, for when your child has a flare-up. These are often inhaled medications. They should work within 30 seconds to two minutes and last for two to four hours. Some people may also need to carry an EpiPen<\/a> to take first if they have severe allergies, depending on their triggers.<\/p>\n Older children should be able to tell you when they\u2019re not feeling well, but you may need to watch small children to see the first signs of trouble.<\/p>\n \u201cIf a little kid is suddenly quiet, and you can see their neck muscles working, or you lift up their shirt and their little sides are pulling in between their ribs, you know they\u2019re struggling to breathe, so give the reliever and consider an emergency visit if needed,\u201d Hicks says.<\/p>\n If you find new medications don\u2019t work as you expect, go back to the doctor and let them know.\u00a0<\/p>\n Find the right balance<\/p>\n Using asthma medications effectively is all about balance. Though the medications should ensure that your child\u2019s asthma is well controlled, it\u2019s also important to consider side-effects. You\u2019re aiming for the lowest dose possible with the most benefit and the least harm.\u00a0<\/p>\n \u201cOne of the main reasons kids may not use their puffers, other than inconvenience, is that parents are really worried about side-effects,\u201d Hicks notes. \u201cThat\u2019s where the asthma educator comes in. They can answer questions and talk about risk factors you should be watching for as a parent.\u201d<\/p>\n Reliever medications will increase the heart rate, for example, so it might look like you\u2019ve given your two-year-old a pot of coffee. Using a puffer can give you a sore throat. Some puffers use aerosols, which contain greenhouse gases, a concern for some families. You can talk to your doctor about greener versions that work for many people, although children under 5 may not be able to activate them.<\/p>\n Controller medications generally contain a steroid, which at low doses has minimal side-effects but can sometimes promote yeast growth in the mouth. To avoid more severe symptoms like thin skin, brittle bones and immune suppression, it\u2019s important to stay below a maximum total steroid exposure from all sources, including nasal sprays, puffers and skin creams. This varies by age and should be carefully evaluated by your pharmacist, asthma educator or doctor, especially in young children.<\/p>\n Expense can also be an issue for families, with some puffers costing as much as $150 each. Hicks encourages parents to seek out programs that can help, such as the Alberta Child Health Benefit<\/a>.<\/p>\n Create an asthma action plan<\/p>\n Hicks advises every person with asthma should have an \u201casthma action plan<\/a>\u201d that spells out exactly what to do when things are under control, when it\u2019s getting worse and when it\u2019s time to get help. There are lots of templates for the plan online, or your doctor may give you one.<\/p>\n Build this plan with your child and their care team. Once it\u2019s complete, take it everywhere your child goes, along with medications and a list of triggers. Camp counsellors, teachers and babysitters all need to know about it.<\/p>\n \u201cThink about Murphy\u2019s law and bring the puffer along. Hopefully you never need it, but if you have it with you, you don\u2019t have to worry,\u201d Hicks says.\u00a0<\/p>\n When your child has an asthma attack that can\u2019t be controlled by their usual reliever routine, then it\u2019s time to head to the hospital.\u00a0<\/p>\n \u201cIf you\u2019re having to give the medication frequently, you either drive into the hospital or you call an ambulance because when you can\u2019t breathe, it\u2019s an emergency,\u201d Hicks underscores.\u00a0<\/p>\n At the hospital, staff will administer steroids and other medications to decrease swelling and relax tight airway muscles, and may also provide oxygen and other breathing supports. Then begins the long process of stabilizing the asthma again. As well as resuming controller and reliever medications, a severe asthma attack should trigger a medication review and potential changes to prevent future issues, Hicks says.\u00a0<\/p>\n Reasons for hope<\/p>\n Children with asthma in Alberta have the opportunity to take part in research projects that aim to make life better, thanks to researchers like Anne Hicks and others.\u00a0<\/p>\n One, called the Mobile Health for Kids With Asthma (MoKA) study<\/a>, is using cellphones to \u201clisten in\u201d on patients and measure their symptoms in real time. The goal is to train a predictive model that can be individualized for patients to help them see an asthma attack coming well before it happens and take action early enough to prevent severe attacks.\u00a0<\/p>\n \u201cImagine if your colds mailed you a postcard and said they were coming. You\u2019d be able to plan for them, and you\u2019d be able to prevent viral-triggered asthma attacks,\u201d Hicks says.\u00a0<\/p>\n One of Hicks\u2019 studies, called ADAPT<\/a>, monitors indoor air quality in a child\u2019s home to measure total exposure to chemicals and analyze their impact on asthma control, sleep quality and skin health. It includes a randomized control trial<\/a> to learn whether HEPA filters<\/a> in the home can help.\u00a0<\/p>\n \u201cWe\u2019ll follow those kids for one year so that we capture all four seasons. And we\u2019ll see if that HEPA filter changes chemical uptake, inflammation, asthma and sleep outcomes,\u201d Hicks explains. \u201cWe are hoping that with more of a cause-and-effect link, we can help people figure out how to make changes in their homes that can decrease asthma symptoms.\u201d<\/p>\n Another project in collaboration with the University of Calgary has an engineering master\u2019s student building an app that will collect local weather, air quality and transportation data in real time, so people with asthma can plan their day based on what they know about their triggers.\u00a0<\/p>\n