Families and their pediatrician or allergist should work together as a team to develop and carry out a plan that includes eliminating asthma triggers and monitoring symptoms, and a plan for what to do when a child's asthma starts to act up.

There are two basic kinds of medication for the treatment of asthma:

• Long-term control medications -- used on a regular basis to prevent attacks, not for treatment during an attack.
  • inhaled steroids (e.g., Azmacort, Vanceril, AeroBid, Flovent) prevent inflammation
  • leukotriene inhibitors (e.g., Singulair, Accolate)
  • long-acting bronchodilators (e.g., famoterol, Serevent) help open airways
  • cromolyn sodium (Intal) or nedocromil sodium
  • aminophylline or theophylline (not used as frequently as in the past)
  • combination of anti-inflammatory and bronchodilator
• Quick relief (rescue) medications -- used to relieve symptoms during an attack.
  • short-acting bronchodilators (e.g., Proventil, Ventolin, Xopenex, and others)
  • oral or intravenous corticosteroids (e.g., prednisone, methylprednisolone) stabilize severe episodes

Children with mild asthma (infrequent attacks) may use relief medication as needed. Those with persistent asthma should take control medications on a regular basis to prevent symptoms from occuring. A severe asthma attack requires a medical evaluation and may require hospitalization, oxygen, and intravenous medications.

Although these are the same medications used to treat adults, there are different inhalers and dosages especially for children. In fact, children often use a nebulizer to take their medicine rather than an inhaler, because it can be difficult for them to use an inhaler properly.

Families play a very important role in the control of asthma by helping get rid of the indoor triggers that worsen asthma. For example, it is extremely important to eliminate tobacco smoke from the home. This is the single most important thing that a family can do to help a child with asthma. Just having people smoke "not in the house" is not enough, as family members and visitors can bring residual smoke in on their clothes and in their hair.

Keeping low levels of humidity and fixing leaks can reduce growth of organisms such as molds. Exposure to cockroaches can be reduced by cleaning and by keeping food in containers and out of bedrooms. Bedding can be covered with "allergy proof" polyurethane-coated casings to reduce exposure to dust mites. Detergents and cleaning agents in the home should be unscented.

All of these efforts can make a significant difference to the child with asthma, even though it may not be obvious right away. Your allergist can assist you with a plan for reducing the asthma triggers in your home.

A peak flow meter, a simple device to measure lung volume, can be used at home to help you "see an attack coming" and take the appropriate action, sometimes even before any symptoms appear. If you are not monitoring asthma on a regular basis, an attack can take you by surprise. Peak flow measurements can help show when medication is needed, or other action needs to be taken. Peak flow values of 50-80% of the child's personal best indicate a moderate asthma attack, while values below 50% indicate a severe attack.

Many children under age 5 can't use a peak flow meter well enough to make the numbers useful, so their asthma must be managed by an adult who needs to watch carefully for the asthma signs. The age 5 "cutoff" is somewhat arbitrary, however, and can be adjusted based on the abilities of the individual child. It's a good idea to start using peak flow meters before age 5 to get the child used to them, but not to actually rely on them too much for monitoring the child's condition.

With proper treatment and a team approach to managing asthma (including, most importantly, the family), most affected children can live a normal life. Asthma, however, can be a life-threatening disease. It is important for families to work together with health care professionals to develop a plan for the child with asthma in order to ensure proper treatment and to minimize the impact of this chronic condition.

The complications of asthma can be severe. Some include:

• chronic cough
• lack of sleep from nighttime symptoms
• decreased tolerance for exercise and other activity
• missed school
• missed work for parents
• trouble breathing
• need for emergency room visits
• need for hospitalization
• assisted ventilation
• chronic lung disease (permanent changes in the function of the lungs)
• death