Asthma is one of the most common chronic childhood diseases. More than six million children in the U.S. have a diagnosis of asthma by the time they reach age 18. Asthma is one of the most common reasons for school and childcare absenteeism, childhood hospitalizations, and trips to the emergency room.

Asthma is a chronic, inflammatory disease of the airways that causes the normal functioning of the airways to overreact. Inflammation causes the excess production of mucus, swelling, and airway muscle contraction. These changes produce temporary airway obstruction, chest tightness, coughing, and wheezing. At its most severe, asthma causes low blood oxygen and even death.

While the exact cause of asthma is unknown, children with asthma seem to have over reactive immune systems. Most children with asthma are allergic to certain substances in their environment that trigger their asthma. Children can undergo allergy testing to determine exactly what they are allergic to. In many cases, a single blood test can identify allergens.

Common allergic triggers include dust mites, pet dander, tree, grass and ragweed pollen, cockroaches, and certain molds. Upper respiratory infections, such as the common cold, also are frequent asthma triggers in young children.

Other environmental triggers include strong odors, very cold air, and tobacco smoke. Exposure to tobacco smoke greatly increases asthma symptoms and episodes. Children whose mothers smoke during pregnancy have a much greater risk of eventually developing asthma.
Despite the fact that almost 80 percent of children with asthma develop symptoms before age five, many children with asthma are undiagnosed because adults do not realize that a child does not have to wheeze to have asthma. Often, the only symptom may be a frequent, annoying cough, particularly at night or during exercise.
Asthma Signs
Asthma can be controlled if the patient or caregiver is aware of its warning signs, uses asthma medications properly, and avoids things that trigger asthma. Early warning signs include coughing, chest “tightness,” feeling tired or out of breath, rapid breathing, and wheezing.
Sometimes wheezing can only be heard with a stethoscope. As the child becomes more and more short of breath, he or she may hunch over, pull in the stomach muscles, and be unable to speak. This is considered a medical emergency and must be treated immediately.
Treatment
Asthma medications include quick-acting, inhaled medications administered via canisters. They are often referred to as “puffers” or rescue medications and work quickly by opening tightened breathing passages and relaxing the airway muscles.
These quick-acting inhalers only last a few hours. Long-term control medications are sometimes needed to manage the chronic inflammation that accompanies the constricted airway muscles.

Long-term medications are administered via inhalers or taken orally and must be taken daily as prescribed, even when the child is feeling well. These medications are important in preventing asthma episodes.

If a child is older than three years of age, a peak flow meter may be used to monitor asthma and the need for medication. A peak flow meter is a portable hand-held device used to measure how air flows out of the lungs and typically, is used once each morning and evening. A low peak flow reading may indicate early airway obstruction before the child develops symptoms of an asthma episode.

The child who has been diagnosed with asthma should have a written asthma management plan in place that includes a list of that particular child’s “triggers” and symptoms. It also should include a list of asthma medications and what the child’s normal peak flow reading is. A written asthma management plan should be completed by the parent, the child’s physician, and childcare staff; it also should be updated as needed.

Asthma also can be managed by controlling the child’s environment. Environmental controls include removing or reducing common asthma triggers in both the home and the childcare setting.

Here are some suggestions to make the childcare setting a safe and healthy environment for children with asthma:

• Wipe all surfaces and floors daily with a dampened cloth or mop versus using cleaning sprays.
• Floors that can be washed easily are optimal. Use washable, small area rugs if needed instead of wall-to-wall carpeting that attracts dust mites and can be difficult to clean.
• Vacuum only when children are not present, and allow sufficient time for dust to settle. Use vacuums with HEPA filters and double thickness vacuum bags when possible.
• If carpeting or area rugs exist, do not allow children to nap or lie on them. Do not use pillows, which attract dust mites.
• Curtains, drapes, fabric wall hangings and other “dust catchers” should be avoided. If used, wash them frequently in hot water. Washable plastic window shades are preferable to fabric.
• Keep clutter in closed boxes or closets to prevent dust accumulation.
• Do not allow furred or feathered pets in the childcare setting.
• Avoid unwanted pests such as mice and cockroaches in the childcare setting by properly storing all food, removing garbage, and cleaning food preparation surfaces thoroughly. If such pests are present, use the least toxic pest extermination methods.
• Use exhaust fans in bathrooms, kitchens, and basement areas to reduce humidity and mold growth.
• Clean mold from bathrooms or other areas by wiping down with diluted chlorine and water solution at the end of the day.
• Avoid having indoor houseplants around since they can promote mold growth.
• If ventilation is adequate, keep windows closed, especially on high pollen days. Use air conditioners with clean filters whenever possible.
• Keep outdoor play areas clean of leaves, grass clippings, and compost piles that promote mold growth.
• Discourage staff from wearing perfumes or heavily-scented products. Do not use air fragrance sprays or air fresheners.
• Smoking of any kind should never be allowed on the premises.

Elaine Abrams, RN
Certified Health Education Specialist and Public Health Educator, Redding Center, CT

Asthma and Allergy Foundation of America, 1233 20th St. NW, Ste. 402, Washington, DC 20036; 877-2-ASTHMA; www.aafa.org. The Asthma and Allergy Foundation of America conducts training for childcare providers called Asthma and Allergy Essentials for Childcare Providers through a joint program with the Environmental Protection Agency (EPA).