In an asthma attack, the airways narrow, making it difficult to breathe. People with asthma have chronic lung inflammation. During an attack, the airway lining swells, the lung muscle tightens, and mucus secretion increases. As the airways narrow, breathing becomes "wheezy."

The American Lung Association estimates that 6.3 million children under 18 years of age have asthma, many of them undiagnosed. In most cases, treatments at home or at the child's doctor's office can control asthma. However, asthma is the third leading cause of hospitalizations among children under age 15.

How Can I Tell If My Child Has Asthma?

The wheezing that many people associate with asthma usually does not appear until a child is 18 to 24 months old. The first symptom is often frequent coughing. If your infant or child has bouts of coughing, especially at night or after running, frequent respiratory infections, or episodes of rapid breathing, ask your doctor to evaluate her for asthma.

How Can I Help My Child Avoid Asthma Attacks?

Talk to your doctor about appropriate treatments and how to avoid the things that trigger your child's asthma.

What About Medicines?

Quick-relief inhalers, known as bronchodilators, are often enough to treat mild childhood asthma. They help relax the muscles that squeeze airways shut during an asthma attack. The most widely used bronchodilators usually contain the drug albuterol (Ventolin[R], Proventil[R]). Use it only as often as prescribed. If it fails to control the attack, call your doctor or emergency room immediately.

What If Bronchodilators Don't Work?

Many children need to use daily medications to control the chronic inflammation of asthma. These medicines will not stop an attack once it has started. Daily use of inhaled medicines cromolyn (Intal[R]) or nedocromil (Tilade[R]) can help lower the risk of an attack, but your child must take them regularly. Ask your doctor about the newer oral medications-zafirlukast (Accolate[R]), montelukast (Singulair[R]), and zileuton (Zyflo[R]).

Your doctor may prescribe an inhaled corticosteroid such as beclomethasone (Beconase AQ[R]) or fluticasone (Flovent[R]). Corticosteroids in pill form may be prescribed for severe asthma. Salmeterol (Serevent[R]) is a nonsteroidal, long-acting bronchodilator that, when used on a daily basis, can help prevent asthma attacks. Another maintenance medication is theophylline (Theo-Dur[R], Slo-Phyllin[R]), but side effects may be a problem.

What Are Some Common Triggers?

Find out what brings on your child's asthma, and help her to learn to avoid the triggers or prepare for them. Common triggers include exercise, infections, allergies, irritants, and weather. Stress, and other emotions that bring on rapid breathing, may trigger an episode. Often, it is the asthma attack itself that brings on the stress. Teach your child how to calmly manage and deal with stressful situations to prevent an asthma attack or worsening of symptoms.

Using a bronchodilator before running or other physical activity can prevent asthma attacks. During respiratory infections, help control asthma episodes by keeping your child hydrated. Talk to your doctor about testing your child for allergies that may be triggers. Keep your child away from inhaled irritants such as cigarette smoke, paint fumes, and aerosol sprays. Restrict outdoor activity during times of high air pollution. Cold air is a common asthma trigger. A heavy scarf or ski mask can warm the air enough to reduce this trigger.

Dave Krishna, R.Ph., is a clinical pharmacist for the drugstore.com online pharmacy. For more information about these and other health-related conditions or to ask Dave a question, visit the "Ask Your Pharmacist" service at www.drugstore.com/ayp.

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