Asthma attacks can impact not just children, but entire families. Getty Images
Asthma is a chronic respiratory disease with a profound, and not fully appreciated, impact. It is particularly perilous to children — and, more specifically, children of color.
Uncontrolled pediatric asthma consistently ranks within the top three causes of emergency department visits in Milwaukee.
Asthma control is easier to achieve in affluent communities. However, in low-income areas, where substandard housing and low health literacy are common, poorly controlled asthma regularly leads to missed school and work days, and has the potential to cause permanent lung damage.
The Journal Sentinel gathered information from doctors, asthma organizations and housing advocates to create a guide for managing your child’s asthma.
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Signs that you or your child may have asthma include shortness of breath, wheezing, chest tightness, changes in breathing, chronic congestion, clammy skin, feverishness, restlessness, difficulty sleeping through the night because of breathing issues, and itchiness around the throat, neck, chin or eye areas.
The Asthma and Allergy Foundation of America has a full list of symptoms on their website.
Having a family history of asthma is a risk factor for developing the disease and diagnoses of eczema and allergies are also risk factors.
Take your child to your pediatrician, and to a doctor who specializes in asthma, such as a pulmonologist, allergist or immunologist. You can also take your child to a clinic that specializes in asthma, such as Children's Hospital of Wisconsin Asthma/Allergy and Clinical Immunology Center, the Allergy, Asthma & Sinus Center or one of many Allergy and Asthma Centers.
You can find support through Fight Asthma Milwaukee Allies, a local nonprofit that provides education and support to families dealing with asthma.
Most doctors do not diagnose children under 5 years old with asthma. However, this does not mean the child cannot receive treatment. If your child is having breathing issues and you suspect asthma or have a history of asthma in your family, it is best to see a specialist.
If you are using Medicaid or BadgerCare Plus (also referred to as CHIP), you can use the Forward Health search tool. If you have private insurance, you should be able to search on the website for in-network providers with the right specialty.
If you are eligible for the Women, Infants and Children (WIC) program, you can call 800-642-7837 or text 608-360-9328 for assistance.
If a child is having trouble with an inhaler, they may need to use a spacer, so the medication is delivered properly. You can purchase a spacer on your own, although it is recommended you request one from your pediatrician or specialist. The CDC has a technique guide here.
For other children, their inhaler technique may be off. Before using a metered-dose inhaler, it should be shaken 10-15 times and the user should fully exhale. Then, the user should ensure their mouth is completely closed around the mouthpiece before taking a deep and slow inhale. For dry powder inhalers and nebulizers, the National Institute of Health has a user guide. You can also have a specialist demonstrate for the child or you can review this video from the CDC.
Even though they look alike, these medications have different functions. The controller is taken daily to calm the airways and a rescue inhaler should be used when those airways begin to spasm in response to a trigger.
Doctors often note that it is essential for children who are prescribed both ensure they take their controller medication on a regular basis, even if it does not feel needed. Doctors also recommend children have at least two rescue inhalers — one for school and one for home.
Common household asthma triggers include dust, mold, humidifiers, pet dander, pest infestations (such as cockroaches and bedbugs), rodent infestations (such as rats and mice), plug-in fragrances, deodorizing sprays, certain chemicals such as bleach, extreme heat or cold, and smoke of any kind including cigarettes.
The Wisconsin Asthma Care Program also features a checklist of household related asthma triggers.
Stress, overexertion and seasonal factors are some of the most common non-household triggers. Doctors encourage patients with asthma to stay away from pollen, ragweed and other common allergens during certain times of the year, and may suggest patients who are extremely sensitive to regularly take a low-dose antihistamine.
To prevent overexertion, doctors recommend avoiding exercise in extreme temperatures, staying hydrated and taking frequent breaks. However, it is not advised to prevent children (or adults) from engaging in any sports or physical activity to prevent flare-ups.
You can:
- Use hypoallergenic bedding (pillow covers, sheets, comforters, etc.)
- Keep carpets and rugs vacuumed with a HEPA vacuum
- Avoid using plug-in fragrances or deodorizing sprays
- Clean with vinegar instead of bleach
- Smoke outside or not at all
- Sweep and dust regularly
Homeowners and landlords are responsible for addressing and removing asthma triggers. Agencies that may be able to help low-income homeowners make repairs, include Revitalize Milwaukee, Habitat for Humanity, Housing Resources Inc., and Community First.
The city of Milwaukee also has a grant program designed to help with major home repairs. Take Root Milwaukee has a list as well.
For renters who have signed leases taking responsibility for any pest management, you will have to find a company to address any infestations. If that is not in your lease and the landlord is not making repairs, you can reach out to Mediate Milwaukee for relief.
You can also report the landlord to the Department of Neighborhood Services. Other triggers you can report include plumbing problems and leaks that may lead to mold developing, a lack of heat or insufficient heat in the wintertime, and a mice or roach infestation.
Technically, DNS cannot issue work orders forcing a landlord to clean up existing mold. However, you can seek out a mold remediation company to test suspected areas of mold and provide you with a report. Some companies, such as AJ Development Group, provide this service free while others may not. If you have proof of mold affecting you or your family’s health, you can reach out to the Milwaukee Rental Housing Resource Center to learn more about your legal rights.
You can purchase a peak flow meter, a device that measures exhales. You can also check with your insurer, Medicaid or local WIC office to see if they will cover the purchase of an at-home spirometer, which offers a more comprehensive evaluation of lung function.
The Centers for Disease Control and Prevention’s National Asthma Control Program uses the acronym “EXHALE” to describe how asthma patients achieve asthma control:
- Education on asthma self-management
- X-tinguishing smoking and exposure to secondhand smoke
- Home visits for trigger reduction and asthma self-management education
- Achievement of guidelines-based medical management
- Linkages and coordination of care across settings
- Environmental policies or best practices to reduce asthma triggers from indoor, outdoor, or occupational sources
Signs of uncontrolled asthma are present if you or your child:
- Have visited the emergency room or an urgent care clinic more than twice for an asthma attack
- Have been hospitalized within the last year due to asthma
- Frequently become short of breath from common activities, such as walking up the stairs
- Experience trouble breathing and fail to sleep through the night because of it
- Have regularly been increasing the dosage of asthma medications
- Go through multiple inhalers within a year
If you or your child experiences any of these scenarios, it is recommended that you see a specialist right away.
This is a myth. Although asthma symptoms may fade in some children, failure to address uncontrolled asthma in childhood can lead to respiratory issues down the road, including poor lung function, labored breathing and diseases similar to COPD.
Asthma triggers in the home
