Establishing an asthma action plan for your pediatric patients is a great first step, but helping them and their families adhere to it could be even more important.

Self-management through an asthma action plan that guides patients in adjusting their medication improves quality of life, reduces use of health care and leads to fewer days missed from school. Poor adherence to medication use has been identified as a reason for inadequate control of preventable symptoms.

“A child’s asthma action plan should go wherever they go. A copy at home — maybe on the refrigerator — copies at school with teachers and the school nurse and anyone else who cares for the child,” said Ronald L. Morton, M.D., pediatric pulmonologist with Norton Children’s Pulmonology, affiliated with the UofL School of Medicine. “A six-month review with their pediatrician or asthma specialist keeps it current and allows for updates.”

Why children may drift from their action plan

For some children and especially teens, there are many sources of difficulty adhering to their asthma action plan. These can include:

• Reluctance to use inhalers if they have to leave class or don’t have privacy
• Concerns about their friends knowing they have asthma
• Teachers who don’t believe a child’s report of symptoms
• Adolescents not understanding the need to review their status with their health care provider when they are feeling well
• Parental supervision that may lapse as a child exerts independence
• Complacency that can lead to a tendency to focus on treatment rather than prevention
• Using ineffective lifestyle changes such as exercise to prevent attacks, leading to delaying medication use

“Allowing the child to have more direct involvement with their pediatrician or asthma specialist when it comes to reviewing their action plan and medication can give them a greater understanding of their situation, leading to a greater sense of control and confidence,” Dr. Morton said.

For teens especially, who may feel a social stigma about their condition, they may find that discussing their asthma openly with friends, teachers and others will be met with support, according to Dr. Morton.

Asthma flare-up prevention

There are some things patients and families can do to help prevent a flare-up:

• Know your asthma triggers and avoid them.
• Stick with controller or maintenance medications, especially when you’re feeling fine.
• Establish a schedule for asthma management tasks. Make taking medication a part of the daily routine like brushing teeth.
• No smoking. Step away from secondhand smoke and discuss quitting with family members who smoke.
• Provide a clean, dust-free room with special mattress and pillow covers to help limit environmental triggers.
• Get a flu shot every year.
• Many patients with asthma can participate in a broad range of sports with proper training and medication. Sports such as swimming and baseball can be less likely to trigger asthma flare-ups.

What an asthma action plan should include

Many asthma action plan templates are available. In addition being shared with the child’s caregivers, the plan should be made up of three parts customized for the patient to include their medications, triggers and other individual information.

• Green zone – Asthma is in control: No coughing, wheezing, chest tightness, shortness of breath during the day or night and no limitations on usual activities. What to do: Avoid asthma triggers, take daily control medications as directed.
• Yellow zone – A flare-up: Coughing, wheezing, chest tightness, shortness of breath, waking at night due to asthma or ability to do some, but not all, usual activities. What to do: Continue taking daily control medication, start rescue medication to control symptoms. Call your pediatrician or asthma specialist if two treatments don’t relieve symptoms or you need to take your rescue medication more than twice in a week.
• Red zone – Rescue medication is not helping, breathing is hard and fast, can’t walk or speak well or other symptoms in the yellow zone are the same or getting worse after 24 hours. What to do: Call your doctor or seek more medical help. The Norton Children’s Pulmonology office can be reached at (502) 588-4940.