One of the great boons to asthma treatment is the Asthma Action Plan, which is why we post a link to one at the top of every page of AsthmaAllergiesChildren.com. However, doctors and parents have always been at a loss for how to deal with children under 5 who can’t reliably measure peak flows. Dr. Thomas F. Plaut, a pediatrician, has been a pioneer in treating children with asthma. In fact, some of us specialists would say he is exceptional among primary care physicians in really learning about it. He has written several books, notably One-Minute Asthma (the sales figures of which we look at with more than a touch of envy). Now he has developed a signs-based asthma action plan for the new edition of One-Minute Asthma as a Kindle edition, but he has very generously allowed AsthmaAllergiesChildren.com to introduce it to the world as part of his guest editorial. We are honored.
–Dr. Paul Ehrlich, Dr. Larry Chiaramonte)
AN ASTHMA ACTION PLAN FOR YOUNG CHILDREN
Asthma patients younger than five are hospitalized at more than double the rate of older children. There are several reasons for this:
• Their airways are smaller, and become blocked more easily.
• They experience upper respiratory infections, a major trigger, more frequently.
• Most of them cannot use a peak flow meter to monitor an episode.
• Their parents have not learned how to track the course of an asthma episode.
Only this last factor is within parents’ control.
Ask your health care provider to teach your how to score the four main signs of asthma, cough, wheeze, sucking in the chest skin and breathing faster. With this knowledge you will be able to monitor and treat your young child appropriately. As a result you will be able to avoid most emergency care and hospitalization.
In contrast, symptoms (what the patient feels) and general signs, such as poor appetite, fussiness, or listlessness are hard to score in a uniform fashion. They are often not an adequate guide to specific treatment.
A sign is an objective finding that an observer can see or hear and can score.
I devised a tool that enables parents to monitor their young child accurately and then treat them properly. I chose signs that appear early in an episode, change as an episode becomes worse, and improve when the episode gets better. The signs are cough, wheeze, sucking in the chest skin (retractions) and increased breathing rate. Here is how to score them:
Cough (in past two minutes)
Less than 1 per minute 1
1-4 per minute 2
More than 4 per minute 3
End of exhale 1
Throughout exhale 3
Inhale and exhale 5
Sucking in the chest skin
Barely noticeable 1
Severe (deep) 5
No increase 0
Slight increase 1
Moderate increase 2
Double usual rate 3
Add the four scores to get a total. This total places the child in one of four treatment zones.
A child with no signs of asthma scores 0 and is in the green zone. No change in treatment is needed.
A child who scores 1 to 4 points is in the high yellow zone. He has a mild episode and needs an increase in treatment.
A child who scores between 5 and 8 is in the low yellow zone He has a moderate episode needs more intensive treatment.
A child who scores 9 points or more demands immediate treatment in the emergency room or a well-staffed and equipped office.
Use the example below to check your ability to use these signs:
• Coughing twice a minute
• Wheezing throughout expiration
• Sucking in of the chest skin -barely noticeable
• Slight increase in breathing rate.
The total is five, the high yellow zone, and identifies a moderate episode.
The Signs-base Asthma Action Plan is available as a free download HERE. Ask your doctor fill it out. This written plan will guide your response to any asthma situation.
Copyright © 2010 Thomas F. Plaut, M.D. www.pedipress.com. Used with permission.