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This is the second of two articles on children and respiratory health, and focuses on managing children’s asthma.

Part one examined the effects of poor indoor air quality on children.

iranda Carr, pictured above, seems to be a fairly typical six-year-old girl. She loves dancing, music and playing with her friends. Indeed, it's hard to believe that the bubbly first-grader from New Brunswick spent the first few years of her life struggling to breathe. Looking back, her mother Jennie says those years are a blur of emergency room trips and doctor's appointments. When Miranda finally received a diagnosis of asthma, Jennie says she was scared, but relieved. "We finally had an answer." As it turned out, this was just the beginning of their journey to getting Miranda's asthma under control.

Asthma is a chronic lung condition that is characterized by difficulty in breathing. Asthma causes the airways to narrow when they become irritated or bothered. This makes it difficult for the air to move in and out. This narrowing or obstruction can cause one or a combination of the following symptoms: wheezing, coughing, shortness of breath, or chest tightness.

According to Statistics Canada almost 2.4 million Canadians have asthma; many are children. There is no cure for asthma, but symptoms can almost always be controlled.

			About asthma management
			Asthma is a common, but manageable, disease. The goal of asthma management is total control of your child's asthma symptoms. With good asthma management, your child should be able to live almost symptom-free and participate in regular activities and most sports. Good asthma control means: No missed days of school or regular activities because of asthma-related symptoms Undisturbed sleep; no night time or early morning symptoms that interfere with sleep Not using the reliever medication (quick relief inhaler) more than four times a week (except when taken before exercise) You can manage your child's asthma symptoms by: Learning about asthma Knowing your child's triggers and avoiding them Learning how to use medications properly Having a written asthma action plan It's important to schedule regular appointments with your child's doctor to make sure asthma symptoms are well controlled. You should also know the warning signs of worsening asthma control.

Jennie recalls feeling overwhelmed when she first learned that Miranda had asthma. "We would have done anything to help Miranda feel better - we literally ripped the house apart," says Jennie, describing how she and Miranda's dad, Rod, frantically pulled up carpets, and installed humidifiers and dust covers.

Certain irritants or "triggers" can set off asthma symptoms. An asthma trigger can be something your child is allergic to: pets, dust mites, pollens or moulds. A trigger can also be an irritant such as tobacco smoke, cold air, strong smells, strenuous exercise or a cold virus. Not everyone with asthma reacts to the same triggers. The key is to figure out what triggers your child's asthma symptoms.

Cathy Gillespie, program coordinator for the Children's Asthma Education Centre in Winnipeg, says it's common for parents to spend lots of time and money on protecting their children from household asthma triggers. Unfortunately, the steps they take aren't always helpful against their child's individual triggers. Research published in the August 2004 issue of the Journal of Allergy and Clinical Immunology supports this view. Parents involved in the study reported buying a mattress cover for a child whose asthma is triggered by plant pollen, but not keeping the windows shut to keep pollen out of the house.

As a certified asthma educator, Gillespie works with families to help them identify their child's individual triggers. "Asthma is a common disease, but it's unique for every child," Gillespie explains. Certified asthma educators (CAE) are trained to help people with asthma and their families to manage their condition and lessen its impact on quality of life.

In Jennie's experience figuring out her daughter's asthma triggers meant becoming something of a detective. A certified asthma educator advised Jennie to keep a diary of Miranda's asthma symptoms and possible triggers. After several weeks she was able to see some patterns. Miranda suffered asthma attacks when she breathed very cold air. Hot, humid air also proved to be a trigger for symptoms. The common cold virus was another thing that set off breathing problems. When Miranda came down with a cold, she often developed a cough that would linger for weeks.

Identifying Miranda's triggers was just one piece of the puzzle. Although Jennie was careful about following the daily medication schedule, she found that Miranda still wasn't getting better. "She would cough until she was blue - it was terrifying." When Miranda was referred to a pediatrician experienced in asthma care, Jennie discovered that she wasn't administering her daughter's asthma medications properly.

Learning how to use asthma medications and devices is a critical part of maintaining good asthma control. It made a big difference once Jennie had a clear understanding of the correct use of reliever (quick-relief) medications versus preventer (controller) medications, a common source of confusion for many people with asthma. She also learned how to properly use and maintain a spacer -a holding chamber for asthma medication.

Armed with the right information, Jennie and Rod were able to get Miranda's asthma under control. She was soon sleeping better, using her quick-relief inhaler less often and missing fewer days of school. "It was like a miracle," says Jennie of her daughter's transformation.

			Asthma and Teens
			It's common for teens to resist taking their asthma medications in front of their friends. Some may even deny that they have asthma. Understandably, many teens don't want their friends to see them as different. As a result, some teens stop taking their daily preventive medications and rely only upon their quick-relief inhalers. This can lead to increased asthma flare-ups and in some cases full-blown breathing emergencies. What parents can do: Make an appointment for your teen to meet with a certified asthma educator. Many centres have teen meetings where your child can learn about asthma in a teen-friendly and supportive environment. Talking to other teens with asthma can be a great help. Find out if your teen's preventer (controller) medication can be taken at home in the morning and evening. Be sure your teen understands the purpose of the medicines used to treat asthma and knows the difference between the reliever and preventer medications. Help your teen monitor his/her breathing with a peak flow meter. A peak flow meter is a device that measures the rate of airflow, or how fast air is able to pass through the airways. Ask your asthma educator or doctor to demonstrate its proper use. Note: peak flow meters cannot be used reliably in children under six. Involve your teen in treatment choices. Teens should be encouraged to ask questions and voice concerns. For further reading see Coping Strategies for Children and Teens

The Canadian Asthma Consensus Guidelines recommend that every person with asthma have a written asthma treatment plan. An asthma action plan helps to ensure that worsening symptoms can be properly controlled. It can also help to prevent a full-blown breathing emergency. "Asthma does not disappear when your child is not experiencing symptoms," warns Gillespie. "It's important to have an action plan and work with your child's doctor."

Jennie created a written asthma action plan with the help of Miranda's doctor. The plan outlines what medications to use and when, Miranda's asthma triggers and the warning signs of poor asthma control. Signs that your child's asthma is not well controlled include night waking, trouble breathing with exercise, and coughing at night. Coughing or wheezing while at rest is another sign that your child's asthma is not well controlled.

Miranda's asthma action plan was also a useful tool for helping teachers understand her needs. "It took a while - we had to do some education," says Jennie. "But we were able to convince the school to keep Miranda indoors on very cold or smoggy, hot days." And when Miranda comes down with the sniffles, Jennie knows to keep a close eye on her and encourage her to rest and take time to catch her breath.

Today Miranda is enjoying her new role as an asthma advocate. She is working with her mother to get the message out to Canadians that with the right support they too can live well with asthma.