The inability to breathe causes anxiety and can be extremely frightening for children with asthma as well as for their caregivers. 

Primary-care clinicians can improve the quality of life for these patients with proper guidance and education designed to lessen the severity and symptoms of asthma and reduce exposure to potential triggers. 


Early intervention and education for children with asthma and their caregivers can improve the family’s quality of life by reducing trips to the health-care provider’s office, the clinic, or the emergency department as well as by minimizing hospital stays, missed school days, and parents’ loss of income due to staying home with the sick child.

This goal can be accomplished by counseling children with asthma and their caregivers on the avoidance of asthma-related triggers, approaches to daily asthma management and medication use, and actions to take when asthma worsens.

Children are extremely susceptible to environmental triggers that can cause and/or worsen asthma, as Wu and Takaro pointed out in Environmental Health Perspectives (2007;115[6]:971-975).

The offending substances and the severity of the asthmatic reactions these elements incite may differ from patient to patient, but health-care providers must become familiar with the long list of potential triggers in order to educate young patients and their caregivers and reduce the likelihood of asthma attacks.

Wu and Takaro named common household risk factors for asthma: tobacco smoke, house dust mites, cockroaches, dog and cat dander, and mold. 

But the full list of culprits that can bring on an asthma flare is much longer, encompassing such diverse stimulants as:

  • Inhalation of smoke from burning wood or burning leaves, or inhalation of chemicals;
  • Influenza, cold, sinus, and other respiratory infections
  • Acid reflux
  • Physical exercise
  • Certain medications such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs)
  • High humidity or cold or dry air
  • Shellfish or certain other foods as well as food additives;
  • Perfumes
  • Stress and many other factors, as specified by the American Lung Association (www.lung.org)

Clinicians should begin imparting asthma information to young patients and/or their caregivers as early as possible in the disease course and ensure that these individuals know how to use spirometers, other equipment or devices, and medications.

Continuous assessment of the patient’s ability to use such products properly and repeated demonstrations are necessary until the asthma is well-controlled and the child is able to manage the chronic condition.

Receiving guidance on how to lessen the severity and frequency of asthma episodes, and knowing the symptoms to watch for, helps the child and/or caregiver remain in control of the disease. Long-term control is achieved through compliance, awareness of the causes of the asthmatic attack, and the use of maintenance medications.

In the office, help the patient and family by developing an action plan that explains how to reduce and control asthma attacks. Encourage immunizations, particularly influenza and pneumonia vaccinations, to decrease respiratory infections in the young patient.

Finally, assess at every encounter spirometry and peak meter device usage as well as medication compliance and understanding. Ask about frequency of use of quick-relief inhalers. Anticipatory guidance and continuous reinforcement will help the child and family identify and treat asthma attacks early.