Attention parents of children with asthma. Summer has probably been an easy time, with few if any symptoms or trips to the emergency room. Perhaps your child has stopped using a daily preventative inhaler, or never used one consistently.

Now is the time to get back on track, because within weeks of returning to school, a child with asthma is at great risk of having a serious attack. The best way to prevent an attack is to use an anti inflammatory inhaler every day, whether you think the child needs it or not.

Back to school asthma has been known for years. In September and October, there is a peak in the number of kids with acute asthma attacks who are rushed to the emergency room or hospitalized. Back to school asthma occurs when kids come back together and spread germs, and we get a striking increase in hospitalizations for asthma. Viral respiratory infections are the leading triggers of asthma attacks.

But viral infections are not the only cause of back to school asthma. Combined with the immunity lowering stress of a new school year and an increased exposure to indoor allergens at school, viruses can create havoc on the hypersensitive airways of children with asthma. While most children use a "rescue" inhaler a short acting bronchodilator like albuterol when they start to wheeze or before exercise, this temporary remedy may not be enough to head off a more serious attack.

Asthma afflicts about one child in 10 in the United States, for a total of 7 million youngsters. Every year, some 5,000 people with asthma, most of them children, die from acute attacks, a toll that could be cut by 80% if the disease were properly treated.

Children with asthma have overactive immune responses to things like viruses, allergens and pollutants. Their so called twitchy airways become readily clogged by immune cells and mucus when exposed to an irritant.

Unlike a cold, asthma is not a once in a while problem: it is always present, even when there are no symptoms.

Asthma is a chronic disease with acute manifestations. But many families, doctors and patients do not view asthma as a chronic illness, and they only treat it when acute attacks occur. As a result, there are 2 million trips to the emergency room and half a million hospitalizations for asthma attacks every year. These could be cut in half if asthma were treated daily with controller medications.

A Canadian study in 2001 demonstrated the September epidemic of asthma attacks in children and the risk of not using preventative inhalers. In their report in The Journal of Allergy and Clinical Immunology, January 2005, is a graph showing a striking annual mid September peak of hospitalizations over a 10 year period in Ontario among 5 to 15 year olds with asthma. The results of this study revealed that while 80% of children suffered upper respiratory viral infections during the first weeks of school, those who required treatment in emergency rooms or hospitalizations for acute asthma attacks were much less likely to be regular users of an anti-inflammatory inhaler. The take home message from this study is that children with asthma should not be taking drug vacations in the summer or any other time.

Other preventative tactics

• Since hands are the main vectors of common viral infections, the best advice is to wash your hand frequently, for 10 15 seconds with soap and water, to keep them as germ free as possible. Avoid touching your eyes, nose and mouth unless your hands have just been washed.

• Tell your children not to share food, cups, glasses or eating utensils. In addition, advise your children to cover their coughs and sneezes either with facial tissue, or if not available, their sleeves or parts of clothing rather than using their hands.

• Every child with asthma should get an annual flu shot. At this time, there are no other vaccines currently available to prevent other common viral infections.

• Every child should have an asthma action plan so that they know what to do when asthma symptoms begin. A peak flow meter should be used at the same time every day to assess breathing capacity. Peak flows in the cautionary (yellow) zone and the need to use rescue inhalers more often (red or yellow zones) often signal worsening asthma and should set off a warning to put the child's customized action plan into play.

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Michigan Allergy, Sinus & Asthma Specialists

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