Get the Right Treatment Plan
Whether it is to start — or to continue — controlling asthma symptoms, a teen needs to talk to his physician about creating and using a personalized asthma action plan. Working with his physician, this means listing severity of symptoms, asthma triggers, exercise modifications, peak flow meter personal best readings, and control medications.
A teenager's asthma action plan can provide good protection against potentially problematic situations by indicating, for instance, when she should use medication when participating in a competitive sport. It also can help avoid possibly scary or embarrassing episodes such as having an asthma attack at a friend's party where partygoers are smoking.
But like the best-laid plans, implementation of an asthma action plan sometimes may fall short. Perhaps your teen might forget to take his medication as prescribed at the right time or he might find it embarrassing to use his peak flow meter to get readings when eating out with his friends. Sometimes he might think — incorrectly — that he is feeling better without his daily medication and doesn't need it. But there are ways for your teen to get back on track and make sure he is taking care of himself.
It's easy for a teen to underestimate the severity of his symptoms. A peak expiratory flow meter can help detect if his lungs are not functioning as well as they should. Generally, he might not notice that his lung function is not good until it is at 50 percent of his personal best peak expiratory flow — a level that could put him in danger if not treated promptly.
Teens need to meet with a physician or health care provider on a regular basis. For teens already diagnosed with mild cases of asthma that have been under control for at least three months, a visit about every six to twelve months would be advised; for teens with moderate asthma, a visit every three to six months would be recommended; and for teens with uncontrolled or severe asthma, a visit every one or two months would be called for.
The discussion should focus on the goals of treatment: to avoid long-term lung damage related to underlying inflammation of the lungs; to decrease the severity and frequency of asthma episodes by avoiding triggers; to treat asthma symptoms as they occur; and to support a healthy quality of life that lets a teen participate in daily activities at home, school, and in the community.
During an office visit, the health care provider will ask the teen about symptoms and peak expiratory flow readings — whether they have been holding steady, improving, or getting worse. The provider also will ask about any asthma attacks, including those that occur during exercise or at night.
To better keep track of these events triggering asthma symptoms, your teen can keep a personal asthma diary either online or on paper. The diary can be used to record ongoing information for each day of the week on points such as:
Her personal best peak expiratory flow meter reading.
Daily morning and afternoon/evening peak expiratory flow meter readings.
Scores from the peak expiratory flow readers that indicate either the green zone (80–100 percent of the personal best reading); the yellow zone (50–79 percent of personal best); or the red zone (below 50 percent of personal best).
Symptom scores based on: no symptoms such as wheezing or coughing; mild symptoms that may occur during physical activity but not while resting; moderate symptoms that prevent sleeping or keeping active; and severe symptoms that occur even when resting and can cause difficulties with walking and talking.
Notation if quick-relief medications are used to address symptoms.
Triggers, location, weather, air quality, and type of environment where asthma symptoms occurred.
Any visits to the physician, hospital, or hospital emergency room due to urgent medical treatment related to asthma.
Monitoring lung function with a peak expiratory flow meter lets her detect — and then treat — any problems quickly. Your teen can ask the physician or health care provider to explain what control medications should be used daily or what quick-relief medication should be used and when. She should also review how to correctly use the medications and make sure she's getting enough to control her symptoms.
These discussions can help the teen feel that she's more in control. It also will help underscore what will happen if your teen follows — or declines to follow — her action plan. The teen should be reminded to check in with her physician to review her action plan or daily personal asthma diary and to ask questions if problems arise.
Either you or your teen should check to see that an up-to-date action plan is on file with her school, physical education teacher, and sports coach. This lets them know what medications she is using, whether exercise modifications are needed, what symptoms should be monitored, and when emergency assistance might be required.
Guidelines for Teenagers
The current asthma guidelines released by the National Asthma Education and Prevention Program include an asthma severity scale created for children and teens from ages twelve though adult with asthma who are not currently taking long-term control medications. The scale can provide a health care provider a base by which to begin or adjust treatment. These levels are:
Intermittent — Symptoms occur less than two days a week, two nighttime awakenings related to asthma are reported, quick-relief medications are used less than two days a week, and no interference is reported with normal, daily activities.
Mild Persistent — Symptoms occur two or more days a week (but not daily), three to four nighttime awakenings related to asthma occur monthly, quick-relief medications are used more than two days a week (but not daily), and minor limitations are reported with normal, daily activities.
Moderate Persistent — Symptoms occur daily, more than one nighttime awakening related to asthma occurs weekly (but not nightly), quick-relief medications are used daily, and some limitations are reported with normal, daily activities.
Severe Persistent — Symptoms occur throughout the day, nighttime awakenings related to asthma occur seven days a week, quick-relief medications are used several times per day, and normal, daily activities are reported extremely limited.
At the current time, data is inadequate to link flare-ups with levels of severity. However, for treatment purposes, the guidelines recommend that patients ages twelve through adult who have had two asthma episodes in the year requiring treatment with oral corticosteroids may be considered the same as patients with persistent asthma (even if they fail to show signs of impairment associated with the other levels). Once treatment has started, your health care provider can determine if your child's symptoms — as in the younger age groups — are well controlled, not well controlled, or poorly controlled using the current guidelines. (See Appendix C.)