For most of his life, Jacob Jernigan, 10, would get frequent colds. This past May, his cough was so bad, his mom took him to the hospital emergency department. “It was very scary,” recalls Jaime Jernigan, Jacob’s mom. “His cough became so hoarse and uncontrollable, it sounded like croup.” Shortly afterward, they learned Jacob had asthma, and his croup-sounding cough was actually an asthma attack.

Asthma is a chronic lung disorder that causes many children to miss school, get sidelined when playing sports, and have trouble sleeping through the night. It can also make children more susceptible to allergies and viruses. Thankfully, asthma can be controlled. With medications and guidance from your health care team, your child can live a normal, active life – without being limited by asthma.

“Unfortunately, many children do not have their asthma under control, making them susceptible to asthma attacks,” says Cynthia Lamb, RN, AE-C, asthma care coordinator at Kaiser Permanente Colorado. Asthma attacks occur when airways tighten, inflame, or fill with mucus, which leads to coughing, wheezing, chest tightness, or difficulty breathing. Some attacks are so severe they cause permanent lung scarring or even death.

Daily dose of prevention
While some children go months or even years without asthma attacks, others are very susceptible to them. “Children who are prone to frequent attacks should be on a daily medication, known as a controller or preventer,” Lamb explains. "This medication, usually an inhaler, provides long-term control that protects against asthma triggers.”

Jacob now manages his asthma with daily controller medication. “So far, this medication has helped Jacob avoid severe asthma attacks,” says Jernigan. “I’m really grateful for this proactive approach.”

“Controller or preventer medication should be taken every day, even when symptoms are not noticeable,” Lamb explains. “We often compare controller medication to brushing your teeth. Just as brushing teeth can prevent cavities, controller medication helps prevent asthma attacks.”

“It’s important for parents and children to know what well-controlled asthma looks like,” says Peter Cvietusa, MD, a board-certified asthma specialist and co-chair of Kaiser Permanente’s Asthma Implementation Resource Group. “When it’s well controlled, children can keep up with regular activities without relying on their quick-relief inhaler more than two days a week.”

When quick-relief medicine is necessary
Albuterol is the generic name for quick-relief medications, and one inhaler should last about one year. “If your child goes through several quick-relief inhalers each year, it’s important to tell your pediatrician, who may want to prescribe a controller medication for everyday use,” Dr. Cvietusa explains.

To assess your child’s asthma, Dr. Cvietusa encourages you to consider the “Rule of 2s”: If children are using their quick-relief inhaler more than two days a week (other than for physical activity), or if their asthma is waking them more than twice a month, it is not under control. For more help assessing your child’s asthma, visit asthmacontrol.com.

Treating severe asthma attacks
To treat severe asthma attacks, children may be given “burst” medication – a potent dose of steroids. Prednisone is the generic name for “burst” medication. “This is a much higher dose of steroids than what is in a daily controller inhaler,” Dr. Cvietusa explains. “It is much safer and healthier to be put on daily controller medication than to take frequent courses of prednisone.”

The “September Epidemic”
After school resumes each fall, health professionals in Colorado and neighboring states see a spike in the number of children seeking emergency treatment for asthma attacks. “During the carefree days of summer, many children neglect to take their controller medication every day,” Lamb explains.

She wants children to get back on track with their controller medication before school resumes so their bodies are prepared to fight off common asthma triggers, such as viruses and fall allergens. Using a sophisticated electronic registry, Lamb searches at-risk patients and sends their parents a back-to-school checklist, encouraging them to

• refill their child’s daily controller medication, if prescribed, and support its daily use
• have a quick-relief rescue inhaler
• have an updated Asthma Action Plan, listing their child’s medications, peak flow rates and contact information in case of emergency

In addition, it is important for parents to submit a current medication authorization to their child’s school, if necessary, and have their child receive a flu vaccine in fall.

“Getting children’s asthma under control can make a big difference in their quality of life,” Dr. Cvietusa continues. Once children begin a controller medication, they often become more active during the day, sleep better at night and, as in Jacob’s case, are better able to fight off colds. “He hasn’t had one cold since starting the medication,” Jaime Jernigan says. “And I can run far without losing my breath,” Jacob adds.

Kaiser Permanente has electronic medical records that help doctors, asthma care coordinators, and clinical pharmacists stay well informed on a patient’s condition and medication use. In many cases, it allows them to reach out to patients who are at risk, before they have bad asthma attacks. “Parents can also go online to refill their child’s medication, e-mail their doctor, or get educated on managing their child’s asthma,” Dr. Cvietusa adds.

Like many members of the asthma care team at Kaiser Permanente Colorado, Dr. Cvietusa trained at Denver’s National Jewish Health – one of the nation’s leaders in respiratory care. The team’s expertise, along with their coordinated care approach, has helped Kaiser Permanente Colorado achieve top-quality ratings from many prominent organizations including NCQA and US News & World Report.

To learn more about managing your child’s asthma, visit kaiserpermanente.org.