Asthma, the most common chronic children’s disease, affects an average of one in 13 school-aged children, according to the Centers for Disease Control and Prevention (CDC). A chronic inflammatory disorder with attacks ranging from mild to life-threatening, its symptoms include shortness of breath, coughing, wheezing and chest pain. Asthma can limit activity and affect a child’s overall well-being. It can also place a significant financial and emotional burden on the family. The number of new cases, hospitalization visits, and deaths from asthma has increased dramatically over the last 20 years.

While these statistics are staggering, with proper planning and education, children and their parents can manage their asthma and learn to breathe easier.

Asthma Management

Doctors are often reluctant to diagnose young children with chronic diseases like asthma. But through intervention, parents are better prepared to manage symptoms.

The goal is to identify asthma triggers, remove life barriers, and motivate healthy behaviors, including medication adherence and self-monitoring of symptoms. One way to control attacks and symptoms is to identify and avoid environmental triggers such as:

• Dust.
• Pollution.
• Stress.
• Household products (aerosol sprays, cleaning solutions, paint).
• Smoke (cigarettes, pipes or cigars, wood-burning stoves, fireplaces, charcoal cooking).
• Infections, colds, upper airway congestion, sinus drainage and sore throat.
• Allergies (animals, insects, foods, pollens).
• Life challenges can get in the way of health. Issues like language barriers or low literacy can often cause confusion about medical advice or prescription guidelines. Parental behaviors are also important to address early. For example, smoking in the home and car can greatly aggravate a child’s symptoms. Knowing the triggers, barriers and behaviors is a critical way to gain and maintain control of asthma.

Motivating Healthy Behaviors

The health of a child is not a “one size fits all” proposition. At Nurtur, a wellness company with a track record of asthma management, including the rare tradition of addressing asthma in children as young as newborns, health coaches play a prominent role in the administration of care.This is yet another area where statistics show that the use of a health coach can return favorable outcomes.

A key, first step is to incorporate the unique needs, which range from the cultural to the socioeconomic. Health coaches go through motivational interview training to learn techniques, such as asking open-ended questions and exploring readiness to change.This background information helps health coaches effectively assess the individual member’s needs. For Nurtur, which is a subsidiary of the Centene Corporation, its approach is based on an inclusive people-centered model and coaching method designed to understand the person in toto.

The National Institutes of Health’s evidence-based guidelines provide a serviceable template for the diagnosis and treatment of asthma:

1. Measures of assessment and monitoring
   • Obtained by objective tests, physical examination, patient history and patient report.
   • Diagnose and assess the characteristics and severity of asthma
   • Monitor response, i.e., whether asthma control is achieved and maintained.
2. Education for a partnership in asthma care
   • Provide patients with the skills necessary to control asthma and improve outcomes.
   • Asthma self-management education should be integrated into all aspects of asthma care, and it requires repetition and reinforcement.
3. Control of environmental factors and co-morbid conditions that affect asthma
   • Evaluate the role of allergens and irritants, particularly indoor inhalant allergens.
4. Pharmacologic therapy
   • Stepwise approach.
   • The type, amount and scheduling of medication is dictated by asthma severity for initiating therapy.
   • Level of asthma control for adjusting therapy.
   • Step-down therapy (after three months) is essential to identify the minimum medication necessary to maintain control.