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It seems as if the attack always comes at night.
On a weekend, with the doctor's office closed until Monday.
A small frightened child and an equally frightened parent, struggling alone in the dark against a potentially life-threatening disease.
Questions fill the mother's mind: Will it pass this time — or will I need to get everyone out of bed and rush to the emergency room? Should I give her another puff on her inhaler, or has she had too much already? Was I wrong to let her play out in the cold today? If I know it's not her fault, why am I so angry? And how will we get through the weekend when I'm so exhausted
Monday morning, at the doctor's office: "She seems to be breathing fine," they say. The look in the doctor's eyes says more: overprotective parent . . . manipulative child
A handful of prescriptions for drugs with strange-sounding names and confusing instructions — short-acting, long-acting. Something about steroids — aren't those supposed to be bad for you? Does anybody know what the long-term side effects are? Am I doing my child harm?
Waiting at the pharmacy. The cash register rings. Again. And again.
Back home, a phone message from the school. "She's been missing so many days, she's falling behind." And another from the boss: "We need to know when you'll be in."
Arguments at home. The same old arguments. Over who can smoke and where. The dog. The carpets. And whether it isn't all just in her head anyway.
Friends and relatives are offended by the suggestion that their house is too dusty, that she can't ride in their car if they insist on smoking while driving. The teacher still doesn't see why she can't wait until lunchtime to get her inhaler from the office.
And it's only Monday.
I've seen the toll asthma takes on families when they show up, worried and exhausted, in a hospital emergency room. Or when they have to fight to be taken seriously by teachers, friends, and relatives. Or when they somehow have to find a way to deal with asthma on top of all the other pressures they face in their daily lives.
For too many parents and children, asthma feels like a roller coaster without the safety bar.
But it doesn't have to be that way. Not any more.
New medications and research and new insights into why asthma occurs have sparked a revolution in asthma treatment.
It used to be that all we really could do was react to asthma — keep an eye on it and try to manage the symptoms when they occurred. Inevitably, though, many patients bounced from crisis to crisis.
Today, we don't have to react. With the right combination of environmental controls and newer, safer medications, we can prevent asthma symptoms from starting.
These new techniques don't offer a cure, in the sense that we can make the underlying disease go away for good. But they come pretty close. They offer a way to control your child's asthma and allow him or her to lead a normal, healthy, active life.
A good analogy is nearsightedness. Glasses or contact lenses don't cure it. But they remove the limitations that nearsighted people would otherwise face, allowing them to drive, read the blackboard in school, catch a baseball, and do just about anything else that people with 20-20 vision can do.
In our medical center — and others in the Kaiser Permanente health care system — we've been working with these new medications and techniques, and we've learned how big a difference they make.
But we've learned something else as well: They're not enough. You can think of them as tools. But even the best tools aren't much use without the knowledge of how to use them. The new medications and tools for asthma treatment are no different. By helping parents and children learn how to use them more effectively, we've seen dramatic changes for the better among our own patients.
The other part of the equation is to put parents and children in charge of their own asthma care. The traditional model of health care, with the doctor making most decisions and the patient following along, isn't very effective in asthma care. A large part of our success has come from helping our patients and their families understand exactly why asthma happens and what they can do to keep it under control.
We've worked with them to apply simple, common-sense techniques to make these medications even more effective with fewer side effects. We've helped them take other steps that have reduced their need for medication. And, working together, we've come up with practical solutions for the real-world problems of asthma, such as how to get relatives and teachers to understand.
We've learned from our patients as well. We've learned about the obstacles they've faced (which are surprisingly similar from one patient to the next), about their fears and concerns, about what they have discovered that works.
This book distills those lessons. You can think of it as a sort of user's manual that helps you understand and make the most of the new advances in asthma treatment.
I can't promise a secret miracle cure for asthma. But I can offer an alternative to living from one asthma crisis to the next. With the right techniques and medications, the vast majority of kids with asthma can live full and normal lives — in control of their asthma.
The Most Important Lesson
In the chapters that follow, we'll explore all of these concepts in detail. But first I'd like to share the most important lesson we've learned about conquering asthma:
The more you expect, the more you'll achieve.
A pamphlet published by the National Institutes of Health sums it up best: "Your Asthma Can Be Controlled: Expect Nothing Less!"
When you've been living from crisis to crisis, it's easy to get discouraged. It's easy to start believing that the medications don't work, or that your child's asthma is especially resistant. It's easy to think that what you do doesn't matter much. That kind of thinking can create a vicious cycle. When kids, parents — and yes, even doctors — set their expectations too low, they're less likely to stick with the things that can really make a difference.
So if you've felt discouraged, I urge you to take the first step right now: Set your expectations high. Don't settle.
The results will follow. You and your child deserve no less.
Copyright © 2001 Harold J. Farber, M.D., and Michael Boyette
|How to Use This Book||xv|
|Introduction: The Mystery Epidemic||xvii|
|Part 1||The Asthma Revolution|
|3.||Welcome to the Revolution||11|
|4.||An Ounce of Prevention||19|
|Part 2||The Three Lines of Defense|
|5.||The Three Lines of Defense||25|
|6.||Managing the Environment||36|
|7.||Managing the Breathing Tubes||56|
|9.||Putting It All Together: How to Create an Asthma Self-Management Plan||100|
|Part 3||Parents' Guide|
|10.||Finding the Right Doctor||123|
|11.||Getting Your Health Plan On Board||133|
|12.||Choosing and Using the Tools||139|
|13.||Asthma through the Seasons||154|
|14.||Infants and Toddlers||159|
|15.||Teenagers and Asthma||165|
|16.||Asthma outside the Home||168|
|17.||Complementary and Alternative Treatments||181|
|18.||The Future of Asthma Care||187|
|19.||Frequently Asked Questions||193|
|Appendix A||Daily Asthma Diary||213|
|Appendix B||Average Peak Flow Rates for Children||214|
|Appendix C||Selected Asthma Resources||216|
Posted May 12, 2003
I am a working mother of a two-year old recently diagnosed with asthma. After two hospitalizations in as many months, my husband and I felt scared, concerned, worried and clueless about asthma and how best to help our son. I wanted to make sure he did not suffer from similar episodes and had lost all confidence in my pediatrician group. I didn't know what to do and it seemed like they didn't either!! First, I went to a specialist and then I decided to empower myself by learning as much as possible about it. This book delivers. It is easy to read, very informative and breaks down the pros and cons of various medicines and treatments. It also helps you understand warning signals of the illness and gives you the right questions to ask your doctor. This is an excellent book and helped me to realize that this illness can be controlled and there are steps that you actually can take to help control it. Kudos to the author for a job well done. It's worth reading and I recommend it highly to any parent that has a child with asthma. It can help you help your child.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.
Posted April 2, 2001
Ok, so I am the author. I still think that this is a really excellent book. The information provided is easy to follow, medically accurate, and up to date. Asthma can be -- and should be -- well controlled. This easy to read book shows you proven strategies for how to work with your doctor to get your child's asthma into good control. PART ONE reviews the revolution in asthma care. PART TWO covers the Three Lines of Defense against asthma: Managing the environment, managing the breathing tubes, and managing flare-ups. We pull it all together in how to create an individualized asthma self-management plan. PART THREE is the Parents¿ Guide: How to find a good doctor ¿ and how to get the best out of him or her. How to get your health plan on board. What strategies work best with toddlers ¿ and teenagers. How to adjust to seasonal changes in asthma severity. How to keep control of asthma outside the home -- in schools, malls, parks, friends¿ homes, etc. Which complementary/ alternative therapies can help asthma ¿ and which ones hurt. An extensive appendix provides a list of reputable asthma resources.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.