My Doctor Online The Permanente Medical Group

Types

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Allergic asthma is the most common form of asthma. It is triggered by allergens your child breathes into the lungs.

The most common allergens are:

• Dust mites
• Pet dander (most common triggers are from cats and dogs)
• Pollen
• Mold

Nonallergic asthma can be triggered by viruses, other kinds of infections, smoke, irritants, exercise, cold dry air, anxiety, or stress.

Childhood-onset asthma begins in childhood and most often occurs in response to common allergens in the home and outdoors.

Symptoms

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Asthma symptoms may be different for each child. Your child's symptoms may not even be the same each time he or she has a flare-up. Some common asthma symptoms include:

• Coughing
• A tight feeling in the chest
• Wheezing (breathing with a whistling sound)
• Shortness of breath
• Difficulty breathing

Diagnosis

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Diagnosing asthma in young children can be challenging. Some asthma symptoms such as cough and wheeze also occur with a viral infection.

We can diagnose asthma based on a physical exam and history, your child's symptoms, and lung function testing in children ages 6 and older. Based on your child's history, we may also recommend allergy testing if we suspect your child has allergic asthma.

Keep track of any patterns related to your child's asthma symptoms and discuss them with us. You may want to keep an asthma diary to track and document your child's asthma symptoms. For example:

• Are his or her symptoms worse in the spring or in the fall (allergy seasons)?
• Does exercise, a respiratory infection, or exposure to cold air trigger an attack?

You may also want to note any family history of asthma or allergic disorders, such as eczema, hives, or hay fever.

Lung Function Testing in Children Ages 6 and Over – Spirometry

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Spirometry is helpful in diagnosing asthma because there are other health conditions that can mimic asthma symptoms.

It is more accurate than using a peak flow meter and may be used to confirm your child's asthma diagnosis.

We conduct the test in the clinic as part of the Allergy Consult appointment, and it takes about an hour.

Causes

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We still don't know enough about the underlying causes of asthma. Current research shows that asthma is probably caused by many factors including genetics, the immune system, how the lungs develop and grow in early childhood, and exposures to infections and allergens in the environment.

Asthma Triggers

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Triggers can cause your child's asthma symptoms to get worse. If your child avoids triggers and limits his or her exposure to those that cannot be avoided, your child may need less medicine to keep his or her asthma in control.

The most common types of asthma triggers are:

• Allergies (allergens)
• Infections
• Air pollutants and other irritants
• Physical activity

Less common asthma triggers include:

• Stress.
• Changes in weather.
• Aspirin or other aspirin-like drugs, such as ibuprofen.
• Sulfites – a preservative found in dried fruits, bottled lemon or lime juice, wine, molasses (often in barbecue sauces), condiments, and many other foods. Read labels carefully.
• Live Christmas trees.

Controlling Your Child's Asthma

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When your child's asthma is in good control, he or she can live a healthy, symptom-free life. Your child should be able to:

• Attend school.
• Play sports and be active.
• Avoid Emergency department visits.
• Sleep without being awakened by asthma symptoms.
• Use quick relief medication no more than 2 days a week (other than for physical activity).

Asthma symptoms are not always consistent. Sometimes your child's symptoms will be in better control than at other times. By keeping track of his or her symptoms, you can predict when a flare-up is coming and do something about it before it gets worse.

There are 2 ways to monitor asthma symptoms. It is important to use at least one of them. For best results, use both:

• Use an asthma diary to keep track of your child's symptoms.
• Use a peak flow meter to measure your child's ability to push air out of the lungs.

We can work together to create a written asthma action plan to help you take action quickly when your child's asthma symptoms get worse.

Your child's asthma action plan will tell you which medications to use, what actions to take to prevent an asthma flare-up, and when to call for medical advice.

Avoid Infections

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Common infections such as a cold or the flu can trigger asthma in some children. A sinus infection or bronchitis can also cause an asthma attack. Tips on how to reduce your child's exposure to infections include:

• Have children wash their hands frequently or apply hand sanitizing gel.
• Teach children to cover their mouths when coughing or sneezing and wash hands afterwards. Use paper towels to dry hands.
• Have all children get a flu shot, each fall.

Managing Asthma at School or Daycare

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Your child will need support to manage his or her asthma at school or daycare. Here are some things you can do to help:

• Keep a set of your child's medicines and a spacer at school and/or daycare.
• Give a copy of your child's asthma action plan to his or her school or daycare facility. Make sure staff (and your child, if old enough) know how to use it.
• Provide documentation. Schools and daycare facilities require a copy of your child's action plan. We can also provide you with a letter authorizing your child to keep asthma medications at school and to take them as needed.

Work with your child's school or daycare facility to minimize exposure to asthma triggers in the indoor and outdoor environments.

Treatment

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Asthma medications are one of the keys to treating your child's asthma. Most children need more than one type of medicine to manage asthma.

There are 3 types of asthma medicines:

1. Long-term control medicines (also called "preventers" or "controllers"). These include beclomethasone (QVAR), fluticasone (Flovent), and mometasone furoate (Asmanex). Use these medicines to control your child's asthma. Usually, they are used daily to prevent asthma symptoms and avoid flare-ups.

2. "Quick-relief" medicines ("relievers"). These include albuterol HFA (ProAir HFA). Use these medicines to relieve your child's asthma symptoms quickly. Your child may also need to use relievers to prevent flare-ups before physical activity or contact with any of his or her triggers. Remember, these medicines do not reduce swelling or mucus.

3. Flare-up reversing medicines ("burst" medicines). These include prednisone and prednisolone (Orapred, Prelone, and Pediapred). Use these medicines for a severe flare-up of your child's symptoms.

When taking these medicines, it is important that your child use the metered dose inhaler with a spacer to get more medicine into his or her lungs and lower side effects.

Asthma is a chronic (ongoing) condition. Your child needs your help to manage his or her asthma. Make sure your child takes his or her long-term controller medication regularly. This helps to let your child breathe easy, prevent flare-ups, and keep your child's asthma under good control.

Your Child's Care with Me

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If your child has already been diagnosed with asthma, your individualized action plan helps you take action quickly when your child's asthma symptoms get worse.

Check your child's plan to see what actions to take to prevent and manage an asthma flare-up, and when to call the Appointment and Advice line or our asthma nurse. 

Please call immediately if your child has "Red Zone" symptoms:

• Persistent cough or wheeze.
• Very short of breath.
• Cannot do usual activities.
• Waking up more than once at night with cough or wheeze.
• Fast breathing.
• If quick relief medicines do not improve symptoms after 20 minutes.
• If peak flow is less than 50 to 60 percent of personal best.

Please call if your child has "Yellow Zone" symptoms:

• Slight cough, wheeze, chest tightness, or shortness of breath.
• Symptoms are not getting better after 2 days of home treatment.
• Mild chest congestion from cold or allergies.
• Cannot do normal activities.
• Regular breathing is a little faster than normal.
• Waking up at night with cough.
• Using quick-relief medicines twice or more a week (except before exercise).
• If peak flow ranges from 50 to 60 percent to less than 80 to 90 percent of personal best. 

During your child's first appointment, we will discuss your child's symptoms and medical history. I will perform a physical exam and may test your child's lung functioning. We will discuss your concerns and address any questions you may have. Together we will create a treatment plan that is right for you and your child.

If your child has already been diagnosed with asthma, I will work with you to help you keep your child's symptoms under control. Depending on your child's needs and condition, I may also connect you with our asthma case manager or resource nurse. We will work with you to provide:

• Education and support for you and your child
• An individualized treatment plan
• Training and practice with necessary equipment
• Medication adjustments
• Ongoing follow-up care

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site, once you have registered to use the Act for a Family Member feature. You can also schedule an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.
• Depending on your child’s symptoms, you may also have the option to schedule a telephone appointment – with me or another pediatrician, if I am unavailable. Please let the telephone staff know what you prefer and what is convenient for you.

Coordinating Your Child's Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting care for your child easier.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your child’s care to stay current on your child’s health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your child’s condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your child’s visit, you will receive information about when he or she is next due for a well child visit (checkup) and immunizations. We can discuss and schedule any preventive tests that may be needed. 
• At the end of your child’s visit, you may receive a document called the “After Visit Summary” that will summarize the issues we talked about during the visit. You can refer to it if you forget what we discussed, or if you just want to recheck your child’s height, weight, or vital signs. (If your child is under age 12, you can also view these summaries online, under Past Visits.)

If you schedule a telephone appointment

• In addition to in-person visits, we now offer the option of telephone appointments for certain common pediatric concerns. Depending on your child’s symptoms, you may have the option to schedule a telephone appointment with me or another pediatrician, if I am unavailable. We will call you at an agreed-upon time, at whichever phone number is most convenient for you.
• Many parents like this new option, but if you prefer to be seen in person, it’s always your choice. Just let the telephone staff know what type of visit you prefer.
• Telephone appointments are not appropriate for all health concerns. The advice nurse can help you decide what type of care is best for you and your child.

If I prescribe medications

We will work together to monitor and assess how your child’s medications are working and make adjustments as needed. 

Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically, in advance.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your child’s medications at the pharmacy.
• If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, such as X-rays, we will schedule an appointment with the Radiology Department. 

When the results are ready, I will contact you with the results by letter, secure e-mail message, or phone. In addition, you can view most of your child’s laboratory results online, along with any comments that I have attached to explain them.

If I refer your child to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your child’s condition. In some cases, I may contact them during your visit, so we can discuss your child’s care together. If we decide your child needs a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

Convenient Resources for You

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My goal is to provide high-quality care and to offer you choices that make your child’s health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available to help you manage your child’s care at any time that is most convenient for you. From my home page you can:

Manage your child’s care securely

You can begin to manage your child’s care online by requesting access through our Act for a Family Member feature. Once you have added your child to your account, you can:

• View and compose secure e-mail messages.
• Manage your child’s prescriptions and refills.
• Schedule well visit and nonurgent appointments.
• View your child’s Preventive Services to see whether your child is due for any immunizations or well visits.
• If your child is under 12, you can also view most lab test results and review information about past visits.

Learn more about your child’s condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your child’s condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Help your child stay healthy

• Sign up for our online newsletters for parents, customized to your child’s age.
• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you keep your child healthy.
• Check to see when your child is next due for immunizations and a well visit (checkup).