Children With Asthma: A Manual for Parents
By Thomas F. Plaut, MD
Pedipress, Inc., Amherst, Mass. 269 pp. $11.95
At 2 a.m., 3-year-old Nancy wakes up crying that she can’t breathe. Her parents rush into her room and discover that she is breathing much faster than normal. A whistling sound is coming from her lungs when she breathes out. When she breathes in and out, her chest skin is sucked ominously inward. It seems to take her longer to breathe out than to breathe in. Nancy becomes more frightened as her breathing worsens and she cries even more. Her parents hurriedly wrap her in a blanket and take her to the hospital. In the emergency room she receives three adrenaline shots, oxygen is administered and an intravenous is put in her arm. She gets only minimal relief from the medication. Three hours later, she is admitted to the hospital. Nancy has asthma.
Unfortunately, the scenario described above is an all too frequent one. Childhood asthma is the No. 1 chronic illness among children in the United States. Five to 10 percent of all children develop asthma. Pediatrician Thomas F. Plaut, in the second edition of his book, “Children With Asthma-A Manual for Parents,” does much to unveil the mystery surrounding this complicated and all too common illness. Dr. Plaut has practiced pediatrics for more than 20 years and currently cares for about 400 children with asthma in his private practice.
In this age of do-it-yourself books, his comes as close as possible to changing the treatment of asthma from a mysterious illness guarded over by priest-like physicians dispensing magic potions to a condition that parents can treat (for the most part) confidently at home, although with frequent telephone consultations with the physician and occasional office visits. The parent can have a large degree of control over the management of the child’s illness. This concept is a novel one in modern medicine-and it is long overdue.
What is asthma? An asthma episode occurs when the small windpipes (bronchioles) become temporarily narrowed or blocked. This blockage leads to difficult and rapid breathing. Medicines are almost always needed to reverse this narrowing. Sometimes, hospitalization is required. The most common triggers for the asthmatic process include viral upper respiratory infections, bacterial sinus infections and exercise, which is a trigger for 80 percent of people of all ages with asthma. Irritants such as cigarette smoke, perfumes, dust, molds, pollen and animal dander also provoke episodes of asthma.
Although asthma is a serious disease, with the advances of modern medicine, deaths are rare. Only one in 25,000 children with asthma will die from it each year.
Asthma is also one of the most frustrating diseases for a parent and a child to face. For too long, the treatment of asthma has been solely in the hands of the physician, who dispenses drugs and advice. This may be appropriate for acute conditions that are of short duration. Asthma, however, is a chronic condition-it doesn’t go away quickly. Many parents have had difficulty finding out what asthma actually is and how they can help their child lead a normal life despite it.
Dr. Plaut dispels many myths about asthma. The 269 pages of this book are aimed at educating parents. Although as many as 50 percent of children with asthma will outgrow it by adulthood, the age of 21 seems a long way away for the parents of a 3-year-old like Nancy.
In “Children With Asthma,” Dr. Plaut first describes what the process of asthma involves, what triggers it and what happens afterward. Personal testimonials from parents of children with asthma are added to those of the children themselves. The book is filled with so many testimonials, though, that by the end of the book the reader is somewhat confused about whose story is whose. Those in the first chapter, “Living With Asthma,” are vivid accounts of the dismay, frustration and helplessness experienced by parents and children in the author’s private practice. These stories will strike a chord in the heart of all parents who have endured an episode of asthma with their child.
Chapter Three, on medications for treating asthma, is one of the book’s highlights. Dr. Plaut summarizes common medicines used in combating asthma and outlines their appropriate uses, side effects and when to consult the physician about medication changes. Some physicians may not place as much emphasis on the use of theophylline, a commonly prescribed oral asthma medication. Many physicians are relying on other newer drugs that often have fewer side effects. He does present an excellent overview of all drugs currently used in the treatment and management of childhood asthma.The chapter on home therapy is really the focus of the entire book-his message that asthma should be treated at home by the parents under the supervision of a physician. Except for rare exceptions, the author feels that every child with asthma should be able to carry out every activity that is usual for the age of the child. If the child cannot carry out normal activity, then, according to Plaut, the asthma is being either under-treated or mismanaged.
The book also offers practical advice: how to handle asthma at school, on a trip or at the babysitter’s house. It includes examples of forms, instructions and checklists for parents to give to teachers, school nurses, babysitters, emergency room doctors and relatives. It even outlines how parents should go about finding a doctor. Tips for setting up a parents’ group also are discussed. The book includes an extensive resource list of books, newsletters, videotapes and organizations that can help parents whose children suffer from asthma. An excellent glossary of medical terms completes the book.
One crucial point is emphasized: Asthma requires a team approach: The parents must have confidence and trust in the physician. Equally important, the physician must trust the parents and be willing to treat them as colleagues in the management of this illness. This will require some adjustment by some physicians.
By educating the parents of a child with asthma, the physician will not be losing control over the patient’s care but rather will gain knowledgeable assistance from people who know the child best and who are with the child the most.