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In Your Health today, this is the peak month for asthma attacks - attacks so severe they tend to send kids to the emergency room. Asthma accounts for two million ER visits each year. The National Institutes of Health has just released new guidelines to help parents prevent these flare-ups.
NPR's Allison Aubrey reports.
ALLISON AUBREY: When 39-year-old Kirstin Carlson-Dakes was a kid, there was little she could do to control her asthma. She recalls long nights in the ER, waiting for shots of one of the only drugs used for attacks back then - adrenaline.
KIRSTIN CARLSON: I do remember gasping for breath, and, it was an intense fear. And my mom and I have actually talked about it since, and she's talked a lot about how scared she was and how she never really knew sometimes, going to the ER, if I was going to make it or not.
AUBREY: When Carlson-Dakes was a child, there weren't effective preventive medicines, and kids didn't have inhalers. Parents had few ways of controlling symptoms, short of steaming up the bathroom. For many kids, activities such as sports and camping trips were a real challenge.
CARLSON: I remember I tried to go on a Girl Scout sleepover, and my parents had to get me in the middle of the night because I had an asthma attack.
AUBREY: But things are very different for her children. Although two of them do suffer from asthma as well, they never end up in the ER and don't miss out on activities.
CARLSON: My daughter can go to Girl Scout camps, she can go on overnights, and we don't have to worry.
AUBREY: That's because the 9-year-old girl has several medications to keep her symptoms under control. And even on a campout, she knows exactly how much of which ones to take when she starts wheezing.
This time of year, just as school is starting, Kirstin keep a close eye on her kids knowing that the risk of attacks spike. Experts call it the September epidemic.
HOMER BOUSHEY: The most common precipitant of bad attacks of asthma is infection with the common cold virus - even the rhinovirus, the most common cause of the common cold.
AUBREY: Dr. Homer Boushey directs asthma research at UC San Francisco.
BOUSHEY: And what happens when kids get back together for school is they start exchanging viruses.
AUBREY: Plenty of parents have learned the hard way that to avoid these seasonal attacks, they need to keep their asthmatic kids taking puffs of corticosteroid inhalers daily even when they're not wheezing.
Mom, Alison Shelton, is among them. She says she resisted giving the drugs to her 9-year-old son Kenneth. She associated steroids with pumped-up athletes and dangerous side effects.
ALISON SHELTON: I thought, oh no, you know, I said, this can't be good, you know? Is there any way you can avoid this? But, you know, the doctor was very clear that this is not the same steroid, and that the benefits are sort of overwhelmingly in favor of doing it.
AUBREY: UC San Francisco's Homer Boushey says Shelton's concerns are typical. He's helped lots of asthmatics through this fear. He explains the beauty of the inhaled corticosteroids, which go by trade names such as Pulmicort and Flovent, is that they reduce inflammation in the lungs with doses that are small and targeted.
BOUSHEY: So we inhale tiny doses, and because the dose is deposited directly in the lungs, it's deposited where we need it. And very little is absorbed into the circulation to cause systemic side effects. That's why they're safe, and they are effective.
AUBREY: Boushey says long-term studies have demonstrated this. Kids do grow slightly slower in the early years while using corticosteroids.
BOUSHEY: But follow-up suggests they catch up. They reach their adult height just as one would predict.
AUBREY: Based on all this evidence, the National Heart, Lung and Blood Institute has just updated its asthma treatment guidelines. And for the first time, they address 5- to 11-year-olds separately. For this group, corticosteroids are the preferred treatment for kids with persistent asthma.
The guidelines also call for children to have short-acting, bronchodilator inhalers, such as Albuterol, as a rescue medication. To keep all the meds and doses straight, mom Alison Shelton and her little boy have written it all down.
SHELTON: Here we have his asthma action plan. It's a sheet of paper. It's got three different parts - the green part, the yellow part, and the red part. The green part is sort of the daily maintenance, and that's the things he does every day.
AUBREY: When he starts wheezing or coughing, or when he gets a cold, they step up to the yellow zone, which means higher doses of medication. And symptoms that put him in the red zone necessitate a call to the doctor for drugs they don't keep around the house.
BOUSHEY: We have 500,000 hospitalizations a year from asthma, and most of these could be prevented.
AUBREY: If, Boushey says, more families learned to stay ahead of the symptoms. The new guidelines urge all parents to team up with their doctors and young kids to develop an action plan. So instead of fearing asthma, they can learn to control it.
Allison Aubrey, NPR News, Washington.
MONTAGNE: You can find out what triggers asthma and learn more about strategies to control it at npr.org.
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