About the Author
Harold J. Farber, M.D., a board-certified pediatric pulmonologist, is chief of pediatric inpatient services at the Kaiser Permanente Medical Center and a consultant on asthma education and management to the American Lung Association of California. He lives in Vallejo, California. Michael Boyette is a veteran medical journalist. He lives in Philadelphia, Pennsylvania.
Excerpt. © Reprinted by permission. All rights reserved.
The Attack
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
