The Challenges of Managing My Son's Asthma

S ince the day he was born I have constantly been told, "Michael

looks just like his dad!" They both have huge, sparkling, dark-

brown eyes. It's unmistakable that they are father and son. Although

Michael doesn't look much like me, he did inherit at least one of my

traits - - my asthma! Having asthma is bad enough, but to watch

your child experience it can be heartbreaking.

Michael's infancy was uneventful except for his coughing. He would often have episodes of coughing during the night. As Michael grew older he began to cough more and more often during the day as well. One day, when Michael was 3 years old, I picked him up from preschool and we headed to the grocery store. While we were shopping I noticed that his cough

sounded different - - it sounded "tighter." That afternoon, his cough worsened steadily. By nighttime, he was so miserable that I sat up with him in a rocking chair right through until morning. By 6 am, I thought he was getting better because his breathing was much quieter. I decided to change his diaper and see if I could get him to go to sleep in his crib for a couple of hours. When I unzipped his pajamas I

noticed that the skin around his ribs and neck looked all "sucked in." Panicked, I called the pediatrician's answering service. They said to bring him right over. In the 10 minutes it took us to get to the office, Michael worsened considerably. He was making moaning sounds as he exhaled and was extremely pale. The doctor met us at the door and listened to his chest. He

immediately administered a neb- ulizer treatment and then lis- tened to his chest again. To my horror the doctor announced that he had asthma.

Michael was admitted to the hospital and spent four days there. He was administered oxy- gen, intravenous corticosteroids and around-the-clock nebulizer treatments. We were sent home with inhalers, oral corticosteroids, liquid bronchodilators, a nebuliz- er, a peak flow meter and an asth- ma management plan. This was nothing new to me - - I had been dealing with the same compo- nents of asthma management for

mysdf for many years - - but I was feeling anxious about having to deal with it in my young child.

Things became routine for a while. Michael took his medicine without com- plaint and, at the age of 4, became proficient at using the peak flow meter. We made pho- tocopies of a peak flow chart and taped it to the refrigerator. We recorded scores and noted any medication changes each da~ I felt as

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though I was in control of the situation. Then came the big d a y - Michael started kindergarten! In preparation for this new sit- uation, I called Michael's teacher and his extended-day program's staff to tell them about his asthma. In addition, I filled pre- scriptions in triplicate, wrote detailed instruc- tions, provided emergency phone numbers and even bought a beeper! I thought I had done everything to ensure that if Michael had any asthma trouble at school, everyone would know just what to do.

Michael went off to school on his first day with much excitement. When I arrived at the end of the day to pick him up, the children were playing outside on the playground. My eyes scanned the group looking for Michael. When I locat- ed him I was alarmed. He was sitting by himself on the pavement watching the other children play. When he caught my eye, he ran toward me and started to cry. He was extremely short of breath and very pale. I picked him up and took him inside to get his inhaler. By that point, however, it wasn't much help because he could not inhale deeply enough for the medicine to work. I took him home and started a neb- ulizer treatment immediately. Sitting in his dad's lap, Michael fell asleep with the nebulizer still running. He seemed to get some relief from the treatment. Upon awakening 30 minutes later, he started to cry and gasp for breath. I examined his chest and noticed, once again, that the skin around his ribs and neck looked "sucked in." His respirations were so rapid that I could not count them. We took Michael straight to the emergency room. His oxygen level was very low. Once again, oxygen, intravenous corticosteroids and nebulizer treatments were adminis- tered. Michael was admitted to the hospi- tal and stayed there for five days.

I was devastated. I felt I was a failure as a mother. Having severe asthma myself, along with all the planning and emergency procedures I had worked so hard to put in place, I thought Michael never should have

a severe episode. I thought I was in control of his asthma. I had never expected that Michael would not tell his teachers he was having trouble breathing. Additionally, on this first day of school, the teachers were getting to know all of the children and their individual behaviors. Two weeks into the school year, any one of them would have recognized that sitting watching the other kids play was not normal behavior for Michael - - it would have been a red flag that something was wrong.

Michael is now 8 years old and in the third grade. He has not been admitted to the hospital since the kindergarten episode; how- ever, he has had many ups and downs - - record high peak flow scores as well as several bouts of pneumonia and many courses of oral corticosteroids. Michael sees an asthma specialist every three months. I appreciate that his doctor understands my knowledge of Michael's asthma. She seems eager to receive my input, and respects my "gut feelings" as a mother. It is frustrating that Michael's asth- ma management needs to be constantly reevaluated (sometimes day to day), but that is the nature of asthma and I am trying hard to accept it. Michael's asthma episodes tend to come on quickly and severely. I find myself constantly struggling to maintain that precarious balance between appropriately overseeing his asthma management but not smothering him. This has been especially dif- ficult as he has gotten older and has naturally wanted more independence.

Despite our asthma, Michael and I stay very active. We love to go hiking and we swim year-round in our town's indoor pool. People might know now that we are moth- er and son. We may not look much alike, but we do have matching inhalers!

--Anne Garrett

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