Question:

<child at day care DO NOT LET AN ASTHMATIC CHILD PLAY OUTSIDE IN VERY COLD WEATHER!!!! The day in question was below freezing, but sunny outside, so they bundled the kids up and took them outside.  Well, cold air makes your lungs constrict, so Austin had quite a nice little asthma attack and turned blue during nap — none of which they bothered to tell me until I came to pick him up, because he had "gotten better so quick"!!!! Well, actually, cold weather does not affect all asthmatics ( though it does a lot. You might look into making sure he has a scarf around his nose and mouth or maybe a neoprene mask. That can make a lot of difference.

AND – and this is VERY IMPORTANT – do not only tell the day care teacher that your child should not go outside. Tell the center director, and make sure he/she understands and will comply with your request. At the day care where I was the toddler teacher, one little girl was asthmatic. One day during very hot, humid weather we (my co-teacher and I) felt that she should not go outside. We did not know exactly how asthma attacks were triggered, but felt that 98-degree, muggy weather could not help. We left her inside with the two’s class, a class of slightly older children. Next thing we knew, the center director brought her outside. We told her that the mother had requested that she stay in (a lie, but we knew the mother would back us, and we really felt she should be inside.) The director told us that the center’s rules stated that a child who could not participate in all the activities, including outside recess, had to remain at home. If they were brought to school, they went outside with their class. Period. That little girl did not have an asthma attack that day, but had one over the weekend during very similar weather. Anyway, just something to watch for. Anne Robotti

Response:

All the previously mentioned items are very important, but here’s one I didn’t think about until my 2-year-old turned blue at daycare last winter. DO NOT LET AN ASTHMATIC CHILD PLAY OUTSIDE IN VERY COLD WEATHER!!!! The day in question was below freezing, but sunny outside, so they bundled the kids up and took them outside.  Well, cold air makes your lungs constrict, so Austin had quite a nice little asthma attack and turned blue during nap — none of which they bothered to tell me until I came to pick him up, because he had "gotten better so quick"!!!!

Well, actually, cold weather does not affect all asthmatics ( though it does a lot. You might look into making sure he has a scarf around his nose and mouth or maybe a neoprene mask. That can make a lot of difference. Mother to die wunderkinder Martha(7) Peter (4) St. John’s College, Annapolis, Class of 1982

Response:

- Hide quoted text — Show quoted text – (Pat – perhaps a section on this should be added to the faq – Mark)  –  I am a child care worker and need your help in answering the following  question.  Please answer the question as best as u possiblty can ~OR~ give me an  e  mail address of some1 who can answer the question ~0R~ give me the URL  (homepg address) of a page which has the appropiate information.  I require all answers (etc) by tomorrow..Basically ASAP!  Question: Give a detailed account of the management techniques for a  child  in Child Care who may suffer from Asthma.

All the previously mentioned items are very important, but here’s one I didn’t think about until my 2-year-old turned blue at daycare last winter. DO NOT LET AN ASTHMATIC CHILD PLAY OUTSIDE IN VERY COLD WEATHER!!!! The day in question was below freezing, but sunny outside, so they bundled the kids up and took them outside.  Well, cold air makes your lungs constrict, so Austin had quite a nice little asthma attack and turned blue during nap — none of which they bothered to tell me until I came to pick him up, because he had "gotten better so quick"!!!! At a daycare center where there are more than one caregiver, instruct at least _2_ people in how yto recognize symptoms and how to treat them.  In Austin’s case, he has a nebulizer that we took in every day, with written directions on the case.  Whenever there was a staff turnover or someone was sick, they didn’t medicate him because no one could figure it out.  Then we instructed the director, assistant director, and two teachers and had no more problems. Wendi Wendi Farrow Professional Mom

Response:

(Pat – perhaps a section on this should be added to the faq – Mark) – Hide quoted text — Show quoted text –  –  I am a child care worker and need your help in answering the following  question.  Please answer the question as best as u possiblty can ~OR~ give me an  e  mail address of some1 who can answer the question ~0R~ give me the URL  (homepg address) of a page which has the appropiate information.  I require all answers (etc) by tomorrow..Basically ASAP!  Question: Give a detailed account of the management techniques for a  child  in Child Care who may suffer from Asthma.  Venus, your question is extremely broad, but I’ll do my best.  1) Obviously, provide the care giver/center with the list of allergens  that cause an attack – and have them removed.  Remember the less  obvious ones, like molds = plants, the indoor air system of the center  will share air with other companies in the same building (watch for  smoking offices, dry cleaners, etc.)    2) Have the staff "warn" you when painting or repairs will be happening  anywhere in the building (even in other offices), the the child will  not go to the center that day and have an attack.  3) Educate the other children about asthma, including visuals of the  phlem and mucus in the airways!  Kids can understand alot – if they are  told about it.  (My nieces and nephews are much more accepting of my  taking meds in front of them and of my asthma in general than their  parents are.)  4) Show the caregiver how to use the peak flow meter, and instruct them  to have the child use it at specific periods throughout the day and  when constant coughing is evident.  You didn’t say how old the "child"  was, but if young enough, you can make it the Peak Flow Meter Game, and  encourage them to best their previous results.  Ie their personal best,  like an athlete does.  5) Instruct the caregiver on the proper use/does of meds and when to  use the emergency ones.  A note from the doctor would reinforce the  criticalness of giving the meds on time, and would also cover you if  they did not give the meds on time or as needed.  6) Also, alert the caregiver to the effects of the meds.  Such as  something with epi will make the child hyper, preds may make the child  moody (and bloated), so the caregiver does not see uncooperativeness as  necessarily a willful action but more as a side effect of the meds.  7) But try to make the child feel normal – with a handicap or a few  extras he has to do – and allow them to play with the other kids as  much as possible.  If you answer me back, I won’t be able to answer for about a week.  My  husband is doing a system upgrade, and he’s a procrastinator about  finishing the job.    Good luck with the child care situation, and I hope this info helps.  Mary-Pat

Instructions to parents of allergic/asthmatic children in a child care setting: Give simple, written instructions regarding:         how to recognize an emergency situation         specific steps for handling an emergency         who to contact and how to contact them in an emergency                 include doctor’s emergency phone number, child’s                 medical record number, and specifically what to                 tell the person answering the phone (e.g., "I have a                 a child under my care who seems to be in respiratory                 distress") If food allergies are an issue, specific instruction on how/what to feed the child, and how to reduce the possibility of cross-contamination from another child’s food. Emergency medications should be available on site, accessible only to responsible adults, with simple, specific instructions on how and when to use them, and instructions on who to contact in case the medications are needed. Also, a medical release form should be readily available in case emergency treatment must be sought and the parent is not available. Separately, give written instructions about how to avoid emergencies, what the child is like normally, what medications they take regularly and what they take when their symptoms are acute. Consider getting a pager. Consider it to be $15/month for a bit of added security. Tell the care giver that no question is too small. Contact your local chapter of the Asthma and Allergy Foundation or AAN/MA and borrow/buy an asthma education video. I believe that there are some geared toward child care providers. Big things to warn them about:         specific, known allergies (obviously)         profound sources of dust (e.g., large pillows, etc)         bleach (commonly used as a disinfectant in day care centers,                 but a strong trigger for some children). — Mark Feblowitz,   GTE Laboratories Inc., 40 Sylvan Rd.  Waltham, MA 02254

Response:

– I am a child care worker and need your help in answering the following question. Please answer the question as best as u possiblty can ~OR~ give me an e mail address of some1 who can answer the question ~0R~ give me the URL (homepg address) of a page which has the appropiate information. I require all answers (etc) by tomorrow..Basically ASAP! Question: Give a detailed account of the management techniques for a child in Child Care who may suffer from Asthma. Venus — (–Vanessa O’Brien–) D’oh!D’oh!D’oh!D’oh!D’oh!D’oh!D’oh!D’oh!D’oh!D’oh!D’oh!D’oh!D’oh!D’oh!D’oh !D’oh!;-) "Whoever said TAFE was easy.. bribed their way thru!" said by — Veenus-Oz <–         << check out my homepage!         <<   Venus17 & Veenus-oz’s:           <<    http://www.geocities.com/TheTropics/3672   Come visit the GOLD COAST – Australia’s Holiday Playground!         SUN , SURF , S*X , SAND !! (and Xcellent niteclubs! and the BEST beer!)

Response:

– Hide quoted text — Show quoted text – — I am a child care worker and need your help in answering the following question. Please answer the question as best as u possiblty can ~OR~ give me an e mail address of some1 who can answer the question ~0R~ give me the URL (homepg address) of a page which has the appropiate information. I require all answers (etc) by tomorrow..Basically ASAP! Question: Give a detailed account of the management techniques for a child in Child Care who may suffer from Asthma.

Venus, your question is extremely broad, but I’ll do my best. 1) Obviously, provide the care giver/center with the list of allergens that cause an attack – and have them removed.  Remember the less obvious ones, like molds = plants, the indoor air system of the center will share air with other companies in the same building (watch for smoking offices, dry cleaners, etc.)   2) Have the staff "warn" you when painting or repairs will be happening anywhere in the building (even in other offices), the the child will not go to the center that day and have an attack. 3) Educate the other children about asthma, including visuals of the phlem and mucus in the airways!  Kids can understand alot – if they are told about it.  (My nieces and nephews are much more accepting of my taking meds in front of them and of my asthma in general than their parents are.) 4) Show the caregiver how to use the peak flow meter, and instruct them to have the child use it at specific periods throughout the day and when constant coughing is evident.  You didn’t say how old the "child" was, but if young enough, you can make it the Peak Flow Meter Game, and encourage them to best their previous results.  Ie their personal best, like an athlete does. 5) Instruct the caregiver on the proper use/does of meds and when to use the emergency ones.  A note from the doctor would reinforce the criticalness of giving the meds on time, and would also cover you if they did not give the meds on time or as needed. 6) Also, alert the caregiver to the effects of the meds.  Such as something with epi will make the child hyper, preds may make the child moody (and bloated), so the caregiver does not see uncooperativeness as necessarily a willful action but more as a side effect of the meds. 7) But try to make the child feel normal – with a handicap or a few extras he has to do – and allow them to play with the other kids as much as possible. If you answer me back, I won’t be able to answer for about a week.  My husband is doing a system upgrade, and he’s a procrastinator about finishing the job.   Good luck with the child care situation, and I hope this info helps. Mary-Pat

Response:

Question:

: Yes Paul. It is clear that if even a single person dies who has been : treated with drugs it is likely that you will say that the drugs were : the cause of the death. That is not what I said at all. In replying to an attack on a very good alternative method (that it would cause death because it is, in the mind of the flamer, essentially non-treatment), I pointed out that drugs have their definite share of associated deaths. Treatment of asthma is DANGEROUS. And all competent healers or doctors know it. Don’t misconstrue my intentions in this way, please.

I am sorry. I don’t mean to misconstrue your intentions but you specifically told this father with a potentially fragile asthmatic child to "stop the steroids and conventional treatment". You don’t even know the case and you are giving this kind of advice. I am responding to your dogmatic views given without having all the information. This advice COULD be fatal for the child. I realize you don’t think so but I encourage to consider the possbility before giving such advice to someone that you have not even personally evaluated. Your advice to stop conventional treatment is an ideologic suggestion not considering the possibility of the harml it may cause. : Have you considered that without the : drug therapy MORE children would die from asthma and that : with drug therapy FEWER children would die from asthma. In case you haven’t noticed, I am not arguing that children SHOULD NOT be treated.

You are quite right. You are not arguing that children should not be treated. You ARE arguing to stop certain treatments and institute other treatments though. And the treatments that you are suggesting MAY not be as effective. The most effective treatment may be conventional treatment.  I am arguing that the enhanced survival brought about by suppressive drugs is bought at a direct cost to the quality of life of the individual. Cure is lost, emotional and mental health is compromised, and physical health remains unstable for an entire lifetime.

Yes I realize that you strongly believe the above. It is an ideologic argument based upon the ETH theories. I am not convinced that this actually happens and you have not provided evidence (I know you don’t feel that you need to do so) of such. It is just your opinion.  The alternative method, specifically traditional homeopathy, may not cure, and drugs may be the only recourse (after perhaps acupuncture). But homeopathy should be tried first, since it offers and produces CURE. But ideologues can’t deal with that.

Yes I realize you think that I am the ideologue and you don’t recognize that you are an ideologue of a greater degree. If someone told me that homeopathic medicine was helping an asthmatic I would not tell them to stop it because it was working. But you on the other hand even if the treatment appears to be working will recommend stopping it based on a ideologic theory that so called suppressive therapies (however you choose to define that) will lead to permanent problems for liffe. : But : I guess your atttitude is "better to avoid what you call : suppressive therapy and use kinder and gentler methods even : if you end up dying since death is just a burden that some people : must bear". That characterization is yours, entirely.

Yes I know that you think that this characterization is mine. However in a previous post you said that if your treatment was not effective at resolving an illness that "some people must bear the burden of the illness". I did not make that up. : You seem more interested in having people not : use conventional therapies despite what the increase in mortality : might be. Why not look at the difference between asthmatics : treated with drugs and those who are not and see the difference. As I have said, I have not been recommending non-treatment.

Quite true. But you may be recommending inferior or ineffective treatment. : You are more interested in spreading propoganda without : validation. Not at all. I am promoting traditional, alternative means from the standpoint of long study and personal experience.

Well we can disagree about this. You tend to focus on only the negative aspects of conventional therapy while only focusing on the positive aspects of homeopathy or ETH. This in my mind is propoganda. : I hope that parents with children with asthma are : intelligent enough to know that the antiasthmatic medications : are very effective (not perfect since nothing is) at facilitating : breathing enabling life sustaining oxygen to reach the body. Whoopteedo. Most cases of asthma are not emergency cases. These drugs have their place, and it is not in primary treatment.

Quite true. Many cases of asthma are not emergency cases. But improperly treated asthma will result in more emergencies. Before committing to a therapy for a potentially life threatening illness I would like to see some study comparing the treatments in objective way rather than using people like guinea pigs. : How would *you* manage a young child whose asthma was : so severe that he could barely get any oxygen in and was : turning blue? : Would you use your holistic, nonsuppressive, : nonaggressive therapy and when the child dies say "well : conventional medicine would not do any better". Yes you : would probably say that. You are maligning me, and concocting views I have never expressed.

Yes I realize that you feel that I am maligning you but you have made statements when confronted with a homeopathic treatment resulting in death that "at least the patient had a chance". : Not much consolation to the : parent whose child has died. Ten minutes of violin. This bathos has nothing to do with the issue.

If a child dies as a result of your telling them to stop the treatment that may be effective then this has  EVERYTHING to do with the issue. : Asthma medications work : physiologically to cause bronchodilation and allow air to come : in. You tell a person who is in "status asthmaticus" gets a shot : of epinephrine and can now breathe that they are taking : a suppressive drug. ETH was using ephedrine for similar effects two and a half millenia ago. This has nothing to do the issue at hand.

Could you explain why ephedrine is not an "isolative" therapy that just deals with the symptoms and does not deal with the whole problem as you criticize allopathic treatments which essentially do the same. Why is ephedrine OK? Aloha, Rich ——- Richard Jacobson Better to be uncertain about something than to be sure and be wrong about it

Response:

: Yes Paul. It is clear that if even a single person dies who has been : treated with drugs it is likely that you will say that the drugs were : the cause of the death. That is not what I said at all. In replying to an attack on a very good alternative method (that it would cause death because it is, in the mind of the flamer, essentially non-treatment), I pointed out that drugs have their definite share of associated deaths. Treatment of asthma is DANGEROUS. And all competent healers or doctors know it. Don’t misconstrue my intentions in this way, please. : Have you considered that without the : drug therapy MORE children would die from asthma and that : with drug therapy FEWER children would die from asthma. In case you haven’t noticed, I am not arguing that children SHOULD NOT be treated. I am arguing that the enhanced survival brought about by suppressive drugs is bought at a direct cost to the quality of life of the individual. Cure is lost, emotional and mental health is compromised, and physical health remains unstable for an entire lifetime. The alternative method, specifically traditional homeopathy, may not cure, and drugs may be the only recourse (after perhaps acupuncture). But homeopathy should be tried first, since it offers and produces CURE. But ideologues can’t deal with that. : But : I guess your atttitude is "better to avoid what you call : suppressive therapy and use kinder and gentler methods even : if you end up dying since death is just a burden that some people : must bear". That characterization is yours, entirely. : You seem more interested in having people not : use conventional therapies despite what the increase in mortality : might be. Why not look at the difference between asthmatics : treated with drugs and those who are not and see the difference. As I have said, I have not been recommending non-treatment. : Perhaps now you will say that the results of the drug therapy will : not occur for many years and that you need not give us any : proof that this is true since you are not at all interested in proof. I am not concerned with the battle to validate alternative healing in your terms, no. But to refer to this as "proof" is to entirely misstate and exaggerate the validation that most conventional therapy has undergone. : You are more interested in spreading propoganda without : validation. Not at all. I am promoting traditional, alternative means from the standpoint of  long study and personal experience. : I hope that parents with children with asthma are : intelligent enough to know that the antiasthmatic medications : are very effective (not perfect since nothing is) at facilitating : breathing enabling life sustaining oxygen to reach the body. Whoopteedo. Most cases of asthma are not emergency cases. These drugs have their place, and it is not in primary treatment. : How would *you* manage a young child whose asthma was : so severe that he could barely get any oxygen in and was : turning blue? able to write prescriptions for these drugs as needed. The difference is that they are not aligned to the suppressive point of view (that asthma is effectively treated by maximum suppression), but rather will utterly minimize the use of drugs in favor of a process that leads potentially to cure. : Would you use your holistic, nonsuppressive, : nonaggressive therapy and when the child dies say "well : conventional medicine would not do any better". Yes you : would probably say that. You are maligning me, and concocting views I have never expressed. : Not much consolation to the : parent whose child has died. Ten minutes of violin. This bathos has nothing to do with the issue. : But you will do anything to : defend ETH even if it means people must die in the process : because above all you want people to stay away from : these so called "invasive" and "suppressive" therapies : which actually may truly help people overcome severe illnesses. The issue is homeopathy, not ETH, and you are being absurd. [snip] :   I propose we call this conventional bromide ‘The George Washington : Effect.’ The poor fellow, in spite of our bleeding and calomel, the : disease was just too strong. All conventional medicine has to offer : for asthma is suppression. : : You like that word "suppression". It is like a catchall phrase to : discredit any therapy that may work. Not all conventional therapies are suppressive. Most drug therapies unfortunately are. ‘Works is not cure.’ If alternatives exist, they should be tried first. : Asthma medications work : physiologically to cause bronchodilation and allow air to come : in. You tell a person who is in "status asthmaticus" gets a shot : of epinephrine and can now breathe that they are taking : a suppressive drug. ETH was using ephedrine for similar effects two and a half millenia ago. This has nothing to do the issue at hand. *** Continued in next message… *** —

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Question:

I agree with that but what does that have to do with going to the ER?  If you have serious problems, don’t you call your doctor immediately?  I get the feeling that a lot of people go to the ER because their doctors don’t make themselves accessible.  Is that true?

Not in my case. I go to ER because they have useful things there that I don’t have at home, like oxygen, hydorcortisone injections, nebulizers with various drugs in them etc. Fortunately, it’s now a rare event, but when I do go there I usually go with the attitude that they have some facilities I need to use to get an attack under control. My GP could come out to me, but he can’t carry all that equipment with him and he has always advised me to get to ER as soon as possible. — Anna      History repeats itself      It has to      Nobody listens                             Steve Turner

Response:

I think frequency of ER visits depends on lot on the individual, their physician and their knowledge of how their asthma works.  If you have a close relationship with a caring physician, then you might get by with a midnight phone call or two, or you might be in a situation where you doc has told you to go to the ER first. My friends who work ER tell me that almost always the problem is an asthmatic (even an experienced one) who waits too long to call for advice, either not wanting to "bother" the doctor or thinking it’ll just get better.  Certainly frequent ER visits are an indication that the asthma is not under control. The publications I’ve seen from National Jewish (etc. etc.; can’t keep their names straight) show a big correlation between close, frequent supervision by the physician and a decrease in ER use. Staying away from the ER "cause your asthma’s not that bad" is not a good solution; anyone finding themselves in deteriorating condition should get help quickly. If there is one good thing about my terrible asthma it is that I tend to slide downhill slowly, so I don’t sit at home getting cyanotic waiting for the ambulance; my docs and I almost always know when I’m headed for a long hospital stay.  My ER visits (as opposed to hospital stays) are almost always for checking up on severe chest pain; I break ribs every now and then from coughing, I’m immunosuppressed so I develop shingles every once in a while, and there is the occasional pneumonia.  In me, all these things show up as similar pains, so if it is after hours or on weekends, it is off to the ER I go, calling my doctor first so he can meet me there.  These add up to three or so visits a year, less the last 12 months because of some successful experimental therapy (HURRAH!). People mention ER visits a lot because they are very traumatic…it is hard to forget stuff like that. Pat Crockett

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– Hide quoted text — Show quoted text -I’ve been asthmatic all my life, diagnosed about 13 years ago (I’m 30).  In all that time, through serious attacks and all, I’ve never even considered going to the hospital.  I’ve been reading this group for 5 months or so and I’m concerned by all the references people make to having to go to the ER for treatment.  None of the asthmatics I know has ever gone to an ER–do a lot of people still go today or is it a thing of the past that gets mentioned because it used to be so much more commonplace?  It worries me that so many people seem to be having that much trouble when really, with all the scientific advances and information available to patients, not that many people should get into emergency situations that can’t be taken care of by talking to a dr or self-medicating. Is there stuff going on about which I don’t know? Marcy T.

Ah Marcy, you’ve echoed my very thoughts.  Im fairly new to asthma (bout a year or so) and my only ER visit was the night of my first real acute attack- that was with a raging bronchial infection and no meds whatsoever.  God I hated that experience more than I could put into words (I know, as opposed to those who really enjoy it, right?). I would do pretty much anything to avoid needing to go to ER – super strict adherence to medication schedule, multiple peak flow readings every day, expensive air filters, major fluid intake, every precaution I can possibly take.  I was happy when I read (in one of the major books about asthma thats widely available – I think its the one by Dr. Weinstein) that only a very small percentage of asthmatics will ever need emergency room care.  But reading this group for a month or two, which has been an invaluable source of information for me, you get the impression that ER visits are pretty common.  I hope people will post their experiences with ER visit frequency – I’d also be very interested in hearing what people’s crisis plans are- that is, what they will try at home before they make the decision to go to ER. Thanks! Cheryl

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- Hide quoted text — Show quoted text -I’ve been asthmatic all my life, diagnosed about 13 years ago (I’m 30).  In all that time, through serious attacks and all, I’ve never even considered going to the hospital.  I’ve been reading this group for 5 months or so and I’m concerned by all the references people make to having to go to the ER for treatment.  None of the asthmatics I know has ever gone to an ER–do a lot of people still go today or is it a thing of the past that gets mentioned because it used to be so much more commonplace?  It worries me that so many people seem to be having that much trouble when really, with all the scientific advances and information available to patients, not that many people should get into emergency situations that can’t be taken care of by talking to a dr or self-medicating. Is there stuff going on about which I don’t know? Marcy T.

 * Marcy,   You may be fortunate to have just not gotten into severe respiratory   problems yet. Infections, allergens etc can lead to stage 2 or 3 attacks   that require nebulizer treatment, oxygen and IV medications, things you   can’t get at home or in the Doctor’s office. Many folks now have portable   nebulizers that enable them to give themselves treatments at home or work.   This greatly reduces the need for ER care but sometimes if the attack is   bad enough or you’re also fighting a pnemonia the hospital is the place to   go.  Trust me, when that airway spasms closed you’ll consider the ER a   great place to be   Baboon  

Response:

I’ve been asthmatic all my life, diagnosed about 13 years ago (I’m 30).  In all that time, through serious attacks and all, I’ve never even considered going to the hospital.  I’ve been reading this group for 5 months or so and I’m concerned by all the references people make to having to go to the ER for treatment.  None of the asthmatics I know has ever gone to an ER–do a lot of people still go today or is it a thing of the past that gets mentioned because it used to be so much more commonplace?  It worries me that so many people seem to be having that much trouble when really, with all the scientific advances and information available to patients, not that many people should get into emergency situations that can’t be taken care of by talking to a dr or self-medicating. Is there stuff going on about which I don’t know? Marcy T.

Response:

I consider my asthma to be mild-to-moderate. I have only had to go to the ER twice, and both times were when I was exposed to an allergen that was too much for my body’s defenses or my meds to overcome.  My children have been to the ER several times. Some times they were kept there for several hours, but, thank goodness, never as inpatients. Each person’s asthma is different, and each person’s approach to asthma control is different. There are non-asthmatics that have unexpected asthma episodes triggered by viruses. There are asthmatics that don’t know it. There are asthmatics that deny their condition and/or under-medicate. There are asthmatics who, for the most part, have been able to stabilize their asthma. And there are asthmatics who, despite adhering to the best protocols, continue to have unstable asthma. I consider myself one of the lucky ones. The medications work, and I’m able to live a relatively "normal" life with little anxiety about surprise attacks or midnight runs to the ER. We’ve learned a lot about asthma and are in better control of our children’s asthma as well, but there are still times when we take them to the ER, either to make sure that their middle-of-the-night episodes aren’t too severe, or because at-home treatment isn’t sufficient. And we never really know when our severly allergic child will have a serious reaction. You sound like you’re one of the smart, responsible, and lucky ones, too. Let’s hope that that remains the case. It’s important to guard against an attitude of "I’m not one of those who needs to go to the ER"; such an attitude may be quite dangerous. If your lungs are reactive, there’s at least the possibility that some powerful trigger may come along; the sooner you identify and respond appropriately, the less likely the extreme consequences. — Mark Feblowitz,   GTE Laboratories Inc., 40 Sylvan Rd.  Waltham, MA 02254

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