context: Children with asthma have different sets of triggers. Triggers are the factors that irritate the airways and cause asthma symptoms. Triggers can change seasonally and as a child grows older. Some common triggers are cigarette smoke, allergens like dust, dust mites, and pet dander, viral infections, irritants like strong perfumes, exercise, breathing cold air, and weather changes. Identifying triggers and symptoms can take time. Keep a record of when symptoms occur and how long they last. Once patterns are discovered, some of the triggers can be avoided through environmental control measures, which are steps to reduce exposure to a child's allergy triggers. Talk with your doctor about starting with environmental control measures that will limit those allergens and irritants causing immediate problems for a child. Remember that allergies develop over time with continued exposure to allergens, so a child's asthma triggers may change over time. Others who provide care for your child, such as babysitters, day care providers, or teachers must be informed and knowledgeable regarding your child's asthma treatment plan. Many schools have initiated programs for their staff to be educated about asthma and recognize severe asthma symptoms. The following are suggested environmental control measures for different allergens and irritants: Indoor controls To control dust mites: Use only polyester-filled pillows and comforters (never feather or down). Use mite-proof covers (available at allergy supply stores) over pillows and mattresses. Keep covers clean by vacuuming or wiping them down once a week. Wash your child's sheets and blankets once a week in very hot water (130 degrees or higher) to kill dust mites. Keep upholstered furniture, window mini-blinds, and carpeting out of a child's bedroom and playroom because they can collect dust and dust mites (especially carpets). Use washable throw rugs and curtains and wash them in hot water weekly. Vinyl window shades that can be wiped down can also be used. Dust and vacuum weekly. If possible, use a vacuum specially designed to collect and trap dust mites (with a HEPA filter). Reduce the number of dust-collecting house plants, books, knickknacks, and non washable stuffed animals in your home. Avoid humidifiers when possible, because moist air promotes dust mite infestation and mold growth. To control pollens and molds: Ventilate bathrooms, basements, and other damp places where mold can grow. Consider keeping a light on in closets and using a dehumidifier in basements to remove air moisture. Use air conditioning because it removes excess air moisture, filters out pollens from the outside, and provides air circulation throughout your home. Filters should be changed per the manufacturer's recommendations. Avoid wallpaper and carpets in bathrooms because mold can grow under them. Use bleach to kill mold in bathrooms. Keep windows and doors shut during pollen season. To control irritants: Do not smoke (or allow others to smoke) at home, even when a child is not present. Do not burn wood fires in fireplaces or wood stoves. Avoid strong odors from paint, perfume, hair spray, disinfectants, chemical cleaners, air fresheners, and glues. To control animal dander: If your child is allergic to a pet, you may have to consider finding a new home for the animal or keeping the pet outside at all times. Even if your child isn't allergic to the animal now, he or she can become allergic with continued exposure. It may (but does not always) help to wash the animal at least once a week to remove excess dander and collected pollens. Never allow the pet into the allergic child's bedroom. If you don't already own a pet and your child has asthma, consult your child's doctor if you're considering getting one. Outdoor controls When mold or pollen counts are high, give your child medications recommended by your doctor (usually an antihistamine like Zyrtec or Claritin) before going outdoors. After playing outdoors, the child should bathe and change clothes. Drive with the car windows shut and air conditioning on during mold and pollen seasons. Don't let a child mow the grass or rake leaves. In some cases, the doctor may recommend immunotherapy, a way of gradually improving your child's tolerance of allergens that bother him, when control measures and medications are not effective. Speak with your child's doctor about these options. Patients with asthma have chronic inflammation of their airways. Inflamed airways are "twitchy" and tend to constrict (or narrow) whenever they are exposed to a trigger (such as infection or an allergen). Some children with asthma may have increased inflammation in the lungs and airways every day without knowing it. Their breathing may sound normal and wheeze-free when their airways are actually narrowing and becoming inflamed, making them prone to a flare-up. To better assess a child's breathing and determine risk for an asthma attack (or flare-up), breathing tests may be helpful. Breathing tests measure the volume and speed of air as it is exhaled from the lungs. Asthma specialists make several measurements with a spirometer, a computerized machine that takes detailed measurements of breathing ability. Another way to know when a flare is brewing is to look for early warning signs. These signs are little changes in a child that signal medication adjustments may be needed (as directed in a child's individual asthma management plan) to prevent a flare. Early warning signs may indicate a flare hours or even a day before the appearance of obvious flare symptoms (such as wheezing and coughing). Children can develop changes in appearance, mood, or breathing, or they may say they "feel funny" in some way. Early warning signs are not always definite proof that a flare is coming, but they are signals to plan ahead, just in case. It can take some time to learn to recognize these little changes, but over time, recognizing them becomes easier. Parents with very young children who can't talk often find early warning signs very helpful in predicting and preventing attacks. And early warning signs can be helpful for older children and even teenagers because they can learn to sense little changes in themselves. If they are old enough, they can adjust medication by themselves according to the asthma management plan, and if not, they can ask for help. Developing an effective medication plan to control a child's asthma can take a little time and trial and error. Different drugs work more or less effectively for different kinds of asthma, and some drug combinations work well for some children but not for others. There are two main categories of asthma medications: quick-relief medications (rescue medications) and long-term preventive drugs (controller medications) (see Treatment of Asthma). Asthma drugs treat both symptoms and causes, so they effectively control asthma for nearly every child. Over-the-counter drugs, home remedies, and herbal combinations are not substitutes for prescription asthma medication because they cannot reverse airway obstruction and they do not address the cause of many asthma flares. As a result, asthma is not controlled by these nonprescription drugs, and it may even become worse with their usage. When you follow the first three steps of asthma control, your child will have fewer asthma symptoms and flare-ups. Remember that any child with asthma can still have an occasional asthma attack, particularly during the learning period between diagnosis and control or after exposure to a very strong or new trigger. With proper patient education, having the right medications on hand, and keen observation, families can learn to control most minor asthma flare-ups by starting treatment early, which will mean less emergency room visits and fewer admissions, if any, to the hospital. Your doctor should provide a written step-by-step plan outlining exactly what to do if a child has a flare-up. The plan is different for each child. Over time, families learn to recognize when to start treatment early and when to call the doctor for help. Learning more about asthma and asthma treatment is the secret to successful asthma control. There are several organizations you can contact for information, videos, books, educational video games, and pamphlets.