Lisa Gill suspected that her children, ages four and two, had asthma after they were repeatedly hospitalized for breathing problems. "(Doctors) would say 'It's just a cough,'" recalls Gill. But because she has asthma herself, she "pushed the issue" and found out, "it is asthma."

Asthma is a "growing epidemic," says Anne Kelsey Lamb, director of the Regional Asthma Management and Prevention Initiative. The increase is greatest for children under five and children of color. Possible reasons include air pollution, indoor allergens, and increasing obesity, which is linked to asthma.

Asthma, a chronic disease that causes breathing problems, can be life-threatening. It "influences all of your life," says Maria Elena Alioto, who has asthma, has a son with asthma, and works as associate clinical researcher at UC San Francisco. "Vacations get cancelled, children miss school, you worry about (paying for) medication. But, she adds, "there are things you can do."

Learn about possible signs of asthma

Talk with your pediatrician if your child has a persistent cough, wheezes, or is often out of breath (especially after exercising). Children may also say their chest feels tight. "Colds can have asthma-like symptoms, but when the cold gets better, the symptoms go away," adds Alioto.

Talk with your pediatrician

"Don't be afraid to say, 'I think my child has asthma,'" says Gill. If the doctor prescribes medication, make sure you understand how it should be taken, what side effects it could have, and how to use asthma equipment, such as inhalers, peak flow meters (that measure how well a child is breathing), and nebulizers (for children too young for an inhaler). Discuss any concerns about the medication or any home remedies you're using. Kati Baker, whose two children have asthma, adds that parents should ask about asthma triggers, signs of bad air days, and exercise.

Control asthma with medication

Children with severe asthma often take daily "controller" medication in addition to "rescue" medication for asthma attacks, which children with milder asthma also use. Gill says her son rarely has symptoms since he's been taking controller medication-but he always has his rescue inhaler with him. "It's hard to get (my two-year-old daughter) to take her (controller) medicine," she adds. "Some days I want to say 'let's not deal with it,' but it will be a lot worse if we don't."

Most health insurance (including Medi-Cal and Healthy Families) covers some asthma medications-and a new law requires them to cover children's asthma equipment. "It's still a financial burden," says Baker. "The co-pay for my (son's medications) has gotten up to $100-$150 a month. I'm a single mom, so it's been tough. There have been months I couldn't afford it and I would ask my pediatrician for (medication) samples."

Parents may be able to find help with medication, transportation, or language barriers through their local asthma coalition (see resources)  or public health department.

Manage your child's asthma with an "asthma action plan"

Develop a personal asthma action plan (see resources) with your child and doctor. These are often based on readings from peak flow meters. When the reading is in the child's "green zone," says Syliva Amaro, manager of the Orange County Breath Mobile, the child "can work and play just fine." Yellow means "Caution, take this medication." Red is "stop, you need to get to the doctor or emergency room."

Reduce asthma triggers

Notice what triggers your child's symptoms. Common triggers include allergies to pollen, mold, dust, cats, dogs, and cockroaches, as well as air pollution, cigarette smoke, and exercise. "Smoke is a huge issue," says Chris Soden, registered nurse and asthma educator. Experts recommend that parents quit smoking or smoke outside.

"I vacuum every day," says Baker, "and dust every other day. I make sure there's no mold. We covered everything (with dust-proof covers)-pillows, mattress. We have no pets except a lizard."

"It's extra effort," agrees Gill, "but it's worth it. When they can't sleep, you're up with them. You're missing days of work, they're missing school."

When a child is having a "bad asthma day," Soden adds, make sure the child gets enough water and rest. During an asthma attack, keep the child calm and breathing slowly, adds Mildred Flores, health education assistant for the Riverside Department of Public Health.

Encourage exercise-in moderation

Sometimes "parents are reluctant to let their child participate in sports," says Soden, but kids should be active. "We did things in moderation," says Baker. "My son played soccer and my daughter did cheering. There were days when they couldn't do it, and that was OK." To help prevent asthma attacks, kids can use their inhaler 15-20 minutes before exercising.

Work with schools and child care

Share your asthma action plan with teachers and child care providers and send medicine to school and child care-a new law allows school children to carry and use their inhaler. Gill tells child care providers, "when he has a continuous cough, my son needs his rescue inhaler."

Baker asks teachers to listen to her children "when they say they aren't feeling well." But she recently had to take her son to the emergency room after he was told to run a mile on a bad air day. "I complained," she recalls, and "now they let him sit out when he's not feeling well." Her son's school now has a program of flag signals for air quality (see Advocacy).

Advocacy

Asthma coalitions around the state are working to improve air quality, housing conditions, and care for children with asthma. For example:

• Schools in Merced and Mariposa counties raise colored flags for air quality -- on "red" days, schools keep all children indoors; on "orange" days, children with asthma are offered indoor activities.
  

• Community efforts aim to reduce diesel exhaust, including a recent regulation that limits school bus idling.
  

• Advocates work for stronger laws to protect tenants' rights to healthful housing.
  

For more information, contact Community Action to Fight Asthma, 510-622-4444, www.calasthma.org

Resources

• Allergy and Asthma Network/Mothers of Asthmatics, 800-878-4403, www.aanma.org, (in English and Spanish) 
  
• American Lung Association of California, 510-638-5864,
  www.californialung.org
  
• Local asthma coalitions offer free education, equipment, medication, and referrals. Contact Community Action to Fight Asthma, 510-622-4444, www.calasthma.org
  
• Sample asthma action plan in English, Spanish, Chinese, and Vietnamese at www.calasthma.org/