Parents teach their children how to avoid obvious dangers such as fire, choking and sharp objects, but what about the oak tree in the front yard? Though it appears harmless to most, children who have asthma are much more likely to be injured by pollen from trees, grass and weeds than by a hot stove or a pair of scissors.

People with asthma, a chronic lung condition characterized by difficulty breathing, have sensitive airways that overreact to stimuli such as pet dander, air pollution, certain foods or medicines, allergies, changes in the weather, perfumes, pollen and smoke.

Any of the stimuli can cause airway inflammation and airway hyper-responsiveness, leading to one or a combination of the following symptoms:

• Coughing
• Wheezing
• Chest tightness
• Shortness of breath

"Although there is no cure for asthma, there are steps that can be taken to lessen the symptoms of asthma," says Dr. William Neaville, an allergy and immunology specialist on the medical staff at Children's Medical Center Dallas. "The goal of asthma management is to achieve a symptom-free, normal life and to prevent the development of permanent lung damage and abnormal lung function."

Successful asthma management depends as much upon the individual as it does on the treating doctor and other health professionals. "It is vitally important for people with asthma to understand the condition and the proper treatment and to be able to manage it themselves between doctor visits," Dr. Neaville says.

Determining what factors are present when asthma symptoms start is the first step to recognizing your child's unique asthma triggers. Some people have only one trigger, while others have many. Many asthma triggers can be identified through a history of reactions or skin and blood testing.

Dr. Neaville recommends reducing your child's exposure to household asthma triggers by eliminating the source of the triggers, keeping dust levels down and reducing excessive moisture in the house.

You also can help reduce your child's exposure to outdoor triggers by staying indoors on days when the pollen count or air pollution level is high, removing plants and trees in your yard that cause asthma symptoms, raking and removing leaves, removing piles of grass immediately after the lawn is mowed and eliminating outdoor containers that hold stagnant water.

A written asthma action plan is helpful, and can be given to doctors, caregivers, teachers and school nurses. The plan should detail what to do if asthma symptoms return or increase, when and how much medication to administer and when to seek professional medical help.

How severe is your child's asthma?
A commonly used assessment tool to see if asthma is under control is the Rules of Two. Does your child:

• Use his or her "quick-relief inhaler" more than two times a week?
• Awaken at night with asthma more than two times a month?
• Refill his or her "quick-relief inhaler" more than two times a year?

If you answered "yes" to any of these questions, your child's asthma is out of control, and you should speak to your physician about his or her medication plan.

The Rules of TwoTM are brought to you by the Dallas Asthma Consortium and is service mark of Baylor Health Care System.

The Children's Asthma Management Program is the first pediatric program in Texas and the third in the nation to be awarded certification for disease-specific care program by the Joint Commission on Accreditation of Healthcare Organizations. For more information, visit www.childrens.com (keyword: asthma management program) or call 214-456-LUNG (5864).

Click here to see an interactive module on asthma and asthma management from www.childrens.com, or click here to view information about the Children's asthma management program