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Monitoring Your Child's Asthma Symptoms

Monitoring your child's asthma symptoms is an effective, "low-tech" way of keeping track of how your child's asthma is doing.

What is good asthma control?

When your child's asthma is well-controlled, he or she will have few (if any) asthma attacks. In addition, your child:

  • should rarely (if ever) have a nighttime cough;
  • should rarely (if ever) wake up at night because of coughing or shortness of breath;
  • should be able to exercise about as long as other children, with little (if any) cough, wheezing, chest tightness, or trouble breathing;
  • should handle "colds" as well as other children.
  • Should need a short-acting beta-2 agonist for asthma symptoms less than 4 times per week

What are the signs of worsening asthma control?

  • Cough at night.
  • Waking up at night because of coughing or chest tightness.
  • Increased cough, wheezing, and/or trouble breathing with exercise, or reduced ability to exercise because of asthma.
  • Cough or wheeze at rest (reading, watching TV, etc.)

What are the signs of a severe asthma attack?

  • Severe shortness of breath, rapid or shallow breathing, laboured breathing, and/or sucking in of the skin between the ribs or at the base of the neck.
  • Blueness — anywhere!
  • Severe cough or wheezing that returns within 4 hours after a treatment with the child's Reliever medication.
  • Inability to speak in full sentences.
  • Sleepiness due to asthma.
  • Fainting because of an asthma attack.

If your child is needing treatments with his/her Reliever medication every 4 hours (or more often than your doctor recommends) OR your child has signs of a severe asthma attack, you should have your child assessed by a doctor. You should also see, or talk to, a doctor, if you are worried about your child's asthma.

Monitoring Using a Peak Flow Meter

decorative image A Peak Flow Meter lets you keep track of your child's asthma using an easy-to-read, simple machine. The American National Heart, Lung, and Blood Institute recommends peak flow monitoring as part of a home asthma management program, designed to control asthma symptoms, prevent sudden, severe asthma episodes, and maintain a normal activity level. Peak Flow Meters cannot be used reliably in children under 4 years of age. It is also difficult to obtain reliable results with a Peak Flow Meter in many children between 4 and 6 years of age. By the age of 7 years, most children can, with instruction, use a Peak Flow Meter well.

If you use a Peak Flow Meter, you should record the results in a diary card, or on a calendar. After a few weeks, you will be able to find out your child's personal best Peak Flow reading. Your doctor can use this number when he creates an Asthma Action Plan for your child. Ideally, your child should check his Peak Flows in the morning, at night, and whenever he/she or you are wondering whether he/she might be having an asthma attack. It is recommended that whenever Peak Flows are checked, the child should repeat the measurement 3 times, and you should use the best measurement for your assessment and for record-keeping. You may even want to record the Peak Flow readings in a computer spreadsheet, which should let you make graphs to track trends, and perhaps even calculate statistics!

Peak Flow Meters, like All-Seasons Radials, don't last forever. In most Peak Flow Meters, the little needle (that slides up to give you a reading) eventually loosens, making the meter's readings a bit too generous. After a couple years of regular use, you should check your Peak Flow Meter against a hospital's, or buy a new one.

When a doctor prescribes a Peak Flow Meter, he/she usually will provide you with a written Asthma Action Plan to go with it. The Action Plan is usually based on the Stoplight Scheme. This will allow you to guide therapy, and judge the importance of changes in your child's Peak Flow Meter readings. In addition to checking where readings lie within your Action Plan, you should look for trends — are the Peak Flows gradually going up after you start a new treatment, or are they gradually going down (for example, in the Spring as the trees start to blossom).

decorative image Green Zone: Peak Flow reading is between 80-100% of your child's Personal Best. This is the "All Clear" Zone — your child should continue his or her usual treatments.

Yellow Zone: Peak Flow reading is between 50-79% of your child's Personal Best. This is the "Caution" Zone — your child's asthma may be getting worse. You should change your child's treatment, as recommended by your doctor.

Red Zone: Peak Flow reading is less than 50% of your child's Personal Best. This is an asthma emergency! You should take a Reliever medication, as recommended by your doctor. Your doctor may recommend that you then call him/her right away. You should see a doctor or go to the hospital right away if your child is struggling to breath, has blue lips or fingers, has a Peak Flow still in the Red Zone 30 minutes later, or 6 hours later, your child's Peak Flow is still less than 70% of his/her personal best, despite additional treatment with his/her Reliever medication.

The Alternative Zone

Some recent research has suggested that children's Peak Flow Meter readings may not drop as much during an asthma attack as the traditional stoplight scheme would suggest. Your doctor may recommend an Alternative stoplight system, similar to the one given below:

decorative image Green Zone: Peak Flow reading is between 80-100% of your child's Personal Best. This is the "All Clear" Zone — your child should continue his or her usual treatments.

Yellow Zone: Peak Flow reading is between 70-79% of your child's Personal Best. This is the "Caution" Zone — your child's asthma may be getting worse. You should change your child's treatment, as recommended by your doctor.

Red Zone: Peak Flow reading is less than 70% of your child's Personal Best. This is an asthma emergency! You should take a Reliever medication, as recommended by your doctor. Your doctor may recommend that you then call him/her right away. You should see a doctor or go to the hospital right away if your child is struggling to breath, has blue lips or fingers, has a Peak Flow still in the Red Zone 30 minutes later, or 6 hours later, your child's Peak Flow is still less than 75% of his/her personal best, despite additional treatment with his/her Reliever medication.

How Do Doctors Determine the Level of Asthma Control?

The treatment of asthma involves reducing exposure to irritants and substances the child with asthma is allergic to, and the use of medication. The purpose of treating asthma is to achieve good asthma control. The Canadian Asthma Consensus Guidelines give precise definitions of asthma control, for Canadian doctors to use. This table gives the definitions of good, and adequate, asthma control, as described in the current Canadian Asthma Consensus Guidelines used by Canadian physicians. If your child's asthma doesn't seem adequately controlled, you should inform your child's doctor, and you should discuss, with your doctor, what you can do to control your child's asthma better.

  Good Control Adequate Control
Daytime Symptoms  None Less than 3 days per week
Night-time Symptoms None Less than 1 night per week
Physical Activity Normal Normal
Use of short-acting
bronchodilator (*apart
from before exercise)
None* Less than 4 doses
per week*
Absences from school
or work
None None
Asthma Attacks None Mild and Infrequent
Peak Flow Readings Normal 90% of personal best
Peak Flow Variability
(highest number in 2 weeks — lowest number in 2 weeks, divided by highest number in 2 weeks, multiplied by 100)
Less than 10% Less than 15%
Pulmonary Function Test
(at the doctor's office)
Normal 90% of personal best


Adapted from the Canadian Respiratory Journal 1996, Volume 3, Number 2.

Please read our Asthma Devices Page for more information about monitoring your child's asthma.

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