Tyrone, twelve, has had asthma for six years. His asthma symptoms used to appear anytime he caught a cold, especially in the first few days, when he'd wake at night, coughing and wheezing. As his cold improved, his night symptoms disappeared, but the cough hung on for about ten days.

His doctor had given Tyrone a quick-relief (albuterol) inhaler with a spacer to use whenever he had a cold. That solution had worked well-until recently. Tyrone began to need his inhaler even when he didn't have a cold. He used it when playing basketball because he got short of breath and started coughing five minutes into a game.

After three months of increasing symptoms, he went back to his doctor. Tyrone's lung function tests had decreased. His peak flow meter reading was 68 percent of his personal best. His doctor started Tyrone on inhaled corticosteroids, gave him an asthma management plan, and told him to begin the plan whenever his symptoms start to change: for example, when he needs albuterol twice in one day, and again when he feels short of breath.

At a follow-up appointment three months later, Tyrone reported that he could play basketball without problems. But when he caught a cold, the wheezing and coughing made him miss two weeks of school. When the doctor asked if he was following his management plan, Tyrone said he started it after he'd had the cold for two or three days.

That was the problem. His physician explained: "You need to begin your management plan as soon as you start waking up at night with wheezing or coughing, or when you need to use your albuterol two times in one day, because those are signs your asthma is starting to flare." Tyrone agreed and added that he could usually tell when his asthma was about to get worse because he'd feel a tightness in his chest the day beforehand. By his next follow-up visit, Tyrone had absorbed the lesson. He'd had one cold but started his management plan immediately and didn't miss any school.

What can we learn from Tyrone? This young man has good symptom recognition. He can spot early signs of a flare and recognize when his asthma is getting worse. And he learned to use his management plan to enable him to control his asthma.

Let's look at another child, ten-year-old Tammy:

Tammy had been feeling well, with no apparent symptoms, when she suddenly couldn't breathe. Her father rushed her to the nearest ER. A week later, she had a follow-up appointment with her pediatrician, who also happened to be Tyrone's doctor. Tammy reported that she has no problem playing soccer. She is her team's goalie and never coughs or wheezes at games. When the doctor asked why she played goalie, Tammy said she got out of breath faster than her teammates so the coach made her goalie.

The doctor started Tammy on inhaled steroids and gave her the same management plan as Tyrone's. On a three-month follow-up visit, Tammy excitedly told the doctor that she could now keep up with her teammates on the field, had switched positions to offense, and scored her first goal. But Tammy and her mother were confused about something. A month ago, Tammy again got sick suddenly and went to the emergency room. Her spirometry was improved but not to the normal range.

Her doctor asked about her medicine use. Tammy had been taking her daily medicines but hadn't started her management plan at any time during the last three months. So the doctor taught her how to use a peak flow meter. Green, yellow, and red zones were set based on her persqnal best and her spirometry.

A few months later, Tammy told the doctor that she was doing fine no problems in sports and no sudden asthma flares that sent her to the ER. Her peak flow readings were all above 230, except for one week when they dropped into the yellow zone. Then she started her management plan and her peak flows returned to the green zone within five days. Interestingly, Tammy didn't notice any difference in symptoms during that time.

What can we learn from Tammy? Some children have flares without obvious symptoms. Peak flow meters are perfect for youngsters like Tammy. Many people recognize symptoms before changes in their peak flow readings, while others see a drop in peak flows before they notice any symptoms. Tyrone's and Tammy's experiences represent two typical situations: either symptom recognition or a peak flow meter will work for different children. You and your doctor will decide which way works best for your individual child.