You think Halloween, I think Asthma
October - You Think Halloween, I Think Asthma
While everyone else starts thinking about Halloween costumes, pumpkins, candy, and all the fun decorations and parties that come with the start of October, I start thinking about asthma.
I've been caring for children in South Texas since my medical school rotations began in 2013, and over the years I've developed a mental association of my own:
October = asthma.
It's not just something I've noticed in my own practice. Asthma-related emergency visits tend to increase in September and October, particularly in children. The return to school, respiratory viruses, changes in weather, pollen, mold, and other environmental triggers can all contribute to asthma flare-ups.
And here in South Texas, our weather doesn't always follow the calendar very neatly.
So over the last decade, I've gotten into the habit of helping parents build a similar mental association:
Think Halloween - Think asthma check-in.
I've probably told more than a thousand parents some version of this:
"When you start choosing your child's Halloween costume, think about restarting that every-day inhaler."
And then, because I'm apparently incapable of letting a seasonal analogy go, I usually follow it with:
"And when you're thinking about Easter baskets, think about that every-day inhaler, too."
October and April have become my little reminders to stop and think:
How is your child's asthma doing?
So what is this "every-day inhaler"?
If your child has asthma, you've probably heard terms like controller inhaler, maintenance inhaler, or daily inhaler.
Many of these medications contain an inhaled corticosteroid (ICS). Examples include medications such as:
fluticasone (brand name Flovent)
budesonide (brand name Pulmicort)
beclomethasone (brand name Qvar)
There are also combination inhalers that contain an inhaled corticosteroid plus another long-acting albuterol, such as Advair or Symbicort.
The important thing to understand is that these medications are designed to help control the inflammation in the airways over time.
Asthma isn't simply a problem of "tight lungs."
There is inflammation happening inside the airways, and when that inflammation is poorly controlled, the airways are more vulnerable to triggers that can lead to coughing, wheezing, chest tightness, and difficulty breathing.
For children who have been prescribed a daily controller medication, the medication is meant to be taken consistently according to their asthma treatment plan—even when they feel completely well.
That's actually the point.
A child who feels great today may still have underlying airway inflammation that needs to be controlled.
The 2020 National Heart, Lung, and Blood Institute (NHLBI) asthma updates continued to emphasize the important role of inhaled corticosteroids in asthma management, while also introducing age- and severity-specific approaches to when and how inhaled corticosteroids should be used.
But isn't albuterol the asthma inhaler?
Yes!
And this is where I see a lot of confusion.
Albuterol is a quick-relief medication. You may know it by brand names such as ProAir or Ventolin.
Albuterol works by relaxing the muscles around the airways, helping open them up when a child is experiencing asthma symptoms.
The controller inhaler and albuterol have different jobs.
Think of it this way:
Albuterol = putting out the fire
ICS = Controller medication = helping prevent the fire from starting
One doesn't simply replace the other.
And depending on your child's age, asthma severity, and treatment plan, the recommended approach can be different. Some children use an inhaled corticosteroid daily; some use an inhaled corticosteroid intermittently; and some children with moderate-to-severe asthma may use an ICS-formoterol inhaler as both controller and quick-relief therapy (this is the new SMART regimen).
Your child's asthma plan should be individualized with their PCP.
Why does October matter?
There isn't one single "October asthma trigger."
It's more like several things start piling up at the same time.
Respiratory viruses
Kids go back to school.
Kids share germs.
Kids bring those germs home.
And respiratory infections are a common trigger for asthma exacerbations.
Fall allergens
Fall pollen, including ragweed, can contribute to symptoms in children who have allergic asthma.
Mold
Changes in weather, humidity, rain, and decaying vegetation can increase mold exposure.
Weather changes
Sudden changes in temperature and humidity can be challenging for some children with asthma.
And then there are the individual triggers that vary from child to child: exercise, smoke, pets, dust mites, strong fragrances, environmental irritants, and more.
The result is that September and October can be a particularly vulnerable time for children with asthma.
What about those oral steroids?
This is another reason I want families to think about asthma before the asthma attack happens.
When a child has a significant asthma exacerbation, they may need a short course of an oral corticosteroid such as prednisone/prednisolone or dexamethasone.
And let me be clear:
Oral steroids have an important role in treating asthma exacerbations.
They can be very effective at reducing significant airway inflammation, and sometimes they are exactly what a child needs.
But they aren't something I want a child to need over and over again if we can safely get their asthma better controlled.
Short courses aren't harmless. Studies in children have found that vomiting, behavioral changes, and sleep disturbance are among the more common side effects of short courses of systemic corticosteroids.
More recent evidence has also found increased risks of some adverse effects such as sleep problems and hyperglycemia, although serious adverse events were uncommon.
So when I talk about preventing asthma flares, I'm not talking about avoiding steroids at all costs.
I'm talking about using the right treatment at the right time so that we don't have to keep rescuing poorly controlled asthma.
The asthma conversation I want you to have this October
If your child has asthma, October is a great time to pause and ask:
✔️ Do we have an up-to-date asthma action plan?
✔️ Do we have their controller medication at home?
✔️ Are we giving the controller medication the way it was prescribed?
✔️ Do we have albuterol available if it is part of their asthma plan?
✔️ Does the school have the medications and instructions they need?
✔️ Do we know what triggers our child's asthma?
✔️ When was our child's asthma last reassessed?
And perhaps most importantly:
Does my child's current asthma plan still make sense?
Asthma management isn't supposed to be a one-time conversation.
Children grow.
Their lungs grow.
Their triggers can change.
Their symptoms can change.
And their treatment needs can change, too.
A note from Dr. Lauren
If your child has asthma and you aren't sure whether their current treatment plan is still appropriate, talk with their pediatrician or asthma clinician. Don't start, stop, or change a controller medication based solely on this article. Asthma treatment is individualized based on age, symptoms, severity, triggers, and response to treatment.
If your child is having significant difficulty breathing, is struggling to speak or drink because of breathing difficulty, has blue/gray lips or face, is unusually sleepy or difficult to wake, or is not responding to their prescribed rescue medication, seek emergency medical care.
Looking for personalized pediatric care in Rockport, Texas?
At Anchor in Tide, I provide relationship-centered pediatric care designed to give families more time, more access, and a more personalized approach to their child's health.
