Ashlynn’s Plan

By Heather Duncan, Region 7 Water, Waste & Pesticides

My daughter Ashlynn is seven years old. She loves the color pink. She enjoys reading but she would rather play outside. She is a daddy’s girl. Her favorite school subject is math. She dreams of being a spy someday.

And, my daughter has asthma.

Ashlynn’s asthma is triggered by sudden changes in the weather (otherwise known as spring and fall in the Midwest), respiratory viruses, acid reflux, poor air quality, and by dry ice at high school theatrical productions. (You can imagine how “fun” it was to discover that last one…)

No matter how well controlled it is, asthma redefines a family’s version of normal routine. Our family has had five years to adjust to our version of normal. It currently includes:

• An asthma action plan involving a full rainbow of colored inhalers and nebulizer treatments with names like Dulera®, Flovent®, albuterol, and DuoNeb®;
• A calendar on the kitchen counter, where we track Ashlynn’s asthma symptoms and her yellow and red zone medication doses;
• Family budget line items for co-pays, annual family flu shots, monthly prescription refills, and caffeine (that last one is for me, not for Ashlynn);
• A roll of quarters in the glove box of my vehicle, for the vending machines during an unexpected journey to the emergency room; and
• A thankfulness for our employers who understand when our family’s schedule changes suddenly – and for the medical insurance they provide.

In other words, our routine involves accepting that from August to April, normal is just a setting on the dryer. The goal of Ashlynn’s asthma action plan is to prevent asthma from being her limiting factor. That goal is a family goal, and most days, we accept whatever version of normal comes with it.

And, we hope for a better day tomorrow.

Implementing The Plan

3:07 p.m.        Just as the meeting conversation picks up, my cell phone buzzes. Caller ID says “Pathfinder Elementary”. I duck into the hallway to answer the call before it goes to voicemail.

3:11 p.m.        I thank Nurse Brooke and hang up the phone, sighing with relief. Thank goodness for amazing school nurses, I think. I step back into the room and reengage with the meeting.

5:35 p.m.        Ashlynn tells me about her day as we walk out of after school club. “I was squeezy after recess. Nurse Brooke gave me my rescue inhaler,” she relays. “How are you feeling now?” I ask. “A little better,” she says hesitantly. Probably time for the yellow zone of her asthma action plan, I remind myself.

5:40 p.m.        I set out the yellow zone inhaler when we get home. Ashlynn takes a daily controller medication in her green zone, and she adds a second controller medication during her yellow zone. There is also a red zone. The red zone is not fun. We hope it doesn’t come to that this time.

6:45 p.m.        Was that a cough I heard? I glance at the clock. It’s been less than four hours since her last asthma treatment. After my not-so-subtle Mom stare, Ashlynn gives in. “Four puffs of your red albuterol inhaler…,” I remind her. Dulera®, Flovent®, albuterol, prednisone… Asthma is a language all its own!

7:15 p.m.        “Mommy, I’m still squeezy,” Ashlynn says, wearily. Her hands jitter from the side effects of the albuterol. I begin to think through our asthma action plan options. Do we try an albuterol stack? “Let’s get your nebulizer and the iPad. You can watch a movie while you take your next treatment.” Ever the daddy’s girl, Ashlynn climbs on her father’s lap to finish her treatment.

8:30 p.m.        Ashlynn’s bedtime. As I tuck her in, I wonder how long the medicine will hold her. Asthma is usually worse at night than during the day, and well, today wasn’t that great. Best get to bed early yourself, Heather. Get some sleep while you can. Meanwhile, I ponder what may have triggered this attack. Was there a big weather change? Is she coming down with a cold? How was Kansas City’s air quality today? Most times, we can point to something.

9:22 p.m.        “I’ll take the first shift,” Jason says. My husband and I have learned to subdivide the night during asthma flares. First shift means asthma duty from bedtime until 1am; second shift involves from 1am to wakeup. This way, we’re both guaranteed a few hours of sleep and someone is fresh enough to help the rest of the family get ready in the morning.

5:15am           I turn off my alarm clock and wander to the kitchen. Ashlynn’s asthma calendar – the calendar where we track her asthma symptoms and her yellow and red zone medication doses – sits on the kitchen table. Only one treatment after bedtime... Not too bad!

6:35am           Ashlynn is not a morning person.

6:40am           Ashlynn begrudgingly gets out of bed, and trudges to her closet to pick and accessorize her outfit. Odds are, she’s wearing something pink.

6:52am           Cough.

6:54am           Cough. Coughcoughcough.  Sometimes, getting out of bed is too much activity for an already irritated airway. I instinctively load another DuoNeb® treatment in the nebulizer.

7:15am           After the treatment, the coughs have subsided, and Ashlynn’s takes her daily and yellow zone medications. I leave a voicemail for Ashlynn’s asthma coordinator at the pediatrician’s office – they will want to know we’ve used four treatments in the past 24 hours.

7:25am           Jason and I agree Ashlynn should go to school today. I shoot a quick email to Nurse Brooke and Mrs. McCall, letting them know how the overnight went and when Ashlynn’s last treatment was. The goal of Ashlynn’s asthma action plan is to prevent asthma from being her limiting factor. Most days, we succeed. Today, even as her asthma flares, Ashlynn will get to be a first grader who loves math class. We hope for an uneventful day today, a restful night tonight, and a better day tomorrow.

Heather Duncan has been with EPA Region 7 since 2006. Since 2006, Heather has also married her husband, purchased a house, gave birth to three children (one with special medical needs), and unsuccessfully attempted to give up caffeine three times.