I am asked this when I help families with asthma. And it's something I wrestled with myself when my kids were little.
I would wonder, "What a I doing wrong? My child is in the hospital AGAIN?!"
Often times, you aren't doing anything wrong!
Some kids just have asthma that is hard to control. And sometimes kids can go from bad to worse VERY quickly.
I found that close monitoring of their symptoms was helpful to me, including:
Using a peak flow meter
This is an inexpensive little hand held device that you blow into as hard as you can for one second. It measures how much air you can push out of your lungs. The marker will end up on a number on the scale ( 0 - 600), which will be your "personal best". That's is YOUR number. It's pretty much the same every morning and every night (unless you start to get sick.)
What I like about the peak flow is that I knew each kid's personal best. They would use their peak flow meter every morning and every night and yell out their number. Hopefully, they were in their green zone. If it was lower than normal, I would ask them to do it again. If it was still too low, I would talk to them. I could actually hear a change in my kid's voices when they were sick. Their voices would get tighter and higher.
A peak flow number that was dropping would give me several days warning that my child was getting sick and their lungs were getting worse. There are several things we could do (see below).
After hours/Urgent Care
Most pediatrician offices have an "after hours" network, where different doctors are on call after 5pm. Don't be afraid to use it! Kids with asthma can go downhill quickly. If you ever say to yourself, "I wonder if......" and if the next part of the question is "go to the doctor" - then GO! That's your gut telling you that something is wrong.
Many times the doctor would say, "It's just a virus." Well, pneumonia can be caused by a virus or bacterial - but it would still put my kid in the hospital. So even if it's a "virus", there are things Asthma Doc could do to help get the swelling down in my kid's lungs. He would have my child double up on their controller inhaler (depending on which one they were on). They were usually just on a corticosteroid, not a combination inhaler, so they could safely double it for a few days. You can't always double up inhalers - it depends on which one you take. Because you can get too much of a LABA (long acting beta agonist).
Sometimes the doctors would start my child on a 5 day "burst" of oral steroids (prednisone.) That would help reduce the swelling in their lungs. Other times doc would give them a steroid shot to get the medicine into their system even faster.
We usually had a 50/50 chance of ending up in the ER after a steroid shot. But it was worth a try!
Our After Hours offices were usually open from 5 - 10pm. After that, we would go to the Emergency Room. I would always give them a quick history - this child had been hospitalized 6 times already for asthma. They seemed to take me more seriously when they knew my child had already been admitted for asthma. Keep your list of asthma medicines and doses on your phone so the ER staff can record them in your child's chart.
Once one of my kids were admitted, did I feel like a failure? No. I had tried everything I could, but they needed more help than I was qualified to give them. That's when I let the professionals take over and sigh in relief.
My kids needed around the clock care and needed to be hooked up to oxygen monitors so the staff can be alerted if they get worse. They have a respiratory therapist that comes in every few hours to give a breathing treatment. And they also have a nurse and doctor keeping an eye on them. That's more than I can do as a parent.
So, hopefully the ideas above can help you monitor your child and try to keep them out of the hospital. But, if they do end up admitted - just know that you did the best you could!