By Gary A. Emmett, M.D.

Stefon is 15 and has asthma. More importantly, his asthma is often out of control – and as a result he's been admitted to the hospital once in the last year and spent the night in the ER twice. He has a preventive steroid inhaler, but stops using it once he feels "better."  So Stefon's asthma gets worse again. It happens so often that coughing, wheezing, chest tightness and night-time wake-ups have become his new normal –he doesn't even notice these warning signs of trouble.

It doesn't have to happen. Asthma is what's called a "reversible airway disease."  We can reverse asthma symptoms so that kids can live full, fun lives – but only if we know whether their daily treatment plan is working and when their asthma's getting worse. The challenge with teen-agers is that, as one recent study found, they dramatically overestimate their ability to control this breathing problem. Parents can help, by asking themselves and their teen-ager with asthma the right questions.

Start with these, which follow "The Rule of 2":

  • Is your child or teen awakened from sleep with coughing 2 or more times monthly?

  • Does your child or teen use an albuterol rescue inhaler 2 or more days per week?

  • Is your child or teen's albuterol inhaler refilled 2 or more times per year?

If the answer to any question is yes, your teen's asthma is not in good control. What's next? It's time to talk with his or her doctor or nurse about changing medication – and it's just as important to make sure your teen is using his or her asthma medication as directed. At least one in three people with asthma don't do this. If your teen's doctor doesn't know this, she may prescribe stronger and stronger medication when all your teen really needed was to use a lower dose regularly.

These questions also show whether your teen's asthma is in control:

  • How much school has he or she missed this year because of asthma? The answer should be close to zero.

  • Does your teen cough when running? If the answer is no, ask your child if she or he ever runs at all, even for a few seconds (such as to catch the bus or in gym class). Unfortunately, many kids with asthma never get much physical activity because they're short of breath or even get chest pain when running.

  • Do you have an Asthma Action Plan for your teen-ager? It's a personalized plan from the doctor, outlining medications to take regularly as well as what to do if your child's breathing is getting worse or becomes a medical emergency. You'll find a sample, blank plan from the National Institutes of Health here.

  • How would your teen rate his or her control of asthma? The American Lung Association's Asthma Control Test for teens is a four-question check that can help him or her honestly evaluate this. (There's also a version for younger children, ages 4 to 11, that helps build asthma awareness.)

I believe teens with asthma have a right to a good life.  That means teaming up with their doctor and care-givers to stay on top of their asthma care. For parents, that means asking the right questions. That way Stefon and other teens with asthma can fully enjoy life.

Next up: What medicines are available for asthmatics

Gary Emmett, M.D., is director of hospital pediatrics at Thomas Jefferson University Hospital.