Imagine trying to breathe through a pinched straw. That's what an asthma attack can feel like to a child. An asthma attack isn't just scary, it can be life-threatening.

Asthma, which is a chronic inflammation of the lungs, is a primary reason why so many children miss school. Also, asthma attacks are the most common reason for pediatric emergency room visits attributed to a chronic illness.

However, a dreaded asthma attack or "flare" as some call it, when a patient wheezes and literally gasps for air, can be avoided with proper care and medication, experts say.

"The best way to treat an asthma attack is before it starts," says John Winder, MD, chairman of the American College of Allergy, Asthma & Immunology's (ACAAI) National Asthma Screening Program. Winder, an allergist in private practice in Toledo, OH, is also director of the Toledo Center for Clinical Research, which performs asthma clinical trials.

How trouble begins

All children who have asthma have airways that are overly sensitive, or hyperreactive, to certain asthma triggers. Many of these triggers are the same as allergy triggers - such as pollen, dust mites, animal dander, mold, and cockroach droppings. Some asthma is also triggered or aggravated by exercise and by viral infections, such as colds.

Two reactions occur with asthma. The airways become inflamed or swell and produce extra mucus, which makes it difficult to breathe. The muscles around the airways also tighten, narrowing the airways and causing symptoms such as wheezing, shortness of breath, and chest tightness. This is called bronchoconstriction. As a result, two kinds of medicine are used to treat asthma: anti-inflammatory medicines and bronchodilators, which can be used to prevent symptoms or to quickly stop asthma symptoms.

The more knowledgeable a family is about asthma and ways to control it, the better off the child patient is, according to Winder. He notes that one study showed that patient education about asthma medication resulted in a 50% reduction in emergency room visits.

Creating asthma action plan

Winder and other asthma experts say families of children with serious asthma should have an emergency action plan. The National Asthma Education and Prevention Program, funded by the National Institutes of Health, includes an asthma action plan for families in a brochure "Facts about Controlling Asthma."

The "asthma action plan" includes three stages:

• Green zone: doing well (no cough, wheeze, chest tightness, or shortness of breath during the day or night; can do usual activities). Take long-term control medicines each day, including an anti-inflammatory.

• Yellow zone: asthma is getting worse (cough, wheeze, chest tightness, or shortness of breath, or waking at night due to asthma, or can do some, but not all, usual activities). Add quick-relief medicine, and continue to take long-term control medications.

• Red zone: medical alert (very short of breath, or quick-relief medicines have not helped, or cannot do usual activities, or symptoms are the same or worse after 24 hours in Yellow zone). Take oral steroid or short-acting beta_2-agonist medication as directed by your doctor. Go to the hospital or call 911 for an ambulance.

Look for early clues

In developing an action plan, Winder urges parents to emphasize early treatment. "ET," as he calls it, is extremely crucial. Also, in his opinion, he says no one should wait a full 24 hours to seek medical attention.

"Anyone can recognize someone having an attack if they're lying on the floor, blue in the face, gasping for air," Winder says. "You want to pick up signals sooner. The earlier you pick them up signals from Mother Nature to herald an attack, you may head it off much more readily."

An early indicator that your child may be having trouble is a cough, perhaps accompanied by itching under the chin or in front of the chest. Smaller children often become more irritable. The cough may then become worse, or raspy, accompanied by shortness of breath, and difficulty breathing.

"These are the early clues an episode is starting," Winder says. "A dead giveaway (of an attack) is full-blown chest tightness, wheezing - symptoms people can recognize readily."

The ABCDs of action

As part of an action plan, Winder offers these ABCDs for parents:

A. Reduce activity. If your child is outside running, have him or her take a break.

B. Bronchodilator, or some form of quick-relief medicine to reverse the broncho spasms.

C. Consume fluids. "This is not in the guidelines," Winder says. "Drinking lots of lukewarm water doesn't thin out the mucus, but it can be a relaxation tool while you are waiting for the bronchodilator to take effect."

D. Decide what to do next. Are the symptoms relieved? Does your child need to use the bronchodilator again? Do you need to call the doctor or 911?

"Asthma symptoms can go very fast or can develop over hours. Recognize early and treat effectively," Winder urges parents. "Don't let those symptoms build for 24 hours."

In addition to early control, he emphasizes prevention. If a child is going away on a trip, for example, make sure he or she has all the medications they would have with them at home. "It's like the Boy Scout motto: Be prepared. That's a key point of not getting caught."

Free asthma screenings, sponsored by the ACAAI, will be performed through the month of May at shopping malls, civic centers, health fairs, and other locations throughout the country.