Children
and Asthma
Asthma is a chronic inflammatory disease of the airways. This inflammation
makes the airways very sensitive so they react strongly to things
that are irritating. When they react, the muscles around the airways
tighten, the inflammation increases, and the cells make more mucous.
All three of these factors work together to make the airways more
narrow, which causes an asthma attack.
There is no cure for asthma, however, if asthma is well controlled,
patients can live a normal life with full participation in all activities.
Causes
There are 15 million Americans who have asthma, and 5 million of
these are children. No one is for sure what causes asthma, and it
is likely a combination of several factors. Some of the things we
know contribute to asthma are family history of allergies, asthma,
or eczema; exposures to irritants such as cigarette smoke early in
life; and lower respiratory tract infection such as RSV and the flu
in the first 2 years of life. Not all infants who wheeze when they
get colds end up with asthma, but it definitely increases the likelihood
they will.
Asthma exacerbations
Asthma exacerbations or "attacks" as they are commonly
called can be brought on by a number of things. The most common cause
of an exacerbation in children is a viral upper respiratory tract
infection or URI. Others include respiratory irritants like smoke,
allergens, exercise, cold air, weather change, and laughing or crying.
Symptoms of an exacerbation include:
- Cough- Cough may be the only symptom of asthma in children.
The cough is often much worse at night and early in the morning,
and with exercise. The cough can be a dry or wet cough.
- Wheezing-
Wheezing is a high pitched whistling sound that is caused by narrowing
of the airways.
- Chest tightness- Patients often describe this as
feeling like someone is sitting on their chest, or like they are
breathing through a straw.
- Shortness of breath-Patients may be breathing
fast and may have retractions under and between their ribs.
- Colds
that "go to the chest"- A child who frequently
gets chest congestion with colds, or has a cough that lasts several
days longer than their nasal symptoms with a cold is likely to
have asthma.
Not all children have all of these symptoms, and symptoms vary from
one exacerbation to the next. If your child has any of these symptoms,
contact your child's physician for further evaluation.
Diagnosis
Unfortunately, there is not a test available to diagnose asthma
in small children. Your doctor will use the patient's history (personal
and family) along with an exam to make the diagnosis. Older children
are usually able to perform PFTs or pulmonary function tests which
aid in the diagnosis. A chest X-RAY and allergy testing may be indicated
as well.
Medications
Medical treatment for asthma has come a long way, and the vast majority
of patients can be symptom free most days.
- Short acting bronchodilators- also called "rescue" inhalers
relax the muscles around the airways. All asthma patients should
keep one with them at all times.
- Inhaled corticosteroids- preferred
medication for control, decreases inflammation in airways
- Long acting
bronchodilators- usually taken with corticosteroid for improved
daily control
- Leukotriene modifiers- are sometimes used alone for mild asthma
symptoms, but usually used with corticosteroids.
Signs asthma is not in control and you should call or make an appointment online if:
- Increase in frequency or intensity of symptoms
- Worse at night or
interrupting sleep
- Missing school or work
- Peak flow is low (if child is old enough to
use a peak flow meter)
- ER visit or hospitalization
- Using rescue inhaler more than 2 times
per week
Keeping asthma in control
- See your doctor for regular
checkups.
- Get a flu shot every year.
- Have and use the asthma action plan given
to you by your doctor.
- Teach
your child and everyone who cares for him about his asthma.
- Protect
your child from cigarette smoke. You will never find a better reason
to quit smoking than the health of your child.
- Keep
your child physically active.
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