ASTHMA IN CHILDREN
ASTHMA is an allergic disease of the lung airways. It is one of the most common
chronic diseases worldwide and the prevalence is increasing, especially among children.
Asthma causes an inflammation of the airways.
This occurs because the airways are oversensitive to certain substances called triggering
factors.
The triggering factors that are implicated in asthma are viral infections like a cold, house
dust mites (tiny bugs that are thought to affect a majority of asthma sufferers which are
found on mattresses, bedding, cushions, carpets, upholstery, cuddly toys and even
clothes),animal dander - fur, feathers, hair as pets or toys (pets - cats, dogs),cockroaches,
pollen, damp living conditions - mould spores in the air, breathing cold and dry air,
sudden changes in air temperature, cigarette smoke, air pollutants (ozone, sulphur
dioixide),coal smoke, strong odours, fumes, exercise, hyperventilation
(laughing),additive chemicals in food, aerosol chemicals, wood dust, spray paints, dyes,
drugs like aspirin and ibuprofen, stress and emotional factors(pressure of schoolwork,
changes of puberty, examinations etc.)
The symptoms of asthma are, dry persistent - a long lasting cough or intermittent cough
more at night or early in the morning or after exercise, difficulty in breathing, wheezing
(a whistling or hissing sound produced when air travels through the constricted bronchi),
chest tightness, chest pain, fatigue due to sleep disturbance etc.
There are some types of childhood asthma:
*Some infants have recurrent episodes of wheeze associated with viral respiratory
infections, and they usually outgrow their symptoms in the preschool years and have no
evidence of subsequent asthma.
*Other infants with asthma have a family member suffering from conditions like
eczema, hay fever, food allergies etc, have eczema as well. Symptoms in these children
often persist through childhood and into adult life.
The NAEPP (National Asthma Education and Prevention Program) of the United States
of America has laid down guidelines to classify asthma according to the severity into
different categories as
a) Intermittent asthma - mild
b) Persistent asthma - mild, moderate and severe.
The treatment depends on the child's category of asthma.
There is presently no conventional cure for asthma, but there are a range of treatments
which can control it quite effectively. These fall into two categories:
Relievers - a range of drugs called bronchodilators (usually a blue inhaler) which act
quickly in an attack and open the airways, which should only be used when the child
actually has symptoms.
Controllers- anti-inflammatory drugs like steroids (which come in various coloured
inhalers) and other medicines, which help prevent the symptoms of asthma flaring up,
which are to be taken every day ,whether the child has symptoms or not.( Mouth rinsing
using a 'swish and spit technique' after steroid inhalation is mandatory to prevent fungal
infection of the mouth and throat.)Many parents are reluctant to use steroids because of
the fear of side effects. But current evidence shows that side effects like growth
retardation do not usually occur with long term "inhaled" steroids in the recommended
dose.
Though there are a number of ways a child can take medicine, the preferred method in
asthma is inhalation (breath-in).
MDI or metered dose inhalers first came into use in the 1970's and has since
revolutionised the treatment of asthma. As the inhaler delivers the medicine directly into
the lungs it is more effective, a lower dose is used and there is a lower risk of side effects
Pills and syrups go through the bloodstream to get to the lungs and so do not work as
quickly, a bigger dose is needed and increase the risk of side effects.
However the MDI's are quite difficult for young children to use properly, and are made
much simpler by the addition of a spacer (with a face mask) .
Once a child has been diagnosed as asthmatic, and has been classified into which
category of asthma he fits in, a written asthma management plan comprising of 2
components, is made for him namely
*Daily management plan
*Action plan for asthma exacerbation
The goals of childhood asthma management aim at maintaining normal activity in the
child with regular school attendance, full participation in sports and games and
prevention of sleep disturbance etc. This is done by identifying and avoiding the
triggering factors, recognising and managing an acute episode and educating the child
and parent on the importance of long term prevention.
An exacerbation may be on the horizon if:
* normal relieving treatment has no effect on symptoms
* child cannot talk
* breathing is severely laboured
* face is pale with a blue tinge
* child is lethargic, drowsy, confused
* wheezing stops (so called silent chest)
and under such circumstances the child should be taken to a paediatric emergency centre
immediately or an ambulance called.
As the most common form of childhood asthma is associated with allergy and as allergen
exposure is associated with more severe asthma parents should be aware of the measures
and try to minimize allergen exposure in the home.
The
preventive measures are as follows:
1. Stop smoking.
2. Breast feeding - exclusively for the first 6 months can protect against asthma.
Allergic diseases like asthma and eczema are 7 times more common in formula
fed infants than in breast fed ones. The antibodies in breast milk form a protective
lining in the gut in the early days, while formula introduces foreign proteins into
the immature intestine. This sets up the allergic reactions which later develop into
food allergy, asthma or eczema.
2. Remove carpets, replace with wood flooring or linoleum. Vacuum rugs every day
and wash them at 60*C water which kills the dust mite.
3. Remove curtains and replace them with vertical blinds as they do not allow dust
to settle.
4. Replace upholstered furniture with leather, vinyl or plain wooden sofas and
chairs. Put cushions in dust mite proof encasings, wash outer covers regularly at
60*C water and vacuum everyday.
5. Put mattresses in sealed covers.
6 Wash the child's bed linen every week at 60*C, and dry in a hot dryer. If possible
clothes can also be washed at 60*C.
7. If possible dust with a damp cloth and vacuum the house every day. Do the
housework when the child is not around.
8. Cut down on dust gatherers around the home - books and book shelves,
lampshades, ornaments, picture frames, plants and toys. Toys can be kept in a
cupboard rather than in a box.
9. Avoid soft, cuddly, furry, or fabric toys.
10. Avoid pets.
11. Encourage children to spend time in the garden in the early morning or late
evening as pollen counts are lowest at these times.
12. Do not randomly exclude food substances from the child's diet as it may lead to
growth retardation and vitamin deficiencies. To rule out food allergies/
intolerance the paediatrician will refer the child to a dietician or a nutritional
therapist.
The above measures, annual anti-flu vaccinations, regular follow-up visits to an asthma
clinic, and taking the prescribed medicines meticulously help asthmatic children to 'fit in'
with their normal, age matched peers. Feeling different because of asthma can lead to
lowered self esteem in children. There are people with asthma in all walks of life-from
actors, politicians, sportsmen, doctors, journalists and teachers. Parents should help
children realise that asthma is as much about attitude of the mind as it is anything else.
Written By : Dr.A.Priya Margaret DCH.DNB(Paed)
Reviewed By: National Health Authority Qatar.
(The medical information in this article is provided as an information resource only, and is not to be used or relied on for any diagnostic
or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and
should not be used as a substitute for professional diagnosis and treatment. If you have or suspect that you have a medical problem or
condition, please contact your physician.)