Printer Friendly Page

                                         Asthma

Asthma can be a scary diagnosis. Parents understandably get fixated on the fact that fortunately very few children, die of asthma every year.

All this fear surrounding asthma is unfortunate, because most cases of asthma are easy to treat with safe medications. Today there is no reason why a child with asthma cannot live a totally normal life, and participate in the same activities and sports as his or her non-asthmatic friends.

If childhood asthma is correctly diagnosed and treated properly, it is nothing to be afraid of.

What is asthma?

• Asthma is the most common chronic disease of childhood, affecting approximately 5 – 10% of children.
  
• Asthma is one of the diseases that have increased significantly in the United States over the last 25 years - approximately five million children in the US have asthma.
  
• Asthma is a disease of the respiratory tract, or the passageways that carry air to the lungs.
  
• During an “asthma attack” your childs airways become irritated and narrowed so that airflow is decreased and breathing is made difficult.
  
• An “asthma attack” results from exposure to many different kinds of environmental triggers (see below).
  
• A child of an asthmatic parent will not necessarily develop asthma. There is only an increased chance of developing asthma.
  
• Prevention and early treatment of asthma may help reduce the number of days your child is absent from school or in the hospital.
  

What can trigger an “asthma attack” or make asthma worse?

       Viral infections of the ear, nose, and throat (e.g., sinusitis,
        the common cold)

       Other infections (such as pneumonia)

       Cigarette smoke 

       Irritants in the air (air pollution) 

       Changes in weather, especially cold air or humidity 

       Things your child may be allergic to (allergens)

       Pet dander 

       Pollen 

       Dust mites 

       Animals 

       Mold 

       Exercise 

       Emotional stress

What are the typical signs and symptoms of an “asthma attack”?

Symptoms of asthma can be different for each child, depending on how often they occur or how much or how fast the airways become narrowed. Some children have symptoms of asthma most days and may have to take daily medication; others just may need medication when they have asthma symptoms. Many children with asthma cough or wheeze at night. Some children are even awakened at night by these symptoms.

Typical signs and symptoms of an “asthma attack” include:

        Cough - may be the first and sometimes the only symptom of early
                       asthma

        Wheezing - this is a high-pitched whistling sound that is produced by
                              air rushing through narrow breathing tubes.

        Chest tightness

The signs and symptoms below in addition to cough and wheezing indicate a severe “asthma attack”:

        Shortness of breath

        Labored breathing – the child is breathing fast and may use
                                               extra muscles from the neck, abdomen and
                                               chest to help "draw in" air.  Will see “drawing in”
                                               of the muscles between the ribs.

        Difficulty speaking

        Anxiety or drowsiness may occur

        Large decreases in your childs peak flow rate measurements
       

What are other causes for wheezing in children?

I was always taught that “all that wheezes is not asthma”. The two most common problems other than asthma that bring children into the ER with wheezing are bronchiolitis and foreign body aspiration (a foreign body such as a peanut stuck in the airway).
Click on bronchiolitis for details on that illness.

      Foreign body aspiration

             o Most commonly seen between 6 months and 5 years
             o Usually a sudden history of choking, cough or wheezing after
                playing with a small object
                For more detail, click on Foreign body aspiration

Some other causes for wheezing include:
             · Cystic fibrosis
             · Pneumonia
             · Gastroesophageal reflux
             · Allergic reaction
             · Heart problem
             · Other congenital abnormalities

What is the treatment for asthma?

There are different kinds of asthma medications. Your pediatrician will choose the best medications for your child; some will be used continuously to help prevent an asthma attack while others will only be used during asthma attacks.

Discuss a treatment plan with your pediatrician so that you will know which medication your child should use first when the early signs of an asthma attack develop. This will help reduce the need for a trip to an ER and for hospitalization. 

There are 3 general groups of asthma medications all of which
may be necessary in the treatment for some children with asthma:

1. Bronchodilators (e.g., albuterol, xopinex) open up narrow passageways. They help relieve chest tightness, wheezing and difficulty breathing. These drugs can be given by mouth or breathed in by metered dose inhaler or by nebulizer in an aerosol (mist) form.

      o Studies demonstrate that inhaled bronchodilator medication is very
         efficiently delivered by the hand-held metered dose inhaler;
         however, this requires that the instructions be followed carefully.

      o Some bronchodilators are used to treat a sudden, acute asthma
         attack (e.g., albuterol, xopinex) while others are indicated for the
         long-term, maintenance treatment of asthma (e.g., serevent).

      o Recent studies suggest that overuse of these medications may
         worsen asthma so only take the amount recommended by your
         pediatrician.

2. Anti-inflammatory drugs (i.e. steroids) help prevent the swelling and inflammation in the airways. These drugs can be given by mouth (e.g., orapred), by injection, breathed in by metered dose inhaler (e.g., flovent) or an aerosol treatment (e.g., pulmicort).

          o Steroids taken by mouth for long periods of time can cause
             unwanted side effects such as weight gain and growth
             problems.  An occasional, brief course (3 – 5 days) of
             steroids by mouth is not expected to be harmful and can
             help improve a sudden asthma attack.

          o The results from a large 2007 study supported the current
              asthma clinical guidelines, which recommend inhaled
              corticosteroids as the preferred initial therapy for children
              with mild to moderate asthma.

          o Inhaled steroids can be taken for long periods of time
             without harmful side effects because they go directly to
             the lungs and not the rest of the body.

          o Anti-inflammatory medications given by metered dose inhaler
             must be taken regularly to be effective. 

These medications (e.g., pulmicort) do not have an immediate effect and therefore are mistakenly discontinued. Their beneficial effects occur gradually over weeks and months of consistent use.

3. Leukotriene modifiers (e.g., Singulair) are a new class of oral
anti-inflammatory asthma drugs available by prescription.


Should my child use a spacer device when using a metered dose inhaler?

• Yes, approximately half of asthma patients do not properly use their inhaler and this problem can be overcome by the use of a spacer device.
  
• Spacer devices allow the metered dose inhaler to first be sprayed into this container and then the patient breathes in the inhaled medication from the spacer.

How can an asthma attack be prevented?

• Create a treatment plan with your pediatrician in order to decrease the frequency and severity of attacks and to allow your child to be involved in childhood activities as much as possible.
  
• Reduce exposure to triggers as listed above
  
• Know how to recognize early signs and symptoms of an asthma attack in your child
  
• The use of a peak flow meter can help you to recognize when your childs airway is narrowing, so asthma treatment can be started early.

                 o Peak flow rate measurements can usually be used for 
                    children older than 5 - 6 years.

                 o Your pediatrician can show you and your child how to use a
                    peak flow meter and how to find out your childs "personal
                    best" peak flow rate.

                 o Peak flow rates decrease (the numbers on the scale go
                    down) when your childs asthma is getting worse.

                 o Peak flow rates increase (the numbers on the scale go up)
                    when the asthma treatment is working and the airways are
                    opening up.

When should I contact my pediatrician concerning my child’s asthma?

You should call your doctor anytime your child’s asthma is worsening and not responding to regular medication.

You should also call anytime you run out of your child’s medication rather than wait until the next asthma attack.

Call immediately for any signs and symptoms that indicate your child is having a severe “asthma attack”.

        o If you are unable to reach your doctor when your child is
           having a severe attack take your child immediately to an
           ER or call 911.