 Asthma
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Asthma
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Asthma is a chronic, inflammatory disease in which the airways become sensitive to allergens (any substance that triggers an allergic reaction). Several things happen to the airways when a child is exposed to certain triggers:
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- The lining of the airways become swollen and inflamed.
- The muscles that surround the airways tighten.
- The production of mucus is increased, leading to mucus plugs.
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All of these factors will cause the airways to narrow, thus making it difficult for air to go in and out of your child's lungs, causing the symptoms of asthma.
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As determined by the National Institutes of Health (NIH), the following is a guideline used by physicians to help determine the extent of asthma in your child. It is classified as "steps," because each child may step up or step down to different levels at any time.
The steps are as follows:
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- Step 1 or mild intermittent asthma - This group of children has symptoms less than two times a week, do not have problems in-between flare-ups, and only have short flare-ups from a few hours to a few days. Nighttime symptoms occur less than two times a month.
- Step 2 or mild persistent - This group of children has symptoms more than two times a week, but no more than one time per day, and may have activity levels affected by the flare-ups. Nighttime symptoms occur greater than two times a month.
- Step 3 or moderate persistent - This group of children has symptoms every day, use their rescue medication every day, may have activity levels affected by the flare-ups, and have exacerbations greater than or equal to two times a week. Nighttime symptoms occur greater than one time a week.
- Step 4 or severe persistent - This group of children has symptoms constantly, have a decrease in their physical activity, and have frequent flare-ups. Nighttime symptoms occur frequently.
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According to the latest available information from the National Institute of Allergy and Infectious Diseases (NIAID) and the Asthma & Allergy Foundation of America, consider the following statistics:
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- About 22.2 million people in the US have been diagnosed with asthma, with at least 6.5 million of them children under the age of 18.
- Asthma is the most common chronic condition among children in the US.
- Asthma accounts for 14 million absences from school each year.
- Asthma is 26 percent more common in African-American children than in Caucasian children.
- African-American children with asthma, most often from inner city populations, generally experience more severe disability from asthma and have more frequent hospitalizations than do Caucasian children.
- Asthma is the third most common cause of childhood hospitalizations under the age of 15.
- More than 200,000 children with asthma experience symptoms that are more severe due to exposure to secondhand smoke.
- About 10 million doctor's office visits annually result in a diagnosis of asthma.
- Asthma cases and asthma deaths have been on the rise, and hospitalizations for asthma have increased.
- Asthma treatment costs an estimated $18 billion, including direct and indirect expenditures each year.
- Asthma causes nearly 15 million lost workdays each year for people over age 18.
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The majority of children with asthma have allergies. Even exposure to low-grade allergens (those that do not cause significant allergic reactions) may increase the severity of the asthma. In addition, allergies may play a role in undiagnosed asthma cases. Other triggers of childhood asthma may include the following:
- upper respiratory infections (i.e., colds)
- inhaled irritants, such as secondhand smoke
- certain weather conditions, such as cold air
- physical expressions of emotion, such as crying, laughing, or yelling
However, with proper management of the asthma, such as avoiding triggers, taking prescribed medications, monitoring for warning signs, and knowing what to do during an asthma attack, an individual with asthma can conduct a healthy and active lifestyle.
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Each person's symptoms are different, but do not ignore the early warning signs of asthma. Early warning signs are important to learn about and watch for, so you know that an asthma episode may be developing.
Some early clues that asthma may be developing are:
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- Breathing changes or cough
- Feeling tired
- Trouble sleeping
- Less energy for exercise
- Dark circles under the eyes
- Chin or throat itchiness
- Lower peak flow numbers
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Asthma symptoms signal that an asthma episode is occurring. Action should be taken to treat these symptoms before they get worse. Follow your asthma management plan or call your child's doctor or nurse with any questions. Common asthma symptoms are:
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- Coughing (for some children coughing is the only symptom)
- Shortness of breath
- Tightness in the chest
- Wheezing
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Severe asthma symptoms require immediate attention and can be a life threatening emergency. You should seek emergency treatment immediately. Some examples of severe symptoms are:
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- Severe coughing, shortness of breath, tightness in the chest, and/or wheezing
- Difficulty talking
- Breathing hard and fast
- Nasal flaring
- Hunched shoulders
- Chest and neck muscles pull in when your child breathes
- Lips or fingernails turn gray or blue
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Although anyone may have asthma, it most commonly occurs in:
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- children and adolescents ages 5 to 17 years.
- a child with a family history of asthma.
- children who have allergies.
- children who have exposure to secondhand tobacco smoke.
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Children with asthma have acute episodes when the air passages in their lungs become narrower, and breathing becomes more difficult. These problems are caused by an over-sensitivity of the lungs and airways.
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- The lungs and airways overreact to certain triggers causing:
- the lining of the airways to become inflamed and swollen.
- tightening of the muscles that surround the airways.
- an increased production of mucus.
- Breathing becomes harder and may hurt.
- There may be coughing.
- There may be a wheezing or whistling sound, which is typical of asthma. Wheezing occurs because of the rush of air which moves through the narrowed airways.
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If a child does not receive treatment immediately during an asthma attack, respiratory failure may occur.
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To diagnose asthma and distinguish it from other lung disorders, physicians rely on a combination of medical history, physical examination, and laboratory tests, which may include:
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- spirometry - a spirometer is a device used by your child's physician that assesses lung function. Spirometry, the evaluation of lung function with a spirometer, is one of the simplest, most common pulmonary function tests and may be necessary for any/all of the following reasons:
- to determine how well the lungs receive, hold, and utilize air
- to monitor a lung disease
- to monitor the effectiveness of treatment
- to determine the severity of a lung disease
- to determine whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)
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- peak flow monitoring (PFM) - a device used to measure the amount of air a person can blow out of the lungs. During an asthma or other respiratory flare up, the large airways in the lungs slowly begin to narrow. This will slow the speed of air leaving the lungs and can be measured by a PFM. This measurement is very important in evaluating how well or how poorly the disease is being controlled.
- chest x-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- blood tests - to analyze the amount of carbon dioxide and oxygen in the blood.
- allergy tests
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How asthma will affect a child throughout his/her lifetime varies, depending on the child. For some children, asthma improves during the teenage years, while others have symptoms that become more severe over time. About half of the children who have asthma at a young age appear to "outgrow" it, although the asthma symptoms may reappear later in life.
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Exercise, such as running, may trigger an asthma attack in the majority of adolescents with asthma. However, with proper management, an adolescent with asthma can maintain full participation in most sports. Aerobic exercise actually improves airway function by strengthening breathing muscles. Some tips for exercising with asthma include the following:
- Make sure your teen stretches before and after exercising, breathing through the nose and not the mouth to warm and humidify the air before it enters the airways.
- Make sure your teen is compliant with all medication before exercising, as recommended by his/her physician.
- Make sure your teen carries a "reliever" or "reserve" medications, just in case of an asthma attack.
- During cold weather, make sure your teen wears a scarf over the mouth and nose, so that the air breathed in is warm and easier to inhale.
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Some adolescents with asthma may need to take their medications during school hours. It is important that the adolescent, family, physician, and school staff all work together toward meeting the asthma treatment goals. To ensure optimal asthma care during school hours, the American Academy of Allergy, Asthma, and Immunology recommends the following:
- Meet with teachers, the school nurse, and other relevant school staff to inform them about your adolescent's condition and special needs.
- Educate school personnel on your adolescent's asthma medications and how to assist during an asthma attack.
- Ask school staff to treat your teen "normally" when the asthma is under control.
- Before your teen starts a physical education class or team sport, educate that teacher or coach on exercise-induced asthma.
- Check indoor air quality, allergens, and irritants in the school.
- Take steps to prevent asthma symptoms from starting that could hamper your teen's energy level.
- Ensure your adolescent's emotional well-being by reassuring him/her that asthma does not have to slow him/her down or make him/her different from others.
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It is very important to be honest with your child about his/her condition, the severity of the condition, and the use of medications. Always remember that achieving independence is an important goal for a child. They do not want to be different, yet they will need guidance and supervision on any restrictions they might have.
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- toddlers - This age group relies completely on the parents. They understand little about the disease. The most important factor with this age group is to try to make medication time a fun one, while stressing the importance of taking the medications. Let them assist in any way possible.
- school-aged - This group has an increased ability to understand their disease and its impact. They should be taught about their medications, how to exercise restriction, and how to avoid their triggers. They should be allowed to play with peers and monitor their own symptoms.
- adolescents - Generally, adolescents resist having to take chronic medications, do not like having restrictions on their life, and do not want to be different. It is crucial to involve your adolescent in every aspect of the management of his/her asthma. He/she should help with goal setting and help decide which medications work best for him/her. Asthma "contracts" can be given to your adolescent child in order that he/she may have some control of his/her asthma, yet continue to allow overall parental supervision of his/her condition.
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Having asthma does not have to mean having less fun than other adolescents. It is important for your adolescent child to tell his/her friends and dates what triggers the asthma, such as cigarette smoke or even perfumes or after-shaves, depending on his/her sensitivity. In addition, your adolescent child should continue taking the asthma medication as prescribed. If your adolescent child has exercise-induced asthma, he/she may need to take a preventive medicine before participating in any physical activities, such as dancing. Always consult your child's physician if you have questions.
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