(Wednesday, 3rd Sep, 2014)
Asthma in children
Asthma is an inability to breathe properly. During an asthma episode, muscle spasms and swelling bronchial tissues narrow the airways, which then become clogged with excess mucus. Stale air gets trapped in the bottom of the lungs, forcing your child to use the top part to gasp for air.
Some people with asthma experience only mild and infrequent episodes, while others experience frequent and serious attacks that require emergency medical treatment.
Symptoms such as tightening of the chest and difficulty in breathing are not always continuously present, but can be 'triggered' by chemicals, pollution, pollen, animal hair, tobacco smoke or stress.
Awareness of your child's triggers may help you to reduce the intensity and frequency of asthma attacks and perhaps even avoid them completely. Asthma appears to have two primary stages - hyperreactivity and the inflammatory response.
Smooth muscles in the airways constrict and narrow in response to inhaled allergens or other irritants. Everyone's airways constrict when exposed to allergens or irritants, but people who do not have asthma are able to breathe in deeply to relax the airways and rid the lungs of the irritant. When asthmatics try to take those same deep breaths, their airways do not relax and they pant for breath.
The hyperreactive stage is followed by the inflammatory response. The immune systems respond to allergens or other environmental triggers by delivering white blood cells and other immune factors to the airways.
These so-called inflammatory factors cause the airways to swell, fill with fluid and produce a thick sticky mucus. This combination of events results in wheezing, breathlessness, inability to exhale properly and a phlegm-producing cough.
Asthma is most likely a result of genetic susceptibility. About one-third of all people with asthma share the problem with another member of their immediate family.
The risk of having an asthmatic child may be six times higher if both parents have a history of asthma than if just one had the disease.
There has been a dramatic rise in the incidence of asthma in industrial countries, even though outdoor air pollutants are decreasing. There are several possible explanations - for example, children now spend more time indoors and are overexposed to indoor allergens. Modern energy-efficient homes may result in dust mites being trapped inside them, and more low-birth-weight babies are surviving and may be more susceptible to asthma.
However, other respiratory diseases, sinusitis and ear infections are also increasing, which suggests that airborne or environmental factors may be involved. Allergies may also play a role.
Your doctor will consider asthma if your child has a history of periodic attacks of shortness of breath, cough, and wheezing, perhaps accompanied by tightness in the chest. You should try to describe the pattern of symptoms and possible precipitating factors - for example, whether they occur at night or whether exercise, a respiratory infection or exposure to cold air has ever triggered an attack. You should let your doctor know of any relatives who suffer from allergies such as eczema, hives or rhinitis.
Pulmonary function tests
Your doctor will probably administer a pulmonary function test, which measures the strength of your child's exhalation. A person without asthma can usually exhale about 75-85% of the air in the lungs within a second and empty them within three seconds. A person with asthma will expel all the air from the lungs within six or seven seconds. A peak flow test is the most common pulmonary function test. It takes readings as your child exhales into a device called a peak flow meter.
Additional tests may be performed to rule out other possible diseases or to obtain more information about the causes of asthma - for example, a bloodcount, chest and sinus X-rays and skin tests to assess your child's response to common inhaled allergens.
Your doctor may prescribe bronchodilators - these are drugs that help open the lungs' constricted airways. These drugs are known as "relievers" as they are used to relieve symptoms cough, wheeze and shortness of breath. They are available in two forms - inhaled and oral.
Doctors usually prefer inhaled bronchodilators, because they are delivered directly to the lungs and use less medicine than oral forms. Generally, one or two 'puffs' relieve the wheezing and chest tightness associated with mild to moderate attacks. Many of the commonly used bronchodilator inhalers are blue in colour.
Oral bronchodilators are usually prescribed for people who cannot tolerate inhaled medication or who suffer from chronic asthma.
If the "reliever" inhaler has to be used frequently, or during a flare up of the asthma your child may also be prescribed a "preventer" inhaler. This contains a steroid medication which treats inflammation. "Preventer" inhalers are usually brown in colour. The inhaler should be used regularly, usually one to two puffs twice daily. Unlike the "relievers", there will be no immediate improvement in symptoms immediately after using the inhaler. It usually takes seven to ten days to see an improvement, so it is important to continue this medication once it is prescribed. The amount of steroid needed to improve the lung function is much less using inhalers than tablets as the drug is delivered directly into the lungs. Therefore, side effects are usually not a problem. It is important to rinse the mouth out after using the steroid inhaler to prevent thrush (oral candida).
During an acute attack of asthma other medications may be prescribed. Antibiotics may be given if infection is suspected. Steroid tablets may be given for a short time (usually three to five days) in severe attacks.
Children under the age of seven may not have the co-ordination required to use the standard inhalers effectively. There are a number of simple devices (spacer chambers) which can be used, even in very small children, to ensure that the medication is effectively inhaled. There are also a number of dry powder devices which do not require as much co-ordination.
Your doctor or asthma nurse will advise you and your child about the appropriate method of delivery and will teach you to use the chosen inhaler.
Asthma attacks can cause a vicious cycle - breathlessness and wheezing trigger a fear of suffocation and death, which produces further tightening of the muscles surrounding the airways and makes breathing even more difficult. If your child is having an attack:
How can I help my child to manage their asthma?
Learn to identify the triggers - keep a diary detailing the environmental and emotional factors that affect your child every day over the course of several months. When your child has an asthma attack, check in your diary to see which factor, or combination of factors, might have contributed to it.
Monitor the changes in your child's lung capacity at home using a peak flow meter, which your doctor can prescribe for you.
Try to reduce the risk of your child catching colds or respiratory infections. Speak to your doctor about vaccinations against influenza and pneumococcal pneumonia.
Pets can trigger asthma but are often emotionally important to children. They should be kept outside or confined to carpet-free areas outside the bedroom. Dogs usually present fewer problems than cats. Washing cats and dogs once a week can reduce allergens. Stuffed animals might be a comforting replacement for small children, although they can harbour dust mites.
Dust mite levels in bedding and curtains can be reduced by using semipermeable coverings to cover mattresses and pillows. Vinyl mattress covers can limit airflow and may exacerbate asthma in children. Synthetic pillows may pose a higher risk for severe asthma attacks in children than feather or no pillows. Replace curtains with shades or blinds and wash bedding using the highest temperature setting.
Keep your house free of damp.
Avoid outdoor activities when pollen counts are high. Children who are allergic to mould should avoid barns, hay, raking leaves and mowing grass.
Exposure to car fumes may worsen asthma.
Food allergies are often blamed for asthma attacks, but true food allergies are rarely the cause. However, some doctors advise children with asthma to avoid nuts and, of course, children who experience reactions to any foods should avoid them .
Cigarette smoke is a hazard for all asthmatic children, so if anyone in the household smokes they should be strongly encouraged to stop, or at least not to smoke indoors.
Limiting physical activities can be distressing for children. Asthmatic children should be encouraged to swim and play sports that will present less difficulties for them. Intense activities lasting less than two minutes, such as sprinting or competitive swimming, are less problematic than longer exercises.
Sport during the summer causes less stress than during the winter - exercise-induced asthma occurs most often during intense activity in cold, dry air. Thorough warm-up before vigorous exercise can help to limit bronchial narrowing and obstruction.
Speak to your doctor about exercises that are suitable for your child. If asthma attacks are brought on by exercise , taking two puffs of the "reliever" (bronchodilator) prior to commencing exercise may be very helpful in preventing an attack.
Teenagers, in particular, may find it difficult to cope with the social stigma of asthma. Support groups, doctors, friends or relatives can provide help and advice.
As a parent, try not to be overprotective of an asthmatic child. The aim of a good treatment plan is to allow the child to live as normal a life as possible.
Many children "grow out" of their asthma as they grow up. Even if asthma persists, asthmatics can expect to live a normal lifespan, provided they follow medical instructions. According to the Asthma Society of Ireland, there are an estimated 274,000 Irish people with asthma, so your child is one of many people living with this condition and for the most part, people deal very successfully with it and lead active lives.
Indeed, some famous Irish sportspeople have asthma and still compete at the highest level. A case in point is former international rugby star, Simon Geoghegan.
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