ASTHMA

Asthma is an increasingly common problem in children. Reasons for the increasing prevalence are not fully understood. Since there is no specific asthma "test" the diagnosis may be difficult in some cases and periods of observation are sometimes necessary to be sure of the diagnosis.

The severity of asthma varies, but in rare instances it can be fatal to a child. Asthma is a disease to be taken seriously.

THE BASIS OR MECHANISM OF ASTHMA

A simplified explanation; asthma is considered to be an inflammatory disease of small airways in the lung. This means that blood cells active in fighting infection and active in allergic reactions [leukocytes] are present in the tissues of the lung's small airways as part of a process called atopy. Infection and allergies are not necessarily present. These leukocytes produce chemicals called cytokines and chemokines that have many effects on the individual with asthma including causing contraction of muscle in the small airways and thus constriction with wheezing and shortness of breath. They also probably cause increased mucous production and related cough. Asthma triggers, noted below, cause these cells to produce and secrete increased amounts of cytokines/chemokines.

SYMPTOMS AND SIGNS

Signs of asthma are primarily wheezing, cough [particularly at night] and shortness of breath out of proportion to work being done. Individual patients may have one or more of these symptoms. Other symptoms may be more subtle.

Asthma, the skin condition atopic dermatitis (eczema), allergic rhinitis (chronic runny or stuffy nose) and gastro-esophageal or acid reflux are related disorders in that an individual patient may have two or more of these disorders at the same time or during different times in their lives. The simultaneous occurrence of these in the same patient is more than coincidental and one or more of the disorders may be present in other family members. Asthma may be difficult to manage unless allergic rhinitis and/or acid reflux are/is controlled. For more on allergic rhinitis, atopic dermatitis and acid reflux click on the disorder.

LEVELS OF SEVERITY

The level of severity of asthma dictates the way it is treated. A contemporary classification of asthma defines levels of severity on the basis of frequency of asthma attacks.

ASTHMA "TRIGGERS" THAT INCITE OR AGGRAVATE ASTHMA

The recognition of things that incite asthma attacks is an important aspect of management since the avoidance or control of these triggers may prevent episodes of asthma. Parents and patients should be alert to events, exposures or illnesses that precede an asthma attack and inform caretakers of these. Is asthma a seasonal problem? Common triggers are:

Exposure to allergens such as those causing "hay fever"; pets [especially cats] and horses are notorious triggers of asthma. Children with asthma and persons that smoke are a bad mix.

Antecedent viral infections. A child may often experience asthma when he or she has a common cold.

Exercise may incite asthma. Asthma may follow periods during which a child plays vigorously, runs or even laughs when being tickled or when playing excitedly. Older children involved in competitive sports may experience more severe shortness of breath than do peers, cough and/or wheezing when playing or practicing the sport.

TREATMENT

The way the asthmatic child is treated is determined in large measure by the severity of her/his illness as noted above. Treatment is divided into preventative measures and measures taken to relieve asthma symptoms once established.

Preventive measures:

• Avoidance of triggers is very important. This includes control of acid reflux and allergic rhinitis.
• Drugs that inhibit the inflammation that is the basis for asthma are often needed to control asthma. Inhaled and systemic steroids are the principal drugs in this class.
• Drugs, other than steroids, that interfere with the production or action of the cytokines/chemokines have also been developed to prevent or minimize the severity of asthma.

Medications for treating asthma symptoms:

• The mainstay of asthma management medication is albuterol, a short/rapid acting drug [a broncho-dilator] that relaxes the constricted muscle explained above. There are other such drugs, but none are used as commonly as albuterol.
• Longer -acting broncho-dilators are also available. Generally they take longer to work, but their effects last longer than those of albuterol. Newer medications act rapidly with long-lasting effects.

Customized treatment:

• Your child's doctor must devise a treatment plan designed specifically for the individual child. Medication delivered by a metered dose inhaler or nebulizer may, in some cases, be combined with medication taken orally.

The more the parents and child know about asthma and its management the more effective prevention/treatment plans will be. This may include use of a peak-flow meter to measure the ability of the asthmatic patient to exhale. The success of education about asthma and its management may be the most important determinate of degree of prevention and control.

Armed with knowledge and appropriate medications parents and children can often live comfortably with asthma.

Nov. 2001

©2002 South Valley Pediatrics
page updated April 7, 2002