Kids and Asthma

Knowing the signs of childhood asthma

By Alex White, M.D.

Asthma is a common medical condition in children. In fact, each year five million children, approximately 1 out of 20, suffer from asthma. Nearly 15% of admissions to the hospital in the pediatric age group are asthma-related. It is important, then, for parents to become educated about this disease. A well-informed parent is able to recognize the early signs of asthma and alert the physician in order to institute therapy as soon as possible. Plus, having a better understanding of this condition will help you, the parent, manage your child's asthma once the diagnosis is established.
Because the symptoms can be very similar to many other childhood illnesses, asthma can easily be misdiagnosed in a young child. Symptoms of asthma are a result of airway inflammation, which is also present in the common cold, bronchitis, and pneumonia. Until asthma is diagnosed, a child might be unnecessarily treated with antibiotics. This happens because often more than one physician will see a particular child when he or she becomes “sick.” It is not uncommon that a child will see the primary care physician for checkups, and an emergency or urgent care physician when they become acutely ill. In the case of a child who has asthma that has not yet been diagnosed, this pattern can disrupt the continuity of care because no one particular medical person is aware of the overall condition of the child. If a child has repeated diagnoses of bronchitis or pneumonia, or if there is chronic coughing or wheezing, the parent should alert the primary care physician. There are several characteristics of an asth
Another aspect of asthma to recognize is the clinical pattern, which can be intermittent, chronic or seasonal-allergic. Intermittent asthma occurs when there are episodes of illness with extended symptom-free periods. The episodes are usually triggered by viral-respiratory infections [colds] or by specific exposure to an environmental irritant. The chronic patient has almost daily symptoms and only with treatment can he or she get any extended relief. The seasonal-allergic patient has daily symptoms during a typical allergy season, and the patterns vary with geographic regions. The most common culprits are molds and pollens. Parents should pay attention to these particular seasons when they are at higher levels and take note if their child develops symptoms such as runny nose, itchy eyes and cough that then progress to expiratory wheezing. By recognizing these symptoms and alerting a physician as soon as possible, parents play a vital role in the early diagnosis of asthma in their child.
Once asthma is diagnosed there are different types of treatments available and each child’s treatment needs to be individualized by a physician. These treatments, called bronchodilators, help open up the airway. The most common medication is the beta-agonist. This is the medication used in the inhalers and breathing treatments that give relief to the acute flare-up or asthma attack. The beta-agonist can be used on a schedule to maintain a patient for the longer term as well. If used just before physical activity, this type of inhaler also helps inhibit exercise-induced asthma. Corticosteroids [steroids] are also used commonly.
These have an anti-inflammatory effect and can be taken orally or inhaled. The oral route is mainly reserved for more severe attacks and is usually only continued for 24 hours after wheezing subsides. Inhaled corticosteroids are used for maintenance in more moderate-to-severe asthmatics. Cromolyn sodium can be used with the beta-agonists, or alone in acute and chronic asthma. Theophylline has been around for many years, but because of its toxic potential, it is used only in severe asthmatics who need additional control. The most recent advance in the treatment of asthma is the use of leukotriene-receptor antagonists. These have a combination of the bronchodilator and anti-inflammatory effect. There is no usefulness of this class of medication in the acute attack, but is used for maintenance in mild-to-moderate asthmatics.
Children with allergies have an increased risk of developing asthma. Recent studies have shown that controlling exposure to allergens early in life may prevent or at least limit the development of asthma. The most significant allergens include dust mites, tobacco smoke and animal dander. Parents should pay attention to a possible association to the development of symptoms such as runny nose and cough when their child is exposed to these and other environmental irritants and try to modify the exposure. This is especially important after asthma is diagnosed.
Parents have to take an active role in preventing flare-ups. Some measures that may need to be taken for the child’s sake include getting allergy air filters for the home, replacing carpeting with tile or hardwood flooring, cleaning the home frequently, and keeping animals outdoors. It is especially important for parents to quit smoking. Smoking outdoors is not enough. The fact that our clothing and hair smell like cigarette smoke means we are carrying the “allergens” that can trigger asthma.
Parents educated about asthma can help in the early diagnosis of this condition in their children as well as aid in their treatment, and even more importantly, learn how to modify a child’s environment to decrease the number and severity of attacks.