Childhood Asthma – What Every Parent Should Know
Asthma, a chronic long-term lung disease that affects nearly 7.1 million American children, is diagnosed more during the fall than any other season.
Classrooms fill. Respiratory viruses spread. Sports activities resume. The weather changes, and asthma – inflammation and narrowing of the lung's bronchial tubes that cause airways to swell and obstruct breathing – becomes one of the leading reasons for school absenteeism.
"We see a peak with every new school year," says Juan C. Martinez, MD, Medical Director of the Division of Pediatric Pulmonology at Joe DiMaggio Children's Hospital in Hollywood, Florida.
There is no proven cause of asthma, no cure and no one-size-fits-all treatment. It is the most common chronic illness that brings children into hospital emergency rooms. While some children with serious, hard to control asthma are sometimes rushed to the emergency room or regularly admitted to the pediatric intensive care unit, other children with mild asthma can also end up in the same frightening situation.
Dr. Martinez says identifying the level of severity and then educating parents and children about how to control the disease makes asthma "extremely manageable."
The National Institutes of Health classifies asthma severity into four levels based on symptoms:
- Intermittent: symptoms less than two days a week, no nighttime awakenings, and no interference with daily activity
- Mild persistent: symptoms more than two days a week, nighttime symptoms with awakenings more than two nights a month, and minor limitation of daily activities
- Moderate persistent: daily symptoms with nighttime awakenings three to four times a month, and some limitation to normal activity
- Severe persistent: symptoms throughout the day, nighttime awakenings occurring for more than a week, and extremely limited with normal activity
Lung function measurements help classify whether the asthma is mild to severe, but a child with mild asthma can still have an asthma attack.
Allergy Symptoms and Triggers
The earliest sign of asthma is sometimes a cough that lingers after a cold for weeks or months. It goes away eventually, then comes back with some frequency that establishes a pattern and causes concern. The most common pattern in children younger than age 6 comes with viral respiratory infection.
Patterns of reoccurrence, lung function tests and exclusion of other possible conditions, such as cystic fibrosis, help diagnose asthma.
Bronchial spasms occur periodically when triggered by specific factors, including respiratory infection, viral respiratory infections, allergies and other stimuli such as dust mites and pet dander. Those triggers lead to bronchial hyperactivity.
Daily medications can help control asthma. Even in times when such triggers as allergies, too much exercise or secondary cigarette smoke cause asthma attacks, parents and children need to know how to properly administer rescue medication.
Frequently Asked Questions
What is asthma?
Asthma is a chronic inflammation of the bronchial tubes that restricts airflow to the lungs. Though manageable, it is the most common chronic childhood disease, the third most frequent reason children are admitted to the hospital and one of the leading causes of school absenteeism.
What causes asthma?
No one knows for sure, but scientists theorize that genetics and environmental factors can spark the disease. For example, some families seem to pass allergies from one generation to another, hence an allergic child exposed to certain respiratory or viral infections can develop asthma. Another theory, the Hygiene Hypothesis, suggests that children today develop asthma more frequently than in previous generations because they are overly protected from childhood infections that in the past would have strengthened the immune system, and they go on to become more allergic.
What are the signs of asthma?
Asthma symptoms include: coughing that becomes worse in the early morning or late at night; sometimes emitting a wheezing sound when breathing; tightening of the chest as if something is squeezing or sitting on the lungs.
How is asthma diagnosed?
Doctors diagnose asthma with lung function tests when children are old enough to perform them, a physical exam and consideration of the patients' history, as well as frequency and types of symptoms. After initial diagnosis, it is important to regularly reassess asthma for optimal control. This usually involves periodic visits to the doctor for detailed questioning and reclassification of asthma as being poorly or well-controlled. Often, medication adjustments are necessary. When children are old enough, lung function assessments are completed as well.
What triggers asthma episodes?
Many outside stimuli irritate and worsen lung inflammation. Triggers include: colds and respiratory infections; sudden cold or temperature change; reactions to such allergens as mold, pollen and animal dander, dust, feathers, food and roaches; stress; exercise; smoke, including cigarette smoke; and strong odors, including perfumes or incense.
Can asthma be prevented?
There is no way to prevent asthma, but there are ways to control and lessen the impact through medication and by avoiding triggers.
What medications are helpful?
Anti-inflammatory medications and bronchodilators are used to treat asthma. Anti-inflammatories such as inhaled corticosteroids and cromolyn sodium are preventative because they interrupt the development of bronchial inflammation. They are safe when prescribed at appropriate doses, and usually must be given daily for best control. Other anti-inflammatories such as leukotriene modifiers block leukotriene chemicals naturally involved in airway inflammation. Bronchodilators dilate the airways by relaxing bronchial smooth muscles and are used when asthma symptoms arise.
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