Asthma

Asthma is a very common respiratory disease in children. Of the more than 11 million Americans who suffer from asthma, more than 3 million, according to the National Center for Health Statistics, are younger than 18 years of age. While the cause of asthma is not fully understood, great strides have been made in treating this common childhood disease.

Asthmatic children have airways that are very sensitive to certain irritants and allergens, going into spasm when exposed to even normal amounts. During an asthma episode the muscles surrounding the bronchial tubes constrict and the lining inside the tubes swells and produces an excessive amount of mucous. Triggers of asthma are divided into two groups, irritants and allergens. The most potent (and preventable) irritant is secondhand cigarette smoke; other irritative triggers include viral infections, rapid environmental changes in temperature and humidity, ozone, smoke from a fireplace and sometimes exercise. Allergens responsible for triggering the bronchial narrowing include dust, molds, pet dander, foods and certain drugs. Some children with asthma only have an attack when two or more triggers are present at the same time. To help control asthma it is important to identify the various triggering mechanisms affecting a child's symptoms and try to remove it from the child's environment.

The airway spasm and mucus plugging that occurs in asthma leads to a variety of symptoms. Although asthma attacks vary in severity, during an attack most children have a hard time breathing and often make wheezing sounds (whistling or squeaking sounds with respiration) in the process. Coughing is also common from irritation of the sputum. Typically the onset is sudden and the child may experience tightness in the chest, severe breathlessness, fatigue, and panic from a feeling of suffocation. No two asthmatics react the same way and not every asthma attack is an obvious one. For instance, some asthmatic children may only have a constant cough or only experience wheezing during vigorous exercise.

No one knows why some children develop asthma, but the condition tends to run in families. If both parents have asthma, at least one in three of their children may have similar symptoms. However, a considerable number of children who wheeze have no close relatives with asthma. There is some indication that exposure to certain injurious agents, such as cigarette smoke (even as a fetus), increases a child's risk for acquiring asthma.

While there is no cure for asthma, great strides have been made in its treatment. The first approach is to identify the triggering mechanisms and try to prevent exposure to those substances. While avoidance of the offending trigger is recommended, it is often difficult, especially when a beloved pet or common substances like house dust are involved.

Medication prescribed to treat and prevent asthma is usually taken orally or inhaled. Antibiotics are not helpful unless a secondary infection is present. The two main types of medications used to treat asthma attacks are bronchodilators and anti-inflammatories. Bronchodilators are medications that relax the muscles around the air tubes to relieve the attack. Examples included various preparations of theophylline and adrenaline-like medications. These drugs should be given as often as necessary but as little as needed because of side effects, including stomach upset, rapid heart beat, and nervousness. Bronchodilators can be administered by mouth or may be inhaled. There has been a trend in recent years to rely on inhaled agents, which offer the child increased benefits with fewer side effects. Medication can be given by a hand-held inhaler or a nebulizer, which consists of an air compressor that delivers medication as a "mist" so the drug is distributed directly where it is needed.

A severe asthma attack is a medical emergency and parents should be prepared to call the child's physician or take the child immediately to a hospital emergency department. The following signs indicate potential problems:

• Blue or gray lips or flaring nostrils.
• The child prefers to sit up and lean forward on elbows or arms.
• The spaces between the ribs become depressed.
• The heart rate becomes rapid.
• The child is unable to say more than a few words between breaths.
• The child is unable to hold down liquids or their medication.

Virtually all asthmatic children can lead normal lives with active physical activity and minimal inconvenience. While the child's "twitchy" airway is a life-long problem, many children indeed "out grow" their asthma as they become teenagers. For these children, the airway apparently becomes less sensitive to the different triggers that in the past set, off their illness. Though childhood asthma can be a serious disease (and a frightening one for parents) it need not ruin the quality of life for its suffers. The important thing for parents to remember is that modern treatment for asthma is both effective and safe. Parents should keep a positive attitude and strive to maintain a normal life style for their child.