Asthma, a chronic disabling illness among children Dr. Arun Varghese

Asthma is the most common chronic disabling illness among children as seen from their absenteeism in schools, and need for emergency treatment and hospitalisation. The incidence of asthma among children and even adults has been increasing steadily in both developing and underdeveloped countries in the past four-five decades. Reasons being quoted include them being exposed more and more to allergens such as dust, air pollution and second-hand smoke. Moreover, most children aren’t exposed enough to childhood illnesses to build up their immune systems.

Unique challenges

Childhood asthma isn’t a different disease from that of the asthma among adults. However, as the airways of children are smaller than that of adults, it affects them more seriously. They may experience wheezing, coughing, chest tightness and troubled breathing, especially early in the morning or at night.

They also face unique challenges, the major one being that childhood asthma can’t be cured completely, and symptoms may continue into adulthood. It can be highly bothersome too, as it can hinder sleep as well as outdoor activities. Among some children, unmanaged asthma can result in dangerous asthma attacks. However, with the right treatment, symptoms can be kept under control, and damages to the growing lungs prevented.

The reason behind repeated asthma attack is that our lungs become easily inflammable when the airways are exposed to triggers such as inhaling pollen or catching cold, or some other respiratory infection.

Risk factors

Factors that might aid the increase in the likelihood of developing asthma among children include:

  • Exposure to tobacco smoke, including even before birth
  • Previous allergic reactions, including skin reactions, food allergies or hay fever (allergic rhinitis)
  • Family history of asthma or allergies
  • Living in an area with high pollution
  • Obesity
  • Respiratory conditions such as chronic runny or stuffy nose (rhinitis), inflamed sinuses (sinusitis) or pneumonia
  • Heartburn (gastroesophageal reflux disease)

Symptoms

The signs and symptoms of asthma vary from child to child, and might get worse or better over time.
The common signs and symptoms of asthma during childhood include:

  • Frequent coughing that worsens when the child has some viral infection, or when it is triggered by exercise or cold air
  • A whistling or wheezing sound when breathing out
  • Shortness of breath
  • Chest congestion or tightness

Childhood asthma might also cause:

  • Troubled sleep due to shortness of breath, coughing or wheezing
  • Bouts of coughing or wheezing that gets worse with cold or flu
  • Delayed recovery or bronchitis after a respiratory infection
  • Troubled breathing that hampers activities like playing or exercise
  • Fatigue due to poor sleep

When to see a doctor

Early identification and treatment of asthma will help control the symptoms and possibly prevent fatal asthma attacks.
Meet a doctor:

  • If there is constant coughing, especially if it seems to be linked to physical activities
  • If there is wheezing or whistling sounds when the child breathes out
  • If there is shortness of breath or rapid breathing
  • If there are complaints of chest tightness
  • If there are repeated episodes of suspected bronchitis or pneumonia

When to seek emergency treatment

Seek emergency care:

  • When the child’s chest and sides pull inward as he/she struggles to breathe
  • If the child has to stop in midsentence while speaking to catch his/her breath
  • If the child is using his/her abdominal muscles to breathe
  • If the child’s nostrils widen when breathing in
  • If the child has to try so hard to breathe that the abdomen gets sucked under the ribs when he/she breathes in

Even if your child hasn’t been diagnosed with asthma, seek medical attention immediately if he/she has trouble breathing as mentioned above. Although episodes of asthma vary in severity, asthma attacks can start with coughing, which progresses to wheezing and laboured breathing.

Prevention

Careful planning and avoiding asthma triggers are the best ways to prevent asthma attacks.

  • Limit exposure to asthma triggers. Help the child avoid allergens and irritants that trigger symptoms of asthma.

  • Don’t allow smoking around the child. Exposure to tobacco smoke during infancy is a strong risk factor for childhood asthma, it’s also a common trigger for asthma attacks.
  • Encourage the child to be active. As long as the child’s asthma is under control, regular physical activity can help his/her lungs to work more efficiently.
  • See the doctor when necessary. Don’t ignore signs of asthma that is not under control, such as needing to use a quick-relief inhaler too often.
  • Asthma changes over time. Consulting a doctor can help regulate treatment to keep the symptoms under control.
  • Help the child maintain a healthy weight. Being overweight can worsen asthma symptoms, and it can make the child vulnerable to other health problems.
  • Keep heartburn under control. Acid reflux or severe heartburn (gastroesophageal reflux disease) could worsen the symptoms. He/she might need over-the-counter or prescription medications to control acid reflux.

Treatment of childhood asthma

Quick-relief medications

Quick-relief medications open the swollen airways swiftly. Also termed rescue medications, the quick-relief medications are used as required for rapid, short-term symptom relief during an asthma attack.

Types of quick-relief medications include:

  • Short-acting beta agonists: These inhaled bronchodilator medications can ease the symptoms rapidly during an asthma attack. They include albuterol and levalbuterol. These medications act within minutes, and the effect lasts several hours.
  • Oral and intravenous corticosteroids: These medications relieve airway inflammation caused by severe asthma. Examples include prednisone and methylprednisolone. However, they may have serious side effects if used for long periods, so they’re prescribed only to treat severe asthma symptoms on a short-term basis.

Long-term control medications

Preventive, long-term control medications reduce the inflammation in your child’s airways that causes the symptoms. These medications need to be taken on a daily basis.

Types of long-term control medications include:

  • Inhaled corticosteroids: These medications include fluticasone, budesonide, mometasone, ciclesonide, beclomethasone, etc. The child might need to use these medications for several days to weeks before getting the full benefit.
  • Leukotriene modifiers: These oral medications include montelukast, zafirlukast and zileuton. They help prevent asthma symptoms for up to 24 hours.
  • Combination inhalers: These medications contain an inhaled corticosteroid plus a long-acting beta agonist (LABA). They include fluticasone and salmeterol, budesonide and formoterol, fluticasone and vilanterol, and mometasone and formoterol.
  • Theophylline: This is a daily pill that helps keep the airways open. Theophylline relaxes the muscles around the airways making breathing easier. It’s mostly used with inhaled steroids.

It’s very important that children with asthma are provided proper treatment. A paediatrician can set your child on the right track by helping you to chalk out a long-term action plan for treating your child. The right treatment will help your child sleep peacefully through the night by helping him/her breathe more easily, thus making him/her avoid missing school. The treatment plan should help you determine when your child’s asthma is under control, when you need to change medicines, and when emergency help should be sought.

Dr. Arun Varghese, MBBS, MD (paediatrics), FPCC (paediatrics critical care), is a Consultant Paediatrics Intensivist at Indiana hospital and Heart Institute, Mangaluru

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