Asthma – A Childhood Disease

Asthma is the leading serious chronic illness of children ,In 2006, the highest current prevalence rate was seen in those 5-17 years of age (106.3 per 1,000 population), with rates decreasing with age.

Asthma is the third leading cause of hospitalization among children under the age of 15.

Asthma is one of the most common causes of school absenteeism;

Even though asthma cannot be cured, it can almost always be controlled. For this reason, the American Lung Association has chosen control of childhood asthma as one of its top priorities.

The better you and your child understand asthma and its treatment, the better you will be able to control it.

HOW DO NORMAL LUNGS FUNCTION?

Lungs allow oxygen to enter the body in exchange for its waste product, carbon dioxide. As the air passes through the nose and mouth, it is rapidly warmed and moistened to avoid injury to the delicate lining of the airways.

The nose and airways also trap large particles (dust, pollen, molds, bacteria) and chemicals (smoke, sprays, odors), which could cause serious injury to the lungs.

The air is then transported through smaller airways. These airways branch like a tree, so that millions of small airways can carry oxygen to the tiny air sacs called alveoli.

The airways have a delicate cellular lining (mucosa), which is coated with a thin layer of mucus, as is present in the nose. Foreign particles are trapped by the sticky mucus and eventually removed from the airways through the normal cleansing process.

The process is assisted by the movement of tiny “whip-like” structures called cilia which move the mucus and trapped foreign particles up toward the mouth and nose where they are coughed and sneezed out or swallowed.

Bundles of muscles surround the airways, and the contraction of these muscles allows airways to selectively direct the flow of air.

WHAT IS ASTHMA?

Asthma is an inflammatory condition of the bronchial airways. This inflammation causes the normal function of the airways to become excessive and over-reactive, thus producing increased mucus, mucosal swelling and muscle contraction.

These changes produce airway obstruction, chest tightness, coughing and wheezing. If severe this can cause severe shortness of breath and low blood oxygen.

Each individual suffers a different level of severity. Virtually all children with asthma, however, do enjoy a reversal of symptoms until something triggers the next episode.

WHAT IS THE CAUSE OF ASTHMA?

Inflammation of the airways is the common finding in all asthma patients. Recent studies indicate that this inflammation is almost always causative in the asthmatic condition. This inflammation is produced by allergies, viral respiratory infections, and airborne irritants among other causes. This airway inflammation can cause scarring if it goes on for a long period of time.

More than 50 percent of current asthma cases can be attributed to allergies. Thirty percent of those are associated with cat allergies. Early exposure to cats may be a protective factor, but becomes a risk factor for asthma if an allergy develops. While preventing, blocking or reversing certain allergic reactions could reduce a large proportion of asthma cases, almost half of cases are not associated with allergies and require further research to determine their cause.

 

Secondhand smoke exposure in both adults and children is a risk factor for new asthma cases. Recent studies have suggested that children of smokers are twice as likely to develop asthma as the childenof nonsmokers, and that even apparrently healthy babies born to women who smoked during pregnancy have abnormally narrowed airways, which may predispose them to asthma and other respiratory disorders. Data from several studies show that prenatal maternal smoking is a risk factor for asthma onset in children, especially young children. Outdoor air pollution also worsens existing asthma. Outdoor pollutants known to trigger asthma attacks include ozone, particulate matter, nitrogen dioxide, and sulfur dioxide

WHAT ARE THE SIGNS AND SYMPTOMS?

Common symptoms include coughing (constant or intermittent), wheezing or whistling sounds audible when a child exhales, and shortness of breath or rapid breathing.

Any child who has frequent coughing or respiratory infections (pneumonia or bronchitis) should be evaluated for asthma.

The child who coughs after running or crying may have asthma. Recurrent night cough is common, as asthma is often worse at night. Chest tightness and shortness of breath are other symptoms of asthma that may occur alone or in combination with any of the above symptoms. Since these symptoms can occur for reasons other than asthma, other respiratory diseases must always be considered.

In a young child the discomfort of chest tightness may lead to unexplained irritability. They may complain that their chest “hurts” or “feels funny.” Infants who have trouble feeding or who grunt during suckling may have asthma.Any child who has frequent coughing or respiratory infections (pneumonia or bronchitis) should be evaluated for asthma.

WHAT ABOUT HIDDEN ASTHMA?

Until rapid breathing, wheezing and coughing become obvious, the condition of many children with asthma will go undetected. These children with asthma usually suffer some degree of airway obstruction, and unless it is brought under control the children may suffer respiratory illnesses more frequently than necessary.

Hidden asthma, however, can produce so few recognizable symptoms that even a health care provider might not be able to distinguish abnormal breath sounds with his or her stethoscope, but it may cause subtle problems such as limitation of physical activity. Pulmonary function testing usually reveals these cases of airway obstruction.

Episodes of asthma often are triggered by some condition or stimulus. Common triggers of asthma are:

 Exercise

Running can trigger an episode in over 80 percent of children with asthma. Bronchodilator medications used before exercise can prevent most of these episodes. With proper control of asthma, most children with asthma can participate fully in physical activities.

There might be exceptions, such as prolonged running, especially during cold weather, allergy season or illness from a “cold.” Swimming seems to be the least asthma-provoking form of exercise. However, there have been recent concerns about excessively chlorinated pools precipitating asthma episodes.

Infections

Respiratory infections, including the flu, frequently trigger severe episodes of asthma. Research indicates that these infections are most frequently produced by viruses, rather than bacteria. Antibiotics are of no benefit for viral infections and thus may be of little value in an asthma episode. It is important for all children with asthma to get vaccinated for the flu each year. Bronchodilator medication, good hydration, and when indicated, corticosteroids are required to control an asthma episode triggered by viral infections. Therefore, a parent should not be surprised if the physician does not prescribe an antibiotic when a child is having a respiratory infection and asthma. On the other hand, the doctor may decide to use an antibiotic if he or she suspects bacterial infection, such as sinusitis or bronchitis.

Note: Chronic sinusitis in childhood due to bacteria can be a very stubborn chronic trigger for asthma. Treatment for 10 days with antibiotics may not be effective. In these children, sinus x-rays are frequently required to diagnose the underlying condition.

Antibiotic treatment for 3 to 4 weeks or longer may be required to completely eradicate these infections. Asthma may also be triggered by an ear infection or bronchitis, which would also require antibiotic therapy.

Allergy

Many children with asthma have their symptoms triggered by allergies. Allergic children can suffer reactions to ordinarily harmless material (such as pollen, mold, food, or animals).

During an allergic reaction, chemicals such as histamine are released from specialized cells. This may produce swelling of the lining of the airway, excessive mucus secretion and muscle contraction in the airways. In this way, an allergy can provoke an asthma episode.

The allergens involved are common indoor inhalants such as dust mites, feathers, molds, pets, insects (especially roaches), outdoor inhalants (molds and pollens), or ingested foods (milk, soy, egg, etc). Foods are much less frequent causes of asthma. These allergens may produce low-grade reactions which are of no obvious consequence; however, daily exposure to these allergens may result in a gradual worsening of asthma.

Allergy may be the cause of unrecognized or hidden asthma. Minor allergic reactions can be more important than more obvious or severe reactions, in that an allergic person tends to avoid exposure to allergens that have caused severe reactions, while ignoring the minor allergens.

 

Irritants

Cigarette smoke, air pollution, strong odors, aerosol sprays and paint fumes are some of the substances which irritate the tissues of the lungs and upper airways. The reaction (cough, wheeze, phlegm, runny nose, watery eyes) produced by these irritants can be identical to those produced by allergens.

Irritants must be recognized and avoided. Cigarette smoking certainly should be avoided in the home of any child with asthma. It has been shown that when the parents of a child with asthma stop smoking, the child’s asthma often improves.

Outdoor air pollution also worsens existing asthma. Outdoor pollutants known to trigger asthma attacks include ozone, particulate matter, nitrogen dioxide, and sulfur dioxide.Children are already at greater risk from outdoor air pollution than healthy adults: they have smaller air passages which are blocked easier, they breathe more rapidly, and are less likely to acknowledge breathing difficulties resulting from pollution and limit their exposure.

If your child has asthma, limit their time outdoors on days with air quality warnings, while ozone levels are peaking in the afternoon, and in areas near heavy traffic.

Weather

Children with asthma have cited a number of climatic conditions as trigger factors. Many identify cold air as triggering asthma. Pulmonary function studies demonstrate that breathing cold air provokes asthma in most children with asthma.

Precautions may be necessary to avoid inhalation of cold air, such as wearing a special ski mask designed for this purpose. A heavy scarf, worn loosely over the nose and mouth, will also help avoid cold air-induced asthma.

The weather affects outdoor inhalant allergens (pollens and molds). On a windy day more allergens will be scattered in the air, while a heavy rainfall will wash the air clean of allergens. On the other hand, a light rain might wash out pollen, but actually increase mold concentration.

Emotions

A common misbelief is that children with asthma have a major psychological problem that has caused the asthma. Emotional factors are not the cause of asthma, though emotional stress can infrequently trigger asthma. 

Emotional stress itself (anxiety, frustration, anger) also can trigger asthma, but the asthmatic condition precedes the emotional stress. Therefore, a child’s asthma is not “in his or her head,” as many people believe.

Emotions are associated with asthma for another reason. Many children with asthma suffer from severe anxiety during an episode as a result of suffocation produced by asthma. The anxiety and panic can then produce rapid breathing or hyperventilation, which further triggers the asthma.

 

Treatment should be aimed at controlling the asthma. When asthma is controlled, emotional stress will be reduced and other emotional factors can then be dealt with more effectively. Any chronic illness, especially if uncontrolled, can have associated secondary psychological problems. More severe psychological problems require a specialist to help the child and his or her family.

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6 Comments

  1. Khushi

    Very useful post for everyone. Is there any diet for Ashthma too?

  2. Mike Edwards

    One really good aid for asthma in children is to use a liquid ioniser. This is a new technology that has only recently come to market. It clears the air in the same way as the effect you get after rains, doesn’t genearte ozone or use propellants, doesn’t move the air – its a remote effect purifier, is affordable and most of all it locks out allergens from the room so they don’t re-enter the air when you sit, move about or disturb the furnishings

  3. sarmila

    not any specific diets, but yes, you have to avoid those which makes the breathing problem,, that you have to notice for few days.

  4. sarmila

    thanks Mike, yes, liquid ioniser is a very good remedy

  5. Indrani

    Thanks Sarmila. A very informative post.

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