A lot of children are affected by respiratory ailments. Asthma is one such ailment, where the air-ways are hypersensitive to a variety of factors known as triggers. This results in a sudden contraction and swelling of airways, which causes wheezing, cough and breathlessness. A trigger is any-thing that can lead to an asthma attack. The common triggers are pollen, cigarette smoke, dust mites, pet dander, cockroaches, viral infections, and so on. Asthma is also over diagnosed.
All wheezing is not asthma. Particularly in younger children, wheezing is most commonly associated with viral infections. Almost 30% of children younger than 3 years have at least one episode of wheezing. Many children outgrow this problem by the time they are 6 years old. Hence, the diagnosis is not made in younger children.
A single episode of wheezing is not asthma. Asthma is a chronic disease associated with recurrent episodes of wheezing or other symptoms. It is not a contagious disease and cannot spread from contact. It does have a genetic predisposition, Children with one or more parents with asthma have a greater risk of being asthmatic. Many children develop asthma even though there is no family history of the disease. There is nothing that you can do to prevent the onset of asthma.
One can, however, predict the risk of developing asthma in a child. There are higher chances of developing asthma if he has three or more wheezing episodes per year and has one or more of the following high-risk factors:
• Skin allergy – eczema/atopic dermatitis
• Family history of asthma or allergies
• Allergic rhinitis
• Wheezing without associated colds
Diagnosis and treatment
Diagnosis is mainly based on a clinical history and examination in addition to response to medicines. However, the doctor may prescribe certain tests to support the diagnosis or rule out an alternate diagnosis. Complete blood count (CBC) and chest X-ray are generally done at the time of the first episode. Bedside peak flowmetry is helpful in older children. Pulmonary function tests may be done in adolescent children.
It is not necessary to get an allergy test for every child with asthma. Many paediatricians do not ad-vice allergy tests for children with asthma. There are many possible allergens in our environment and it is not possible to test for all of them reliably. Also, false positive reactions may occur some-times. It is not possible to avoid common allergens like dust, pollen and molds completely.
Management of asthma
Management of asthma is a culmination of avoidance of triggers, use of medicines—inhaled and oral medications, and monitoring and follow up with home treatment plans.
When your child is around something that triggers symptoms, keep track of it. This can help you find a pattern in what triggers symptoms. Maintaining a symptom diary/asthma diary would definitely help.
Inhaled medicines act directly at the site of swelling and hence act faster. Also, these medicines have lesser side effects as these do not enter the bloodstream. There are two types of medicines for management of asthma: the relievers and the controllers. Relievers are used for acute attacks and controllers for long-term suppression of reactivity. In moderate to severe cases, controllers need to be used for a prolonged duration (3–6 months on an average).
Another popular misconception is about steroids in asthma, which belong to the controller category. Parents are apprehensive that steroids are strong, harmful and addictive. However, there is no need to be scared of inhaled steroids used for asthma. Most kids are started with minimum dose and low potency steroids. Even for children on high dose or high potency steroids, the systemic side effects like hypertension, obesity, growth retardation are extremely rare.
There are other drugs available for asthma prevention but steroids are usually the preferred drugs and are totally safe.
Serious side effects are rarely seen with inhaled steroids. Chances of local side effects like thrush can be reduced by using spacers and by gargling and rinsing mouth after each use.
It is important that your child is regularly reviewed by your paediatrician to ensure that he is using the lowest dose needed to control asthma and to look for any possible side effects.
Many children have mild asthma but for some people it can be a severe and life-threatening disease. Even people who usually have few symptoms can have severe asthma attacks that start very suddenly. The good news is that asthma symptoms and control can almost always be improved with the right treatment.
If your child does actually have asthma, then it will not go away. But if she is having recurrent wheezing and is younger than 6 years of age, then you should definitely be hopeful. Sixty percent of young kids with wheezing outgrow it by the time they are 6 years old. There is no permanent cure for asthma at present.
Diet and play
Contrary to popular belief, there are no “cold” foods (i.e., milk, curd, rice, citrus fruits, etc.) as such which aggravate cough. Hence, there is no need to avoid them. Many food colors and additives are known to trigger wheezing. So, try and find out if any specific food item triggers an attack of wheezing. A wholesome diet is essential for growth and development, and there is no need for a general ban on milk, fruits, nuts, etc.
There should be no restrictions on children's ability to play, take gym class, or compete in sports just because they have asthma. A well-controlled asthma doesn't interfere in day-to-day activities. However, if your child has been instructed to take medicine before physical activity, make sure that she does not miss it, even if she seems fine. Children with poorly controlled asthma or those on long-term steroid inhalers should take the influenza vaccine yearly. To conclude, tackling asthma is a team work with the parent and doctor working in tandem to help maintain a symptom-free and unrestricted lifestyle for the child.
The author is the founder and director of The Pediatric Network.