about childhood asthma2

8/14/2019 About Childhood Asthma2

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ABOUT CHILDHOOD ASTHMA

Asthma is one of the most common chronic diseases ofchildhood.

In 2004, an estimated 4 million children under 18 yearsold have had an asthma attack in the past 12 months,and many others have "hidden" or undiagnosed asthma.Asthma is the most common cause of schoolabsenteeism due to chronic disease and accounted foran estimated 14 million lost school days.

Even though asthma cannot be cured, it can almostalways be controlled.

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


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HOW DO NORMAL LUNGS

FUNCTION? Lungs allow oxygen to enter the body in

exchange for its waste product, carbondioxide. As the air passes through thenose and mouth, it is rapidly warmed andmoistened to avoid injury to the delicatelining of the airways.

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

The air is then transported throughsmaller airways. These airways branchlike a tree, so that millions of smallairways can carry oxygen to the tiny airsacs called alveoli.


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The airways have a delicate cellularlining (mucosa), which is coated witha thin layer of mucus, as is present inthe nose. Foreign particles are

trapped by the sticky mucus andeventually removed from the airwaysthrough the normal cleansingprocess.

The process is assisted by themovement of tiny "whip-like"

structures called cilia which move themucus and trapped foreign particlesup toward the mouth and nose wherethey are coughed and sneezed out orswallowed.

Bundles of muscles surround theairways, and the contraction of thesemuscles allows airways to selectivelydirect the flow of air.


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WHAT IS ASTHMA?

Asthma is an inflammatory condition ofthe bronchial airways. Thisinflammation causes the normalfunction of the airways to becomeexcessive and over-reactive, thusproducing increased mucus, mucosalswelling and muscle contraction.

These changes produce airwayobstruction, chest tightness, coughingand wheezing. If severe this can causesevere shortness of breath and lowblood oxygen.

Each individual suffers a different levelof severity. Virtually, all children withasthma, however, do enjoy a reversalof symptoms until something triggersthe next episode.


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WHAT IS THE CAUSE OF

ASTHMA? Inflammation of the airways is the common finding

in all asthma patients. Recent studies indicate thatthis inflammation is virtually always causative in theasthmatic condition. This inflammation is produced

by allergy, viral respiratory infections, and airborneirritants among others.

Childhood asthma is a disorder with geneticpredispositions and a strong allergic component.Approximately 75 to 80 percent of children with

asthma have significant allergies.


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WHAT ARE THE SIGNS AND

SYMPTOMS? Wheezing, though characteristic of asthma, is not the most common symptom.Coughing is noted especially with even "hidden" asthma when wheezing may not

be apparent to the patient, his or her family or the physician. 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.

Infants who have asthma often have a rattly cough, rapid breathing and may havean excessive number of "pneumonias," episodes of bronchitis or "chest colds."Obvious wheezing episodes might not be noted until after 18 to 24 months of age.

Chest tightness and shortness of breath are other symptoms of asthma that mayoccur alone or in combination with any of the above symptoms. Since thesesymptoms can occur for reasons other than asthma, other respiratory diseasesmust always be considered.

In a young child the discomfort of chest tightness may lead to unexplainedirritability.

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


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WHAT ABOUT HIDDEN

ASTHMA? Until rapid breathing, wheezing and coughing become

obvious, the condition of many children with asthma willgo undetected. These children with asthma usually suffersome degree of airway obstruction; and unless it isbrought under control, the children may suffer respiratory

illness more frequently than necessary. Hidden asthma, however, can produce so few

recognizable symptoms that even the physician mightnot be able to distinguish abnormal breath sounds withhis or her stethoscope but it may cause subtle problems

such as limitation of physical activity. Pulmonary functiontesting usually reveals these cases of airway obstruction.


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WHAT USUALLY TRIGGERS

ASTHMA?

Episodes of asthma often are triggered by some

condition or stimulus. Common triggers of asthma are:

Exercise

Infections Allergy

Irritants

Weather

Emotions (infrequent)
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Exercise

Running can trigger an episode in over 80percent of children with asthma.Bronchodilator medications used beforeexercise can prevent most of theseepisodes. With proper control of asthma,most children with asthma can participate

fully in physical activities.

There might be exceptions, such asprolonged running, especially during coldweather, allergy season or illness from a"cold." Swimming seems to be the leastasthma-provoking form of exercise.However recently there has been concernabout excessively chlorinated poolsprecipitating asthma episodes.


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Infections

Respiratory infections, including the flu, frequently trigger severe episodes ofasthma. Research indicates that these infections are most frequently producedby viruses, rather than bacteria. Antibiotics are of no benefit for viral infectionsand thus may be of little value in an asthma episode. It is important for all childrenwith asthma to get vaccinated for the flu each year. American Lung AssociationResearch has shown that the vaccination itself will not precipitate an attack.

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 antibioticwhen a child is having a respiratory infection and asthma. On the other hand, thedoctor 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 stubbornchronic trigger for asthma. Treatment for 10 days with antibiotics may not beeffective. In these children, sinus x-rays are frequently required to diagnose theunderlying condition.

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


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Allergy

Asthma symptoms of many children with asthmaare triggered by allergies. Allergic children sufferreactions to ordinarily harmless material (pollen,

mold, food, animals).

During an allergic reaction, chemicals such ashistamine are released from specialized cells.This may produce swelling of the lining of theairway, excessive mucus secretion and musclecontraction in the airways. In this way, an allergy

can provoke an asthma episode.

The allergens involved are common indoorinhalants (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 mayproduce low-grade reactions which are of noobvious consequence: however, daily exposureto these allergens may result in a gradualworsening of asthma.


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Allergy may be the cause of unrecognized or hiddenasthma. Minor allergic reactions can be more importantthan more obvious or severe reactions, in that an allergic

person tends to avoid exposure to allergens that havecaused severe reactions, while ignoring the minorallergens.

For instance, if your child is highly allergic to cats and

develops severe wheezing when he or she is aroundthem, you'll probably avoid cats at all costs. But whatabout your dog that sleeps with your child and doesn'tcause obvious wheezing? This could be an importantfactor. If so, skin testing usually will reveal any reaction

the child has to the dog. The child would then do betterwith both the cat and dog removed from his or herenvironment.


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Irritants

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

Cigarette smoke is a good example, because it is highly irritating and can triggerasthma. Most people are not allergic to cigarette smoke; that is, there is noknown immunologic reaction. Nevertheless, this irritant can be more significantthan any allergen.

Secondhand smoke can cause serious harm to children. An estimated 400,000 to

one million asthmatic children have their condition worsened by exposure tosecondhand smoke.

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


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Weather

Children with asthma have cited a number of climaticconditions as trigger factors. Many identify cold air astriggering asthma. Pulmonary function studies demonstrate

that breathing cold air provokes asthma in most children withasthma.

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 alsohelp avoid cold air induced asthma.

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

There does not seem to be one best climate for all childrenwith asthma, and moving to a new area to reduce asthmaseverity often is met with disappointment in the long run, evenafter initial improvement.


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Emotions

A common misbelief is that children with asthma have amajor psychological problem that's caused the asthma.Emotional factors are not the cause of asthma;however,emotional stress can infrequently trigger asthma.

A child's asthma might only be noticeable after crying,

laughing or yelling in response to an emotional situation.These normal "emotional" responses involve deep rapidbreathing which in turn can trigger asthma, as it does afterrunning.

Emotional stress itself (anxiety, frustration, anger) also can

trigger asthma, but the asthmatic condition precedes theemotional stress. Therefore, a child's asthma is not "in his orher head," as many people believe.


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

During an episode, anxiety and panic should be controlled asmuch as possible. The parent should remain calm, encouragethe child to relax and breathe easily and give appropriate

medications. Treatment should be aimed at controlling the asthma. When

asthma is controlled, emotional stress will be reduced andother emotional factors can then be dealt with moreeffectively. Any chronic illness, especially if uncontrolled, can

have associated secondary psychological problems. Moresevere psychological problems require a specialist to help thechild and his or her family.


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Controlling Your

Child'sAsthma


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HOW DO YOU CONTROL

ASTHMA?First, it is important that you and your child understand whatcontrol means. To completely control asthma is to reduce itsfrequency and severity, so that the asthma does not interferewith normal activities.

The degree of control varies with each child as some childrenwith severe asthma are extremely difficult to control.

Control of asthma begins by learning which trigger factors areimportant to your child. Since no two children with asthma arealike, an individualized comprehensive evaluation must be madeof your child to determine his or her trigger factors. The child's

history is by far the most important part of the evaluation.


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Your physician may recommend that you see a lung or anasthma/allergy specialist to help him with this evaluation. Skin

testing may be required to determine which allergens may beimportant. Special diets and careful challenges with suspectedfoods usually will detect food allergies.

Other laboratory studies, including pulmonary function studies,may be requested by your physician. Pulmonary function studiesare performed to determine the severity and reversibility of your

child's airway obstruction.

After the evaluation, your physician will outline those factors thatare important in your child's asthma and prescribe an individualtreatment program.


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WHAT IS THE TREATMENT

PROGRAM?

Treatment includes:

Avoidance of Trigger Factors

Asthma Medications

Allergy Injections When Indicated

Team Approach/Patient Education


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1. AvoidanceAvoiding trigger factors can make a great difference in yourchild's condition. If your child could avoid exposure to all ofhis or her allergies (such as house dust, molds, pets, etc),

he or she might still have asthma; however, the severitywould be lessened.

Trigger factors, such as viral respiratory infection andrunning, could still provoke asthma symptoms. Wheneverpossible, your child should avoid such trigger factors as

cigarette smoke and other inhaled irritants.


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2. MedicationsMedications that control asthma are available. The amount, frequencyand duration of medications depend on your child's asthma.

Some children only have asthma episodes a few times a year associatedwith colds, while others have episodes daily during spring and fall whenthere is increased exposure to outdoor allergens.

Some children wheeze only with exercise, while others wheeze daily forno apparent reason. Several different approaches might have to be triedbefore the proper medication program is achieved (see the "Asthma Medication Groups For Kids" section).

Fortunately there are many excellent medications with few side effects.Asthma can usually be controlled with safe effective medications.
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3. Allergy Injections

Small quantities of proven allergens are given in graduallyincreasing dosage until the child is able to better tolerate his orher allergies. This form of therapy has been shown to decreasethe allergy antibody level and to increase the protective orblocking antibody level.

Usually a one-year series of allergy injections is prescribed todetermine their effectiveness.

Allergy injections are no substitute for avoidance of allergens ormedication. You must continue allergen avoidance measureseven when your child's asthma is controlled or the problem mayagain worsen.


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4.Team Approach/Patient

Education

Emphasis is now placed

on improved

patient/parent education

and goal setting.Physicians and nursing

staff are spending more

time teaching patients

about the subtleties ofasthma management.


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Asthma Medications for

KidsInhaled Bronchodilator Medications

Systemic Corticosteroid Medications

New Medications
http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22883http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22883


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INHALED BRONCHODILATOR

MEDICATIONS Inhaled bronchodilator medications are

highly effective in opening airwaysnarrowed by asthma. In addition, theyhave few severe side effects when usedin the recommended dose andfrequency. They are available by bothmetered dose inhaler and nebulizer.

For children with mild asthma this is oftenthe only medication they will need.Inhaled bronchodilators are highlyeffective, and they have also proven tobe the bronchodilator medicine of choice

for moderate and severe asthma whenused with other medications.


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Because inhaled bronchodilator medications are veryeffective with few or no side effects, some patients tend tooveruse them, which can be very dangerous. Overuse of

these medications can delay proper evaluation andtreatment of severe asthma episodes.

There are now long acting inhaled bronchodilators which

are prescribed for use in the morning and evening. It isnow recommended that this be used as add onmedication from a person who is taking inhaledcorticosteroids. REMEMBER:

If you need to use inhaled bronchodilator medicationmore often than prescribed, this is a sign that yourasthma is not in control and you should consult yourdoctor.


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SYSTEMIC CORTICOSTEROID

MEDICATIONS Systemic corticosteroid medications are highly effective in controlling

asthma and reversing severe episodes. Unfortunately they cancause serious side effects when used for prolonged periods, andtheir use is therefore limited to severe episodes or chronic severeasthma which cannot be controlled with the first three groups ofmedication listed above.

Corticosteroid is a class of normal hormone of the human body andis produced by the adrenal gland. It is very effective in the control ofallergies, asthma and many other diseases. It is not like performanceenhancing "steroids.

When your child is having a severe allergy or asthma episode, his orher adrenal gland responds by producing more corticosteroids (up toten times more). In this way, the body can help control asthma.


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When asthma is not controlled, despite maximal therapeutic doses ofbronchodilator medication, additional corticosteroids must be given.A short course of systemic corticosteroids for less than two weeks is

rarely associated with significant side effects. For most children, 5days of use is adequate.

It must be remembered that severe uncontrolled asthma ispotentially fatal; and therefore, a much greater risk than 1 to 2 weeksof systemic corticosteroid. If the asthma is severe, your child may

also require hospitalization so that more intensive therapy can begiven.

Whenever possible, long-term use of corticosteroids should beavoided. However, severe uncontrolled asthma might requirecorticosteroids on a regular basis for months or even years. In this

case, the risks of chronic uncontrolled asthma are greater than thepossible side effects of systemic corticosteroids.


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INHALED MEDICATION

DELIVERY SYSTEMS Inhalers must be used properly to be effective. Approximately half of asthma patients do not

properly use their inhaler and this problem isovercome by the use of a spacer device.

Spacer devices or "spacers" allow the metered doseinhaler to first be sprayed into this container (usually6 to 16 ounces in size) and then the patientbreathes in the inhaled medication from the spacer.This is almost foolproof, thus improving proper useof inhalers from 50 percent to almost 100 percent.

Some authorities recommend spacers for allchildren.


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Pulmonary nebulizer machines or"nebulizers" are also very helpful. They areused to give routine medication treatmentsof inhaled bronchodilators and/or cromolynto very young children or any adult whohave difficulty using metered dose inhalersand spacers.

Nebulizer machines may also berecommended for anyone with asthma witha severe asthma episode to ensure

maximal delivery of bronchodilatormedication.

Proper selection and use of inhaledmedication, metered dose inhaler, spacerand nebulizer will be provided by your

physician and his or her nursing staff. Besure to carefully follow their instruction foruse and cleaning.


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NEW MEDICATIONS

Leukotriene modifiers are a new class of

oral anti-inflammatory asthma drugs

recently approved by the U.S. FDA. Sold

under the names Accolate, Singulair andZyflo, these are also available by

prescription.

about childhood asthma2

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