The incidence of asthma is increasing dramatically, due to the increasing air pollution. It is a chronic disorder where the airways are hyper-reactive to a variety of stimuli. This hyper-reactivity is reversible but recurrent. Recurrent attacks are a hallmark of asthma. The airways constrict in response to the offending stimulus (e.g. pollens, viral infection etc.), which narrows their lumen.
As a result, breathing becomes laboured particularly during the phase of expiration (breathing out). Thus the child suffers from an increased work of breathing i.e. he has to strain his muscles of breathing in order to breathe out through the narrowed airway tubes (called bronchi). Sometimes as air is expelled out through these narrowed passages, an audible sound is heard called “wheezing”, which most of the parents whose child suffers from asthma have heard sometime or the other.
Wheezing need not always be audible. Often, only the stethoscope picks it up. Remember that wheezing though a characteristic feature of asthma may not always be present. In fact an asthmatic may present simply with chronic cough without wheeze or breathing difficulties. Also remember that all wheezing is not asthma (there are many other diseases that can cause wheezing). A helpful point in diagnosing asthma is a positive family history of asthma or allergies.
In children, the stimulus that often precipitates an asthmatic attack is the common cold. Parents often give the history that the child had a running nose for 1-2 days and now has started having a tight cough i.e. an attack of asthma. Other allergens can also cause asthma, like in hay fever (refer above). Asthma can be without cough, so don’t think why the doctor is diagnosing asthma when my child has no cough. The treatment of asthma is bronchodilators (drugs which dilate the constricted air passages) and steroids.
Bronchodilators should preferably be delivered directly to the air passages rather than orally. Oral bronchodilators are less efficacious with more side effects like tremors etc. There are various ways of delivering bronchodilators to the lungs directly, e.g. by nebulization, use of inhalers, rotacaps, spacers, baby masks etc. The method most suited for your child will be decided by your doctor.
For instance, inhalers are useful only for adults and older children. For smaller children, an assist device like spacer or rotahaler may be required. Steroids, the second mainstay of treatment, can be given by inhalation, but during an acute attack of asthma; they are given orally for 5-7 days. The use of deriphylline or an injection of adrenaline, therapies that were popular in the past, is nowadays seldom used and that too as a second line measure.
If there are frequent recurring attacks, some type of preventive therapy (such prevention only decreases the frequency of attacks, it doesn’t stop them all together) is advocated. Usually inhaled steroids taken twice a day or inhalation of sodium chromoglycate is efficacious as a preventive therapy. Nowadays, a new generation of drugs called “leukotriene receptor modifiers” are available that are also of benefit in reducing the incidence of asthma i.e. they have a preventive role.
Each case has to be individualised, as to what suits him the best. Your doctor may have to try out permutations and combinations of various drugs before striking the optimum balance. As the child grows older, in about 50% of cases, the attacks of asthma become less frequent and may even subside completely.
An asthmatic child should be allowed to lead as normal a life as possible. He should be allowed to play all types of games he loves. If exercise precipitates an attack of asthma (called exercise-induced asthma), it is readily preventable by taking some puffs of bronchodilators before the exercise. So activities of the child should not be curtailed. There is no need to cut down on any food until is proved that the child is allergic to that particular food (food allergies seldom cause asthma).
The family members of the asthmatic child, particularly if the attacks are severe and frequent, require a lot of emotional support. It is always best to take the support of your social system i.e. friends, relatives etc. Also talk over these things with your doctor who will give a sympathetic hearing to your emotional problems and try to alleviate them as much as possible. On the whole, the outlook is not that bad and once you accept the situation, you start feeling better.
Triggers of Asthma
Allergens
Allergens are an important triggering factor of asthma. Some examples of outdoor and indoor allergens are:
1. Pollen
2. Mold
3. Animal dander
4. House dust/dust mites
5. Cockroach
6. Certain foods
Viral infections
Viral infections of the respiratory tract often act as a major aggravating trigger. Viral infections produce an added irritation in the airways, nose, throat, lungs, and sinuses. This irritation often precedes attacks of asthma. The exact biological mechanism for this is not known.
Sinusitis
An inflammation of the nasal sinuses, known as sinusitis, often begins as an upper respiratory infection. Childhood symptoms include wheezing, postnasal drip, night-time i cough, and enlarged lymph nodes. Adolescents and adults may have headaches and sinus pressure of pain. Asthma may be aggravated by drainage of mucus into the nose, throat and bronchial tubes.
Irritants
Irritant can play a large role in triggering asthma. Some examples are:
1. Strong odors and sprays, such as perfumes, household 13 cleaners, cooking fumes (especially from frying), paints and varnishes.
2. Other chemicals such as coal, chalk dust, talcum powder.
3. Air pollutants
4. Tobacco smoke
5. Changing weather conditions, including changes in temperature, barometric pressure, humidity, and strong winds, all are likely to affect and irritate airways.
Tobacco smoke and wood smoke
Tobacco smoke, whether directly or passively inhaled, has harmful effects on the airways and is especially irritating for patients with asthma. An increased incidence of asthma has been reported in children whose mothers smoke. No one should smoke in the home of an asthmatic patient.
Smoke from wood burning and heating stoves can be extremely irritating to asthmatic by releasing chemicals such as sulphur dioxide. Proper ventilation must be maintained if these devices are used.
Exercise
Exercise can also trigger an asthma attack. It is estimated that 85% of allergic asthmatics have symptoms of wheezing following exercise. Inhaled cool and dry air seems to be a strong asthma trigger. Long distance running, a longterm strenuous activity, is most likely to induce asthma and swimming the least likely.
Gastroesophageal reflux
Gastroesophageal reflux, a condition characterized by persistent reflux of stomach acids, is common in individuals with asthma. Symptoms may belching, or spitting up (especially in infants). Nighttime asthma is common.
Industrial or occupational exposure to chemical irritants while on the job
Many cases of asthma in India are worsened or caused by exposure to occupational vapours, dust, gases or fumes. Typically, occupational asthma improves when the individual is away from the workplace for several days, e.g. weekends and vacation.
Sensitivity to medications, such as aspirin and sulphites
Five to 20% of adult asthmatic patients will experience an asthma attack as a result of sensitivities or allergies to medications.
Medications that are known to induce asthma attack include:
1. Aspirin.
2. Other nonsteroidal anti-inflammatory medications in patients with aspirin sensitivity, such as ibuprofen, indomethacin, naproxen, etc.
3. Sulphites used as food and beverage preservatives.
Before taking any medication, (including over the counter medications) asthmatics should consult their physician.
Emotional anxiety
Emotional anxiety and nervous stress cause fatigue and may add to asthma symptoms and aggravate an attack. These psychological factors alone cannot provoke asthma and are considered more of an effect than a cause.
Your doctor can provide you with more information on the causes and treatment of asthma.
Taking a New Look at Asthma
Unfortunately… asthma prevalence, particularly in children, is increasing worldwide. It is underdiagnosed and undertreated.
Fortunately…
• New methods are available for recognising, diagnosing, treating, and controlling asthma.
• Personal, social, and economic burdens of asthma can be minimized.
• Patient education increases the likelihood of lifelong success.
• You can make a difference.
Asthma causes recurring episodes of coughing, wheezing, chest tightness, and difficult breathing. Asthma attacks can be life threatening. They can be prevented.
Asthma is a chronic inflammatory disorder of the airways. Chronically inflamed airways are hyper-responsive; they become obstructed and airflow is limited (by bronchoconstriction, mucus plugs, and increased inflammation) when airways are exposed to various stimuli, or triggers.
Common asthma triggers (that is, factors that make asthma worse) include viral infections; allergens such as domestic dust mites (in bedding, carpets, and fabric-upholstered furnishings), animals with fur, cockroach, pollens, and molds; tobacco smoke; air pollution; exercise; strong emotional expressions; chemical irritants; and drugs (aspirin and beta blockers).
Asthma attacks (or exacerbations) are episodic, but airway inflammation is chronically present. Asthma is a chronic disorder requiring longterm management.
For many patients, this means taking preventive medication everyday.
• Asthma can change over time. Asthma can be mild, moderate or severe; asthma attacks can be life-threatening. The severity of asthma varies among individuals, and it can change in one individual over time. Treatment decisions are made based on the severity of asthma.
• Asthma can be treated and controlled so that almost all patients can:
• Prevent troublesome symptoms night and day.
• Prevent serious attacks.
• Require little or no quick-relief medication
• Have productive, physically active lives.
• Have (near) normal lung function.
• Asthma is not a cause for shame. Olympic athletes, famous leaders, other celebrities, anal ordinary people live successful lives with asthma.
• Asthma may be preventable. For infants with a family history of asthma or atopy, it is highly likely that avoiding exposure to passive smoking and to domestic dust mite, cat, and cockroach allergens will help prevent the initial development of asthma. For adults, avoiding exposure to chemical sensitizers in the workplace is helpful.
Identify and Avoid Triggers
• When patients avoid exposure to asthma triggers (allergens and irritants that make their asthma worse), asthma symptoms and attacks can be prevented and medications reduced.