Between five and ten percent of children in the United States suffer from asthma, a respiratory disorder that causes episodes of wheezing, coughing and breathlessness. In most cases, the symptoms are mild, but some children with asthma have severe, frequent attacks. For these children—the majority of whom develop asthma before the age of three—the condition may lead to numerous emergency-room visits and hospitalizations. Even for children with severe symptoms, however, asthma can be controlled.
WHAT HAPPENS DURING AN ASTHMA ATTACK?
People with asthma have overly reactive bronchial tubes. The bronchial tubes are the airways in the respiratory tract, branching off the two mainstream bronchi, which are the large airways at the bottom of the windpipe. The bronchi carry air by way of smaller branches called bronchioles to the alveoli, tiny sacs in which the blood exchanges carbon dioxide (a waste product of cellular activity) for oxygen.
When a person with asthma comes into contact with an irritant (such as cigarette smoke), allergen (such as dust, mold or pollen) or some other trigger, the muscles that encircle the bronchial tubes go into spasms and the lining of the tubes becomes inflamed, leading to increased secretion of mucus. As a result, the bronchial tubes become narrower, causing tightness in the chest, coughing, a hunger for air, wheezing and an increase in respiratory and heart rate.
Early signs include slight coughing and a high-pitched wheezing sound when the child exhales. Mild attacks may not get much worse than this. In more severe cases, respiration becomes rapid, the skin pales and the chest pulls inward with every breath. The child may vomit. As the attack worsens, the wheezing may become louder, although in very severe cases, little or no wheezing is heard because the breathing tubes are so narrow.
WHAT CAUSES ASTHMA?
Two-thirds of childhood asthma cases stem from allergic responses to dust, animal dander or plant pollens. Less frequently foods, drugs or chemicals may cause wheezing. Children with this type of asthma often have other allergies, such as eczema and hay fever. Their siblings and parents tend to have allergic sensitivities, as well. The other third occur in response to an upper-respiratory infection (a cold or bronchitis), exercise, cold air, emotional upsets or irritants such as smoke. Many children with asthma are sensitive to both types of triggers.
Following exposure to an irritant or allergen, the bronchial tubes may remain hypersensitive for weeks or months. Because of this reactivity, asthma attacks may occur without direct contact with a trigger.
• Sulfite preservatives in foods, such as fresh vegetables and shrimp served in restaurants
• Emotional distress
WHEN SHOULD I SUSPECT THAT MY CHILD HAS ASTHMA?
If your child has any type of allergy, it's a good idea to watch out for asthma. Likewise, children who tend to develop dry, hacking nightime coughs and wheezing when they have colds or after they exercise may have mild cases of asthma.
You will know when your child has an acute asthma attack. In addition to wheezing, coughing and shortness of breath, the child may become anxious and agitated. At the opposite extreme, children suffering severe asthma attacks often become abnormally lethargic.
WHAT TREATMENTS ARE AVAILABLE?
A number of medications—all of which work by dilating the tightened bronchial tubes—are available to treat acute asthma attacks and prevent their recurrence. Depending on the child's age, the severity of the symptoms and the circumstances (treating an acute attack or preventing recurrences), the medication can be injected, inhaled or taken orally.
If the child has asthma only as an occasional complication of a cold (once or twice a winter), medication may be taken as needed at the first signs of a cold. Children who have asthma attacks regularly need daily medication to prevent recurrences and control symptoms. Likewise, children with severe, recurrent asthma often need medication regimens that combine different classes of drugs.
For children with allergy-related asthma, identifying and avoiding allergens is a key to successful prevention. Your pediatrician may recomend skin tests, in which tiny amounts of common allergens are scratched onto the surface of the skin to identify the ones that provoke reactions. After allergens have been identified, the doctor will advise you on allergy-proofing your house. In addition, some children undergo immunotherapy (allergy shots), a process in which allergens are injected beneath the skin to dampen the abnormal immune-system response. Your child may need to have these injections on a weekly basis for a year or more.
PREVENTING ASTHMA ATTACKS
• Administer medication in the exact dose and at the exact time prescribed by the doctor.
• Avoid substances that trigger attacks.
• Consider allergy shots (immunotherapy) if your child is allergic to such substances as houshold dust and if avoidance measures do not reduce the attacks.
• If cold air, exercise or respiratory infections trigger asthma in your child, ask your pediatrician about administering preventative medication on an as-needed basis—for example, before going out on the coldest days, before gym class or at the first signs of a developing cold.
• Smoking parents should stop.
COPING WITH ASTHMA
Parents of children with asthma may become overprotective. Once you've nursed your child through one or two severe asthma attacks, you'll probably go to almost any length to avoid a recurrence—even if it means discouraging certain normal childhood activities. Being too protective, however, can set the state for power struggles that go much deeper than the illness itslf. Sometimes, children with asthma use the threat of an attack to get their way.
They may also needlessly avoid exercise and other healthy activities.
To prevent these problems, keep your child's life as normal as possible. Stick to rules of acceptable behavior, particularly regarding bedtimes, meals and other routines. If daily medication is necessary, it should become as automatic a part of the day as brushing teeth and putting on socks. At around age five, many children can assume some of the responsibility for taking their medication on schedule.
When attacks occur, stay calm and act fast. Remember that asthma is, by definition, reversible, and that very few attacks are severe enough to warrant hospitalization. Moreover, your own distress can heighten your child's anxiety, which may worsen the symptoms.
USING AN INHALER OR NEBULIZER
Most children with chronic asthma learn to take their medicine by inhaling it. Inhaled medications work faster than those taken by mouth. Also, because the drug goes directly to the lungs, a much smaller dose is needed, causing fewer side effects. Until about age four, most children use nebulizers, which infuse tiny droplets of medication into air from an air source (such as a portable compressor) attached to a mask that fits over the mouth and nose.
Older children can learn to use an inhaler, with which they self-administer a metered dose of medication in mist form. In this way, they may take cromolyn (which prevents attacks but does not relieve them) according to a schedule and terbutaline or a similar preparation at the onset of symptoms. Some corticosteroid drugs are also available in inhalers. Inhaled corticosteroids are used often for moderate or severe asthma.
GETTING HELP
Call your doctor if:
• Wheezing or difficult breathing fails to subside after medication is adminstered
• Vomiting prevents the child from retaining the full dose of medication
• You can see the child's chest moving in with every breath
• Wheezing becomes inaudible but breathing remains difficult
• The child's skin looks dusky and her lips and fingernails are blue
• The child becomes uncharacteristically agitated or lethargic
