Asthma in children

Asthma in children 

Defining asthma in children
Asthma implies chronic inflammatory problem of air passages, reflected by recurrent obstruction in airways. The inflammation causes hyper-reactivity of airways to various stimuli like allergens and cold air. It is very a common disease of childhood just like other allergic conditions including eczema, food allergy, and allergic rhinitis. A recent CDC survey shows that asthma is affecting nearly 8.5% of children population in USA, which means 7 million children. School absenteeism and hospitalization are caused more by asthma than any other chronic disorder in USA. In fact it is a global concern now with the rapid industrialization and consequent environment particularly air pollution. In many developing countries, tropical climate with uncontrolled pollution causes respiratory track problems like chronic upper respiratory track inflammation, lower respiratory track inflammation, and asthma.



Risk of asthma in children:

1. The polluted environment is the most vital reason for developing allergic asthma in children. 
2. Life style is another factor, which is close related to environment as such.
3. Genetic components also play a vital role. Tendency of developing asthma can be inherited from either of parents. In case of identical twins, it is observed that either both or none is affected. So genetic link to asthma cases cannot be ruled out.
4. In the past 20 years, which is too short period to reflect genetic contribution, cases of asthma has raised rapidly indicating environment plays more crucial role in this chronic disease condition than inheritance. The environment includes all allergens, infections, food habit, and life style.
5. However, genetic trait may make a baby more vulnerable to asthma. 
6. Children exposed to cigarette or any kind of tobacco smoking become more vulnerable to allergic attack like sneezing, having burning sensation on throat, chest congestion, and in worst case asthma.
7. Although cold is primary factor, humid weather also increases asthma problem.  
8. Children or even adults may develop asthmatic symptoms due to presence of pollen of certain plants. Thus, green environment with irritant pollen can also be a threat to allergy and asthma problems.
9. Population near coalmine, industries causing flying stone dust etc are very much vulnerable to grow asthma and bronchial diseases. 

Symptoms of asthma in children

Asthma symptoms are reflected by several indications in case of children. You need to minutely observe your child and symptoms may vary with the ages. Some notable indications are:

1. Slow feeding and shortness of breath during feeding is observed in case of infants if they have chest congestion and asthmatic condition.
2. In case of toddlers, decreased interests in activities like running and playing and increased fatigue are typical symptoms of asthma in the child. Condition gets worsened by cold and other respiratory infections. The child’s cold lasts longer than usual.
3. Most common symptom is coughing. Usually coughing is non-productive, which is called cough-variant asthma.
4. Wheezing in a whistling sound is another sign of asthma. Such sound is produced due to turbulent airflow along narrowed air passages.
5. In acute case, children breathe with great difficulty.
6. A feeling of chest heaviness or tightness is felt.
7. Young ones get easily tired on exercise and play due to insufficient air supply to lungs.
8. Coughing increases during night. Recurring bronchitis also shows threat of asthma attack.
9. Problem of breathing in laid posture. Support of pillow or sitting position helps the child to breathe with ease.
10. Recurrent viral attacks on upper respiratory track exaggerate  the other symptoms of asthma. Viral fever/attack last for a week or so.  
11. Automobile and tobacco smoke are likely to aggravate allergic symptoms like sneezing, coughing, breathing trouble etc. The tobacco smoke also complicates treatment of asthma. Passive smoking is a potential cause of developing childhood asthma. 
12. Such children are easily attacked by bronchitis with productive cough. 
13. During spasm, respiratory rate increases, heart beat increases, and children seem to be grasping air to breathe. 
14. Young children may become lethargic and loose appetite.
15. Your child is likely to lose interest in games and physical activities.
16. The problem subdued may be triggered to severe attack by seasonal allergies and tobacco smoke or spray of insecticides.

Remember, some children may have regular day-to-day problems like coughing, sneezing, breathing with difficulty, while some other may have occasional but severe attack. Still some other children might be having mild symptoms getting worsened by cold and respiratory track inflammation. It is notable that blood oxygen level remains almost normal even during severe asthma exacerbation although air intake reduces due to narrowed airways.

Diagnosing and monitoring asthma on regular basis 

For the children above 5 years almost same test and monitoring is recommended by the doctors as those are done for adults. But extra caution should be adopted for the infants. A newborn or a toddler cannot express her or his agony and it’s up to you to detect her/his problem from the symptoms mentioned earlier. Normally, two types of test are  conducted to detect and monitor asthmatic condition.

1. Using a Peak Flow Meter – It is a portable device which indicates how your child’s lungs are performing. It measures the amount of air exhaled out quickly by your child. A low reading implies that the baby’s lungs are not working at standard level. You can relate low peak flow reading before asthma attack. This will help you to plan when to visit doctor before situation goes worse. In case of infants who cannot express their problems in words, such device is a big help. Asthma like symptoms may appear due to some other reasons also. But early detection of whatever the problem is  ensures better remedies. Since asthmatic condition in children varies with age and diagnosis and treatment also differ from teens and adults.
2. Nitric Oxide Content test - Inflammation in the air passages and condition of lungs can be judged by measuring the percentage presence of nitric oxide. Higher level of nitric oxide is indicative of malfunctioning of lungs and asthma is to be treated without delay.

Emergency cases of asthma attack 

Severe spasm or asthma attack can claim life. So don’t delay to hospitalize if you find your dear one is :

1. suffering greatly with breathing difficulty
2. having persistent coughing and wheezing 
3. not improving even after using inhaler containing corticosteroid
4. leaning forward to breathe in a sitting position 
5. gasping to speak 
6. Peak flow meter showing the danger zone
7. Breathing so hard that the abdomen is sucked to vertebra.

As an emergency measure, you can call for an ambulance with oxygen cylinder and mask.

Treatment of asthma in children

Asthma is not completely curable. But its symptoms can be reduced by proper precautions against cold, dust, allergens. If you find your child exhibiting some of the symptoms mentioned above for more than a month, immediately consult a doctor. Early detection can control the disease significantly. Steroid drug though gives fast symptomatic relief, it is not at all advisable for children unless the case is too acute to claim life. Inhalers are better choice to treat youngsters or even adult. Antihistamine drugs are often prescribed for controlling allergies. While treating asthma, children below five years need more care and precautions than above five years.

Medications available are of two general categories in terms of time period of usage –

1. The first type of medication is prescribed for long-term use as a therapeutic treatment. Simply oral antihistamines like montelucast sodium, zileuton etc are advised if the symptoms are manageable with those. Use of Pheniramine maleate and Cetirizine are no more prescribed in USA for their side effects. In case the condition is serious, inhalers containing corticosteroids like beclomethasone, budesonide, fluticasone etc are prescribed to use on daily basis. Some times with heavy congestion on chest some bronchodilator mixed with steroids are also prescribed. One thing should be kept in mind that prolonged consumption of steroids is  not recommended for children at tender age. Even adults manage to control the symptoms preferably by non-steroidal medicines.
2. In emergency case of acute spasm, medicines for instant relief are administered. These are also referred as rescue medicines or SOS (save our soul) medicines. Bronchodilators like albuterol and levalbuterol are commonly used. Oral medicines like prednisone and prednisolone are given if the child is able to take it. The other option is intravenous injection. The patient may need oxygen mask for breathing. Inhalers are used in emergency too.

Starting with strong dose the medication is gradually decreased with the gradual improvement in condition and sustained relief medications are advised thereafter. Actually, every individual needs customized treatment. Often other complicacies are found along with asthma, and combination of such problems varies from children to children.

To deal with asthma in children precautions, timely diagnosis, regular monitoring, timely hospitalization in emergency, and regular consultation with the pediatrician – all are important. With careful monitoring and proper treatment, your child can enjoy normal life like other children. It is not a communicable disease, but invites bacterial and viral infections.