Asthma is an inflammation of the breathing tubes of the lungs, a bronchitis, caused by a variety of triggering agents. It is very common in childhood, afflicting perhaps 10% or more of kids at some point in their childhoods. In recent years much more has become known about the way in which asthma develops and how it affects the lungs; this has led to new and much better understanding of how to effectively treat asthma.

An asthma attack begins in the body when something stimulates certain trigger cells in the lining of the lungs to release various inflammatory substances. These substances cause direct inflammation of the bronchial tubes and also attract more inflammatory cells that release even more inflammatory chemicals. The cough reflex is greatly stimulated by the inflammation and the prescence of the sticky mucus clogging the air tubes. The lining of the bronchial tubes swells and starts to block air flow. Thick, sticky mucus is secreted in large amounts, and it clogs the tubes, increasing the blockage of airflow. The inflammation stimulates the muscle that is wrapped around the bronchial tubes to contract, narrowing the diameter and increasing the resistance to air flow even more. All these factors tend to decrease the diameter of the bronchial tubes and produce shortness of breath and usually audible wheezing.

From the perspective of the child, an asthma attack usually begins with cough. At first, it may be just a dry, nagging little cough, especially at night. If recognition of what is going on and proper treatment are delayed, the cough may become more severe, and the child may start coughing up or even vomiting mucus (phlegm). The child starts to experience wheezing, shortness of breath, can't sleep, and is restless. As the attack worsens further, the child begins to experience increasing air hunger, and is using all the muscles in the chest just to get air in and out of the lungs. Hopefully, by this time the parents have recognised the need for prompt medical attention.

A variety of triggers can set off the asthmatic reaction in the lungs, for example:

  • allergic triggers such as the house dust mite, pollens, and animal danders
  • exercise - probably because of cooling of the bronchial tubes by increased airflow
  • infections, especially viral infections - colds
  • air pollution (especially CIGARET SMOKE) or certain chemicals
  • cold weather

The tools we use to effectively treat asthma:

  • peak flow meters - measure how fast air can get out of the lungs - a very sensitive measure of lung condition that allows earlier effective treatment to head off attacks
  • metered dose inhalers - portable little canisters that deliver a measured puff of asthma medication any time, anywhere
  • spacer devices - make metered dose inhalers much more effective - Inspirease¬, Aerochamber¬ to name a couple
  • home nebulizers - air compressors that create an inhalable mist of medication that is breathed directly into the lungs
  • EDUCATION - the real key to asthma control is parental and patient education and understanding about asthma

The medications that are used include:

  • cromolyn sodium - a non-steroid anti-inflammation drug - very, very safe, and very effective as a preventative medication
  • inhaled steroids - a major part of asthma treatment today - inhaled steroids act only in the lungs and have very little to no effect on the rest of the body (medicinal steroids have no relation to the potentially bad side effects of steroid hormones abused for body-building)
  • oral steroids - sometimes used for very young patients for whom inhaling medication on command is a problem
  • inhaled brochodilators - medicines such as albuterol (Ventolin¬, Proventil¬) or metaproteranol (Alupent¬) that relax spasm of the bronchial smooth muscle tissue and open the tubes up for easier breathing
  • oral bronchodilators - the same medications, given orally to children in whom inhalation is a less viable alternative
  • leukotriene inhibitors - these new medications inhibit the trigger cells that start the cascade of inflammation in the lungs.

Asthma should no longer be an almost crippling disease for children. With advances in therapy and continuing education in treatments, many primary care pediatricians now do an excellent job managing even the more difficult asthmatics. Additionally, there are in most cities of any size allergists, even pediatric allergists, and pulmonologists (specialists in lung disease) who manage pediatric asthma patients. I think it is very important that a child with asthma have a physician who is interested in and comfortable with the modern management of this condition.

These are the goals of therapy for your child from One Minute Asthma, by Thomas F. Plaut, M.D.:

"You and your doctor should be able to work out a plan to control asthma. After you have a good plan, your child will:

  • run as long and hard as anyone else
  • attend school every day
  • sleep through the night without cough or wheeze
  • avoid emergency visits to the doctor
  • avoid hospitalizations for asthma

If your plan does not control asthma symptoms fully, you and your doctor need to learn more about your child's asthma so you can work out a better plan."

I think that says it all.

A helpful book for parents: Children with Asthma - by Thomas F. Plaut, M.D.; bookstores or available directly from Pedipress Fulfillment Center, 200 State Road, South Deerfield, MA 01002; 1-800-611-6081. Also available on the Web at the Pedipress web site. The Pedipress web site includes current edition information and descriptions, pages on using asthma diaries, and will soon include excerpts from Children with Asthma. If your child has asthma you should visit their site.

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