Asthma in children is one of the most common medical problems facing children. According to statistics from the National Institutes of Health and the National Center for Health Statistics, childhood asthma affects over six million children under the age of eighteen and is the third leading cause of pediatric hospitalizations.
The direct medical costs of pediatric asthma have exceeded a staggering eleven billion dollars, while the indirect costs (lost productivity of parents, for example) add another five billion. Fortunately, deaths from childhood asthma are rare, but over four thousand people in the United States die each year from this disease. Allergy specialists play a vital and crucial role in treating childhood asthma, and more importantly, preventing asthma symptoms from occuring in the first place.
Asthma in children usually presents within the first few years of life. It commonly has its onset associated with an upper respiratory tract infection which may be caused by a variety of viruses, including the respiratory syncytial virus (RSV). The most common presenting symptom is coughing, although wheezing and difficulty breathing may be present.
Coughing, wheezing, tightness in the chest, shortness of breath and difficulty breathing are common symptoms in childhood asthma. Frequently, asthma symptoms are worse at night. They can be precipitated or made worse with play or exertion, as well as emotions such as crying or laughter. These symptoms may be delayed 10 or 15 minutes after exercise.
If there is obstruction to breathing, small children may have flaring of the nostrils and retracting of the chest wall. Some asthmatics will speak in short sentences or become agitated during episodes. These symptoms are very important to recognize as they indicate a potentially severe asthma attack or episode. It is also important to note that many asthmatics, especially children, may not recognize or report the signs of an asthma attack until they become quite severe.
Upper respiratory tract infections, most frequently the common cold, are common triggers of asthma episodes in young children. Allergies also play an important role in asthma attacks and in their chronic symptoms. Common allergens include dust, dust mites, cat and dog dander, mold, cockroach, and seasonal pollens.
Children with asthma are particularly susceptible to second-hand cigarette smoke. Research has shown tobacco smoke directly correlates with wheezing early in life, as well as sick visits to the doctor and hospitalizations. Poor air quality, strong odors such as household cleaners, and other airborne irritants play a role in many asthma exacerbations in young children. In addition, both environmental and genetic factors play a role in the development of asthma.
Many children are diagnosed early in life with “reactive airways disease” (RAD) or “recurrent bronchitis”. In young children, it will be necessary for an allergist to take a detailed history of a child’s symptoms, perform a physical exam, and assess their response to medications in order to establish or confirm the diagnosis of asthma. Chest x-rays are sometimes helpful in ruling out other causes of wheezing.
An allergist will also use pulmonary function testing in older children and teenagers to help make a diagnosis and to determine the severity of a child’s asthma. Pulmonary function testing requires the patient to blow forcefully into a computer called a spirometer. This procedure, called spirometry, does require cooperation and coordination, but it can usually be successfully performed in children over five or six years old.
Allergies often play a role in childhood asthma. Your allergist may perform allergy skin testing to dust mites, mold, pollen, and other allergens. Based on this information, your allergist will then recommend a comprehensive treatment plan for your child with the goal of reducing or eliminating asthma symptoms.
The goal in asthma treatment is to control your child’s asthma symptoms in order to allow him or her to live, play, and sleep without limitations. A peak flow meter may be recommended to help detect an impending episode or to follow treatment progress. An asthma specialist will likely provide an asthma action plan which will include a list of symptoms with corresponding recommendations about when to start medications, or when to seek medical attention. It is crucial that parents educate themselves on the proper use of inhalers, spacer devices such as the aerochamber, and nebulizers. Inhaler technique is crucial, as failure to use the device correctly will like result in treatment failure.
For chronic symptoms, controller or preventative medications such as inhaled steroids and/or leukotriene blockers are often used. Reliever medications such as beta agonists (albuterol) should be available at all times. Your asthma specialist will follow specific guidelines set forth by the National Institutes of Health for young children with asthma.
Environmental control is of great importance. Children with asthma should never be exposed to second-hand smoke. They should also avoid exposure to all noxious airborne irritants, both indoors and outdoors. This may require susceptible individuals to remain indoors on poor air quality days.
Asthma in children, although a common disease, can be controlled. It is up to parents to become educated in proper childhood asthma symptoms and treatment. This is an attainable goal that will allow our children to live healthy, normal lives.