Asthma in Children

What is Asthma

Asthma, is a chronic inflammatory disorder in which the airways(Small tubes) inside the lungs become inflamed when exposed to certain triggers like dust, pollen, smoke etc. In case of children they can be triggered by childhood infections like upper airway infections mostly viral.

What are the symptoms of childhood asthma

The most common symptoms of asthma are night time or early morning coughing, wheezing(Whistling noise during breathing), difficulty in breathing, Complaints of chest tightness, chest pain and few children may complain difficulty in breathing after exercise/sports and difficulty in sleep.

What causes Asthma?

Some of the most common factors which increase the risk of asthma are

  1. Environmental Pollution:Dust (Indoor and outside), smoke.
  2. Smoking tobacco: Cigarette smoke both inside or outside the house increase the risk of asthma
  3. Family history– Family history of asthma in parents or siblings, allergies or eczema (dry skin) increases risk of developing asthma.

In majority of children there is no specific cause.

What are the usual triggers, which bring an asthma attack?

  1. Respiratory infections: – Viral respiratory infections (Common cold) can trigger asthma in infants and young children. So kids with asthma should use asthma treatment for cough and cold rather than cold medications.
  2. Environment: Kids with seasonal allergies, asthma can be triggered during certain seasons of the year when the trees or grasses pollinate (especially during summer) or due to molds (fungus) during rainy season. Cold air can trigger asthma in some kids.
  3. Allergens:allergens like House dust , cats, dogs, paint, perfume etc can trigger an asthma attack
  4. Exercise: Asthma can be triggered by exercise (during sports, swimming etc) in kids who have exercise-induced asthma. The symptoms usually start within 5 to 10 minutes of start of exercise and would disappear after 20 to 30min after exercise.

How do we diagnose asthma

The diagnosis of asthma is mainly based on clinical symptoms and by examining the child by your doctor. However in older children we can do few investigations like spirometry and Peak flow meter to diagnose asthma

Fig:Peak flow meter usage in children

 

How can we treat asthma

Treatment depends on the severity of symptoms or the frequency and nature of these attacks plus how much they affect the quality of life/daily activities of the child. The key in treating asthma are

    • Avoiding the triggers
    • Proper and regular use of medications as advised by your doctor
    • And regular monitoring of treatment with your doctor

Medications

Can be broadly classified into two different groups

Relievers– Brings about quick relief of symptoms eg., Salbutamol

Preventors– These medicines prevent further attacks or reduces the frequency of attacks. Usually need to be taken daily even if the child is not having any symptoms eg ., Monteleukast,steroids, Long acting bronchodilators.

 

How are these medications given?

As oral suspension/syrup– for very shortterm relief of symptoms

By Drip(Intravenous infusion)- In case of serious attack

Metered dose inhalers– This device dispenses liquid or powder medications in a particular dose and can be breathed into the lungs. Using a spacer and a face mask helps to deliver greatest amount of medication into the lungs.

Nebulisers– Nebulisers change a liquid medication to a fine spray that can be inhaled using mask

 

Will my child continue to have asthma as an adult?

Majority of these children improve and stop having these problems around the age of 5-7 years. A small number of them will continue to have these symptoms into adulthood and need to be treated as asthma.

 

How does steroid medications work and are there any side effects

Steroids work by reducing the inflammation and swelling in the airways and help prevent the asthma attacks. This medication is used in kids with persistent asthma. Usually given through an inhaler with a spacer. Usually this medication has to be taken daily and is usually used in kids with persistent asthma. Short course steroids for 3-5 days can be given as a tablet or syrup form.

Steroids when given via inhaler very little of the medication is absorbed into the body, so there will be very few side effects. But when higher doses are used, then some of the medication can be absorbed and can cause some side effects. Though the side effect for this medication is a common concern for most parents, the risk form an untreated asthma is far more than the side effect from this medication (minimal side effect if any)

How can I administer medications via inhaler

Please watch this video to understand the correct technique to use a metered dose inhaler with spacer

 

 

Author:Dr. S. Boopathi MD, DNB, MRCPCH.

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