Emotions. Children do not
develop asthma as a result of psychological problems. However, crying,
laughing or yelling in response to an emotional situation involves deep,
rapid breathing which can sometimes trigger an asthma attack.
Weather. Studies have demonstrated that
breathing cold dry air provokes an attack in most children with asthma.
What
Are the Signs of Asthma?
Asthma suffers have narrower airways because of an ever-present inflammation.
Then in response to a child's triggers, muscles surrounding the bronchial
tubes go into contraction, narrowing air passages even further and making
breathing difficult. An attack can be mild to severe and last a few minutes,
hours, or even days. Severe attacks, which may be fatal, can be prevented
or shortened with the appropriate treatment. About one-third of young children
with asthma outgrow it by the time they are teens, but beating asthma depends
on a number of factors such as heredity and how well the condition is controlled
at an early age.
Clues that a child may have asthma include a persistent dry cough, nighttime
coughing that disturbs sleep, wheezing, fast breathing, or shortness
of breath. Wheezing, though characteristic of asthma, is not its most common
symptom. Coughing, on the other hand, is noted with even "hidden" or undiagnosed
asthma.
Infants who have rattle-like coughs, rapid breathing or repeated bouts
of pneumonia or chest colds should be evaluated for asthma. Also, if your
child is diagnosed with bronchitis, consider getting a second opinion because
this condition is rare in
children and is usually misdiagnosed asthma. (Bronchiolitis, a viral
infection of the lower respiratory tract, is a different disease that occurs
in infants under 18 months of age.) Obvious wheezing episodes might not
be noted until after 18-24 months of age.
Chest tightness and shortness of breath are other signs of asthma that
may occur alone or in combination with any of the above symptoms. However,
since any of these symptoms can arise without asthma, other respiratory
diseases must always be
considered.
How
Is Asthma Treated?
Most asthma attacks develop gradually over days, but their frequency
and severity can often be reduced so that they do not interfere with normal
activities. You and your doctor can control your child's asthma by developing
a management plan and
following these steps:
1. Identify your child's triggers.
Given the wide range of possible asthma triggers, it may be hard to figure
out what starts your child's asthma attacks. It may appear that they occur
out of the blue, but this generally isn't true. Something usually sets
attacks off, and your pediatrician must make an individualized evaluation
to find out exactly what that is. The doctor may also recommend you see
an allergist since skin testing is often required to determine which allergens
may be important. Special diets
and careful tests with suspected foods usually help detect food allergies.
2. Avoid triggers.
Once your child's triggers are identified, a plan must be formulated to
avoid them in order to lessen the severity of attacks (see "Preventing
Attacks"). For example if eggs are found to be culprits, they should
be eliminated from the diet.
3. Medications. There
are four types of medications used to manage asthma:
Anti-inflammatory drugs are used to control asthma on a long-term basis--even
when no symptoms are present--by helping to inhibit swelling and irritation
in the airways.
Treating this underlying inflammation may not only prevent attacks but
damage to the lungs later on in life. Anti-inflammatory drugs come in pill
or aerosol forms and can also be injected.
Inhaled steroid medications and cromolyn sodium are highly effective in
taming asthma's inflammation. However, oral steroids (these are not related
to the controversial steroids athletes take) can cause unwanted side effects,
including stunted growth. For that reason, oral steroids are reserved for
severe cases of asthma, which are not controlled by inhaled steroids
or cromolyn.
Bronchodilators do nothing to tame asthma's underlying inflammation but
they may be used to relax the muscles of the airways and open them up when
symptoms do occur. They are available in spray and oral form. Young children
(usually under 8 or 10) may be given oral medication if they cannot use
sprays correctly. Asthma sufferers are cautioned to use bronchodilators
only as directed. Anti-Allergy drugs help prevent triggers from causing
attacks, but they do not work after one starts.
4. Allergy injections.
Hyposensitation, allergy shots, immunotherapy or desensitization are synonyms
for injection treatments which reduce a person's sensitivity to certain
allergens. These are mostly recommended for allergens, such as ragweed,
that cannot be avoided. Usually a one-year trial of allergy injections
is prescribed to determine their effectiveness. If proved effective, injections
are then continued on a schedule determined by your physician. Note: Allergy
injections are not a substitute for avoiding asthma triggers.
5. Early treatment of asthma episodes.
Most episodes do not occur suddenly; they develop gradually over days.
Emergency room visits and hospitalization can be reduced by recognizing
the subtle signs of an impending asthma episode, including a hacking or
tight cough, coughing at night or after exercise, and an increased need
for medication. Ask your doctor to outline which signs indicate the onset
of an attack for your child. If your child has more than a few attacks
during the course of the year, your doctor will recommend the use of a
peak flow meter--a portable, inexpensive, hand-held device used to measure
a person's ability to push air out of the lungs. These devices can be used
reliably by most children over the age of five
and are an important part of most asthma management plans.
If a peak flow meter is recommended, keep a chart of your child's peak
flow rates and discuss the readings with your doctor to determine what
is normal for your child and what readings call for medication. If at any
time your child does not respond to treatment, call your doctor for further
instructions. Early aggressive treatment will usually prevent progression
into an acute episode.
Leading
a Normal Life
It is important to remember that while asthma must be controlled, it
should not keep
children from normal childhood activities. Keeping youngsters cooped
up out of fear of an attack may, in fact, be counterproductive. Some experts
think the increasing amount of time children are spending indoors has contributed
to rising numbers of asthma cases. Take a positive approach to the problem.
The American Lung Association (ALA) affirms that learning to control asthma
can help a child gain confidence and learn qualities such as self-discipline
and personal responsibility.
You should encourage physical activity within your child's limits. Fortunately,
the vast majority of children with asthma can participate in all activities--including
vigorous sports like track, basketball and soccer. At the 1984 Olympics,
there were 34 medal winners who had asthma. Also, the ALA sponsors approximately
141 summer residential or day camps around the country for children with
asthma. For more information on the camps, asthma management, stop smoking
programs or other asthma projects, call the ALA at 800-586-4872, which
will automatically dial your local ALA chapter.
Race
Disparity
In 1985 the prevalence of asthma among African-Americans was 7 percent
greater than among whites. By 1991, the difference was 21 percent. Among
Hispanic children 6 months to 11 years old, 20.1 percent suffered from
asthma--more than children of any other ethnic group. This racial disparity
is particularly dramatic in one study that shows between 1982 and 1986,
82 percent of those hospitalized for asthma in New York City were African
Americans or Hispanics, and these two groups accounted for 76 percent of
asthma deaths. The reason certain ethnic groups are harder hit by asthma
seems to be due more to economic reasons than genetics. Lack of adequate
medical attention leads to a failure to diagnose asthma and keep it under
control. Also, urban living conditions, which are usually crowded and less
sanitary, may result in a greater exposure to allergens.
A study in the medical journal Lancet in 1992, confirmed that avoiding
exposure to various allergens in the first 12 months of life can help prevent
or delay childhood asthma. In this study, infants in one group were breast
fed or given allergy free formula. Their diets were free of cows' milk,
eggs, fish, nuts, soy products, wheat and oranges (breast-feeding mothers
followed thesame diet). The bedrooms and living areas of this group were
cleaned with anti-dust mite solution for the first year of life (dust
mites are microscopic bugs that cause allergies to dust). The infants
in the other group ate freely and lived in untreated environments. After
one year, the specially treated group had a 13 percent rate of allergies
and asthma while the untreated group had a 40 percent rate.
Preventing
Attacks
The following tips can help your child avoid triggers and lessen the
frequency and severity of asthma attacks:
Make sure your child's home is smoke-free.
Keep your child's room as uncluttered and dust-free as possible by:
removing any carpets or rugs so the floor is easy to clean (washable throw
rugs can be used); making sure stuffed animals are washable or are kept
covered with plastic when not in use; using washable drapes on the windows
instead of venetian blinds; avoiding open book shelves, upholstered furniture,
fuzzy blankets or feather- or wool-stuffed comforters and pillows; using
a washable mattress cover; and washing all the bedding once a week in hot
water. Dust mite resistant solutions, mattress covers and pillows are also
available.
The National Institutes of Health recommends steam or hot water heat
instead of hot air heat for asthmatics.If there is a hot air furnace outlet
in your child's room, install a filter made of several layers of cheesecloth
or some other adequate material (such as old nylon hose) and change it
frequently. Also, seal holes and cracks in the floor around heating or
other pipes with adhesive tape.
Clean your child's room daily, and once a week do a thorough and complete
cleaning of floors, furniture, tops of doors, window frames, etc., with
a damp cloth or oil mop. Air the room while cleaning, but then keep doors
and windows closed.
Strong odors often provoke symptoms. The Allergy and Asthma Network
in Fairfax, Virginia, advises that parents use the following away from
children: aerosol cans, paints, insecticides, detergents, chemicals, household
cleaners, strong soaps, perfumes, cosmetics, air fresheners, and potpourri.
Test children to see if they are allergic to animal dander (small scales
from animal hair or bird feathers). Cats, dogs, birds, etc., can cause
problems for asthmatics.
In cold weather, have children cover their noses and mouths with a
scarf or cold weather mask (available in drug stores).
Make sure your child gets regular exercise to improve the strength
of the lungs and airways. If vigorous exercise triggers an attack, talk
with your pediatrician. Adjusting medication or exercise may help.