Asthma in children is a reversible disease of the airways that causes cough, breathlessness and wheezing. Asthma is the most common chronic disease among children and accounts for 250,000 deaths every year worldwide
What Happens in Asthma?
Airways are the tubes that carry air in and out of the lungs. In asthma, the airways become inflamed and narrowed. In addition the inflammation causes excess production of mucous which results in cough and sputum production, which aggravates asthma in children.
These changes can occur as a result of several triggers including viral respiratory infections, allergies, exercise, weather changes etc. The above triggers cause release of some chemicals (inflammatory mediators) in the body leading to inflammation and narrowing of the airways. Fortunately, in the majority of the cases, the above changes could be reversed with the appropriate treatment for asthma in children.
Causes for asthma in children:
Asthma in children can be triggered by allergic and non-allergic triggers.
The common allergic triggers include:
- House Dust Mite
- Animal allergens
The common non-allergic triggers include:
- Viruses (colds, flu)
- Cold air and weather changes
- Air pollutants (outdoor and indoor pollutants including cigarette smoke)
Half of the adults with asthma and two thirds of the children with asthma will have an allergic component to their disease. It should be remembered that the triggers mentioned above produce asthma symptoms only in individuals sensitive or predisposed to have asthma. Some substances act as irritants and act on the airways that are already over reactive due to asthma. These irritants cause symptoms briefly for 30 to 60 minutes whereas the triggers cause asthma symptoms for days or weeks.
The irritants include vehicle exhaust fumes, perfumes and aerosol sprays, paints etc. Smoking is a significant risk factor for the development of asthma in adults. Smoking during pregnancy is a significant risk factor for the development of asthma in children.
Symptoms of asthma
Half of the children develop the symptoms of asthma before the age of ten years. Half of the asthmatics develop symptoms before the age of 10 years. Because of the inflammation and narrowing of the airways, it is difficult to get air in and out of the lungs. A typical attack of asthma consists of cough, breathlessness and wheeze.
The cough is typically worse at night time and early morning. The breathlessness could be experienced as tightness of the chest or in more severe cases rapid breathing and increased effort of breathing.
Wheezing may be heard as a fine whistling sound by your doctor with a stethoscope. In severe cases the wheezing sound may be heard outside. In more severe cases your child may become extremely tired and find it difficult to speak, eat or drink.
Patients whose asthma is poorly controlled may wake up at night time with the above symptoms (particularly cough). Some children may have symptoms only when they do exercise, laugh or cry.
The medication for the management of asthma include those used for treatment of acute asthma attacks (relievers) and those used to prevent the attacks (preventers).
An acute attack of asthma in children is treated by using medication (bronchodilators) that relax the muscles around the airways. Relaxation of the muscles opens the airways and makes it easier to breathe.
The medicine commonly used by children is called as salbutamol and is preferably given through an inhaler and a spacer device.
Steroids are the definitive treatment for asthma as it acts on all the inflammatory changes that take place in the airways. Depending on the condition, steroids may be given through the mouth or using intravenous.
Inhalers and Nebulizers:
Inhalers are the preferred option in mild to moderate asthma. Maximum benefits from inhalers can be obtained when they are used with spacer devices. Use of spacer results in more effective deposition of the drug into the lower airways and fewer side effects. Only in severe cases, nebulizers are required.
Inhalers have several advantages including:
- Smaller dose compared to nebulizers and syrups
- Require lesser time for administration
- Portable and can be used during travel
- Not dependent on electricity
- Can be given during sleep without disturbing the child
Common misconceptions about asthma:
- Some parents are reluctant to accept the diagnosis of asthma. Accurate diagnosis is very important because it could help in the appropriate treatment and avoid unnecessary treatment. Undiagnosed asthma gets treated with antibiotics and cough syrups until a proper diagnosis is made.
- Some parents feel that asthma is a very serious condition. With the current available medication, the disease can be very well controlled and the child can live a normal life.
- Some families also have misconceptions about the use of inhalers. As described above, inhalers have several advantages and are the preferred mode of administration of the medications in asthma.
There are also a lot of misconceptions surrounding steroids. Although steroids can cause side effects, they have many benefits when used appropriately under guidance.
It’s important to understand that with the right treatments, children can live a normal life, even if they have asthma. The key lies in diagnosing it early, and taking correct measures to ensure that medications and doctor consultations are regular.
About the Doctor:
Dr. Srinivas Jakka is an experienced Paediatrician, Pulmonologist and Allergy Specialist. He completed his training in India and world renowned hospitals in UK. He has vast experience in the management of children with complex paediatric problems, asthma, complex respiratory diseases and allergies.
About The Hospital:
Ankura is a chain of Children’s Hospital in Hyderabad. Set up in the year 2011 in KPHB, near Hitech Railway Station, the Ankura Hospitals family has today spread its wings to Secunderabad, Khammam and Vijayawada.