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What Is Asthma

What Is Asthma

ASTHMA

  1. What is asthma?

Asthma is a disorder of the bronchial tubes (the smaller airways in the lungs) characterized by over sensitivity of these airways. During an asthma attack, the muscles that wrap around these bronchial tubes tighten, and there is more sticky mucous secreted. This narrowing and mucous plugging of the bronchi make it more difficult for air to move into and out of the lungs, and cause the wheezing sound and cough that is characteristic of an asthma attack. There are about two million children in the U.S. that have asthma.

2. What causes asthma?

No one really understands why certain children have overly sensitive airways. Sometimes, the tendency toward asthma is inherited, and occasionally it may be secondary to lung damage early in life as in certain premature babies that are born with severe breathing problems. It is not contagious. Often, no real cause for the asthma can be found. However, we do know that certain conditions can set off an episode of asthma in children that have the predisposition:

  1. Allergy – Most asthmatic children older than 5 years may have symptoms caused by allergy. Usually this is due to something inhaled in the air (e.g. pollen, dust, mold, animal dander). In infants, wheezing can occaisionally be caused by food allergy. Children with asthma often have other allergic problems, such as hayfever or eczema.
  2. Infection – Viral upper respiratory infections (colds) are the most common cause of episodes of asthma in children younger than 5. Some children actually seem to be “allergic” to the virus. Some doctors call this type of asthma “bronchitis”, “wheezy bronchitis”, “asthmatic bronchitis”, or “reactive airways disease”. Unlike the type of bronchitis found in adults that smoke, antibiotics will not usually help children with wheezing because the cause is not a bacteria, but a virus, allergy, or both. There is reason to be optimistic: 75% of children with viral-related wheezing will “outgrow” it as their bronchial tubes become larger.
  3. Exercise – Many children with allergic asthma can also develop “exercise-induced asthma”. This usually starts 5 minutes or so after exercise starts and manifests as cough, chest tightness, and wheezing. It is more likely to happen in cold, dry air or if there are pollutants or allergens (e.g. pollens) in the air.
  4. Irritants- Though not a true allergy by medical definitions, some children wheeze when they breathe cigarette smoke, smog, hairspray, insect repellant, paint, etc.
  5. Drugs- 25% of children with chronic asthma may have more wheezing if they take aspirin. Acetaminophen (Tylenol) is usually tolerated well.
  6. Other – Some children may develop asthma if they have a sinus infection, pneumonia, or emotional upset. Asthma is often worse at night. Occasionally, nothing in particular can be pinpointed as the cause of an asthma exacerbation.
  7. What is the treatment of asthma?

Unfortunately, there is no cure for asthma. However, in almost all children, the symptoms can be controlled, and the child can lead a normal life with modern medical therapy.

  1. Environmental control- Allergens and irritants should be avoided as much as possible. There should be no cigarette smoking in the house of an asthmatic child. The bedroom should be kept dust-free. Don’t use a vaporizer, as this can promote mold growth.
  2. Medication- There is now availabile a variety of medications to help the asthmatic child. You, your child and your doctor will determine which medicine or combination of medicines is best for your child based on his age, severity of symptoms, frequency of attacks, side effects, and, often, by trial and error.
  3. Bronchodilators – These work by relaxing the muscles that surround the bronchial tubes:
    • Theophylline – This can be given as a liquid or tablet every six hours or in a long acting tablet or capsule that can be sprinkled on food every 8 to 12 hours.
    • Adrenergics – These can be given as shots (adrenaline), “breathing treatments” (metaproterenol), pocket-sized inhalers (metaproterenol, albuterol, terbutaline), or orally as liquid or tablets (metaproterenol, albuterol).
      • Anticholinergics – These have only recently been used for asthma. They must be inhaled.

        ii. Cromolyn – This drug must be inhaled. It is not used to treat wheezing, but is used in certain patients to prevent wheezing.

        iii. Steroids – Prednisone or other steroid medicines work by reducing the inflamation in the bronchial tubes. Occasional short term use of these drugs will not have significant side effects and can be of great help in stopping severe attacks and preventing hospitalizations. However, if used frequently or over a long period of time there can be severe side effects, so doctors are careful to use these only when necessary. Recently, pocket nebulizers for inhaling steroids have become available that are free of the side effects seen with oral steroids, so these are sometimes used in patients with chronic asthma.

  4. Immunotherapy (“Allergy shots”)- If your doctor feels that your child’s symptoms can’t be adequately controlled with medication, he will refer him to an allergist for skin tests and possibly shots to “desensitize” the child. Allergy shots may be of help to some asthmatics whose symptoms are due to allergies, but will not be useful when symptoms are caused by viral infection, exercise, etc.
  5. General Health – Good nutrition and physical fitness are as important for children with asthma as they are for everyone. Children should also drink plenty of fluids to keep the bronchial secretions loose. With appropriate medication, nearly all children with asthma can take physical education class and can participate in competitive sports. As a matter of fact, 75 members of the 1984 U.S. Olympic Team had exercised-induced asthma. As much as possible, avoid exposure to cold and flu viruses and pay attention to careful handwashing to help lessen the number of respiratory infections that might trigger an asthmatic episode. If your child has severe asthma, your doctor may recommend a yearly “flu” shot.
  6. When should I call the doctor’s office?

Asthma severity can range from the patient who has only a nagging cough without wheezes, to a life threatening emergency. Fortunately, in most children, asthma is mild and easily controlled with medication. However, if your child has mild symptoms that do not clear in a few days with his usual medication, please call us. Likewise, if he seems to be having difficulty breathing and is not relieved after his medication is started, call us right away. It’s always better to start asthma therapy “too early” rather than too late. If you are unsure about whether to give a particular medicine, how much to give, or whether your child needs to see the doctor, please call us. When you bring your child to see the doctor for asthma, either bring his medicines with you, or write down the names and dosages.

For additional information, you may write to:

Asthma and Allergy Foundation of America 1302 18th St., NW, Suite 103
Washington, D.C. 20032

American Lung Association
909 12th Street
Sacramento, CA 95814