Positive Options for Children with Asthma: Everything Parents Need to Know

Introduction

Asthma is a worldwide problem. The prevalence of asthma in children varies from 0 to 30 percent in different countries. There is strong evidence that suggests the prevalence is increasing, but the available data is insufficient to determine the likely causes for this increase or for the variations among countries.

The increase in the prevalence of asthma may be due to changes in the indoor or outdoor environment, and the main changes that generally cause problems are airborne allergens like domestic mites, tobacco smoke, air pollution, and occupational allergens. Other triggers for asthma symptoms include home insulation, the presence of a large number of insects like moths or cockroaches, and climate. Climate is an important factor because it directly affects the amount of allergen present in the environment. For example, a damp and warm climate favors the growth of mites and molds.

Urbanization appears to be correlated with an increase in the prevalence of asthma in some populations. For example, in the more polluted cities of Sweden, the prevalence of allergy has increased. In Chile and in other areas of South America, school children living in heavily polluted areas are more susceptible to asthma than those living in less polluted areas.

The role of air pollution in causing asthma and allergy was studied by comparing the prevalence of asthma and other allergic disorders in school children living in two German cities: Leipzig, which has heavy industrial pollution, and Munich, which has heavy automobile traffic. Asthma and allergy were more prevalent in Munich, while bronchitis was more prevalent in Leipzig.

The factors that are known to increase the incidence of asthma in children include

    viral respiratory tract infections in early childhood

    environmental factors at home and outdoors

    air pollution

    environmental tobacco smoke

    an increase in the prevalence of allergic tendencies

The rising prevalence of asthma is not the only problem. Mortality due to asthma has gone up in the last decade and has not changed in recent years. Morbidity due to worsening and persistent symptoms presents a huge burden to individuals as well as the health-care services.

It is essential for parents with children prone to asthma to avoid asthma triggers, or things that make it worse. For example, parents with an asthmatic child should neither smoke nor allow anyone to smoke indoors where the child spends time. Allergies are a problem for many children with asthma, and parents should take environmental control measures to reduce allergens. These measures also help make asthma medicines more effective. Day-to-day management of asthma is most effective when parents and the doctor work together as a team.

Chapter 1

Asthma in Children

Asthma, generally speaking, manifests itself in the form of coughing, wheezing, and breathlessness. Attacks may be short or long; mild, moderate, or severe; rare or frequent; and may come on at the change of season or persist throughout the year. Children from families with a strong history of asthma, eczema, and allergies are most prone to developing asthma.

Is Asthma Inherited?

Just why asthma occurs in some children and not in others is not well understood. While asthma is probably a heritable disease, it does not always follow a predictable line of inheritance. Asthma can skip from one generation to another or appear in cousins, uncles, or aunts. Many asthmatics who seemingly do not have a family background of asthma probably have a parent or other relative with a wheezy condition that was incorrectly labeled as chronic bronchitis or pulmonary emphysema, a condition in which the air sacs of the lungs are either damaged or enlarged causing breathlessness.

In addition, the presence of an asthmatic gene in an individual does not necessarily lead to the development of asthma. Many brothers and sisters of asthmatic patients carry the asthmatic gene yet never show any outward signs of the disease.

Asthma that starts in infancy or childhood is more likely to be inherited than asthma that develops later in life. When one parent has asthma, especially the allergic type, the chances are one out of two that their child will develop asthma. When both parents are afflicted, the odds increase to three out of four.

How Is Asthma in Children Diagnosed?

The first one or two episodes of coughing are quite likely to be called bronchitis or bronchiolitis by the family doctor, which unfortunately delays the correct diagnosis of the problem. Often doctors are unwilling to use the term asthma in the case of a young child, because it implies that the child may have a chronic disease. Thus, asthma in children remains underdiagnosed and undertreated.

Asthma may develop during the first few months of life, but it is difficult to make a definite diagnosis until the child is about four years or older or until the child has had repeated attacks of coughing that are investigated.

Midchildhood Asthma

If asthma develops when children are four to ten years old or in midchildhood, it is usually the allergic form of asthma. This form is generally easy to treat and has the best prognosis, or prospect of recovery. Such children often lack a family history of asthma, have normal breathing, and show normal results for breathing tests between attacks. Some may go on to develop hay fever or sneezing fits in their teenage years.

Do Children Outgrow Asthma?

No clear answer is available to this question. The long-term prospects for the treatment and cure of childhood asthma are now a major concern. The hope is that childhood asthma will disappear when the child becomes an adult, but medical and scientific evidence is less than promising. It has been estimated that asthma disappears in 30 to 50 percent of children in adolescence but often reappears in adult life. Almost two-thirds of children with asthma continue to suffer from the disorder through puberty and adulthood.

While many children go into a permanent or partial remission as they grow older, some continue to have twitchy or sensitive lungs. Moreover, even when asthma symptoms have disappeared, lung function remains altered and airway hyperresponsiveness (hypersensitivity) or coughing persists. As a result, wheezing may occur during a bad chest cold or while exercising in cold air. In one study in England, two-thirds of the three hundred childhood asthmatics tracked were still symptomatic when they were twenty-one years old.

The growth of the lungs appears to be relatively normal in most children with asthma, but it can be less than normal or impaired throughout childhood and adolescence in those with severe and persistent symptoms.

The long-term prognosis for childhood asthmatics appears to be worse when the child has eczema or a family history of eczema, but wheezing in the first year of life is not a prognostic indicator for asthma or for more severe asthma later in childhood. It should also be noted that 5 to 10 percent of children with less severe asthma develop severe asthma in later life.

Childhood asthma should never be left undiagnosed or untreated in the hope that the child will simply grow out of it. This can lead to some loss of lung function in the long run. Children with mild asthma are likely to have a good prognosis, while children with moderate or severe asthma will probably continue to have some degree of airway hyperresponsiveness (hypersensitivity) and may be at risk of having long-term asthma.

What Is the Impact on the Family?

Asthma in a child affects all family members, especially the parents. When bouts of coughing and wheezing occur at night, the parents must administer medication, attend to other needs, and call the doctor if necessary. The other children in the family may be awakened or may have to be called upon to help look after the patient.

The financial cost of looking after the asthmatic child can be substantial and may require a reworking of the family budget to provide funds for treatment and medicines. This could, in some cases, require the postponement of other expenses.

Parents may also have to make adjustments at home. Sometimes the child requires a clean, separate room, and all the carpets, sofas, and mattresses must be removed or replaced to decrease the amount of airborne allergens.

Special arrangements may be necessary if the family has to travel. For example, parents need to be sure to pack adequate supplies of all prescribed medicines, make preparations for any dietary issues that might arise, and pack any clothing items that might be needed for the weather conditions at the new location.

The child with asthma must be looked after and cared for and yet still be treated like any other child. Managing asthma calls for patience, understanding, and cooperation from every member of the family, but asthma is more of an occasional nuisance than a serious disease, provided the child and the family are adequately informed and prepared in the event of an attack.

Chapter 2

Early Symptoms and

Warning Signs

Asthma may present itself differently in children than it does in adults. In children, asthma usually manifests as recurrent coughing attacks that occur over weeks or a season. In many cases, the cough is worse at night. If there is a family history of allergy in any form (e.g., asthma, sneezing, eczema, or hives), then some of the children in these families (33 percent of the children in one study) will develop coughing, wheezing, or breathlessness as well. Breathlessness in children usually does not come in the form of intermittent attacks, but as a cough and/or a cold.

In some children, the symptoms of bronchial asthma may start at the onset of the disease, while in others, symptoms may appear later. In some infants, wheezing and coughing may occur at infrequent intervals; in others, wheezing may be quite frequent and asthma may be well established. A recent study has demonstrated that the majority of seven-year-old children with airway hyperresponsiveness (hypersensitivity) suffered from allergy as infants, i.e., they had a tendency to have immediate allergic reactions to common substances in the environment. A study concerning lung development showed that asthma in infancy can result in a decrease of approximately 20 percent in lung function when the individual reaches adulthood, indicating the possible harmful effects asthma may have on the development of the lungs.

Cough: The Most Common Indicator

Cough is the most common indicator of a disorder in the respiratory tract. Any malfunctioning of the lungs or the bronchi leads to cough as the lungs try to throw out whatever is unwanted: secretions, bacteria, particles of dust, smoke, or gases. Thus, coughing is a useful defense mechanism for keeping the lungs clean.

Coughing is one of the indicators of asthma in infants and children. Such coughing may be either severe and of a short duration or chronic and of a long duration. Wheezing is also common. Coughing and wheezing are usually more predominant in the early morning hours.

What Other Illness Can a Cough Indicate?

The following lung conditions can have cough as a prominent symptom, but as these illnesses are not asthma related, they need to be treated differently.

Whooping Cough

A cough that worsens at night, has a whooping sound, and is often accompanied by vomiting should be regarded as a whooping cough. The typical whoop may not be heard for a week or two after the onset. Diagnosis is usually done by taking a nasal culture.

Foreign Body Aspiration

The aspiration, or inhalation, of a foreign body may cause the sudden onset of a severe coughing fit with choking sensation. Aspiration is usually followed by a silent period, after which the child may develop