Asthma

What is asthma?

Asthma is a common disease among children. Up to half of children will have wheezing at some point before 5 years of age. Asthma is a pattern of recurrent wheezing, and not all children who have wheezing a single time will go on to have asthma.

The symptoms of asthma include cough that is worse at night or after exercise, chest tightness, and wheezing. Sometimes the wheezing can be heard by a parent, but sometimes it can only be heard with a stethoscope by your doctor.

What triggers asthma?

Asthma is frequently triggered by viruses. This is why your doctor will tell you to start your child’s asthma medications at the first sign of a cold. Other substances which have been found to trigger asthma include cold air, cockroaches, mice, cats, dogs, pollens, and dust mites. You can ask your pediatrician for allergy testing to try to identify what is triggering your child’s asthma. This will help you to make a plan to try to reduce your child’s exposure to these irritating substances. At Pediatric Healthcare, we have also found that allergy shots can be helpful in controlling asthma, if it is difficult to avoid the substance your child is allergic to.

Cigarette smoke is a very irritating substance and an important trigger for asthma. Parents of children with asthma should make an effort to quit smoking. If you have tried quitting smoking on your own, ask your child’s pediatrician or your own doctor for help. Sometimes medications (nicotine patch or gum or Zyban) or support groups can really help you to quit smoking. Some insurance plans will now pay for these medicines to help you quit smoking.

Until you are able to quit smoking, at least try to do the following.

• Smoke only outside the house
• Do not smoke in the car
• Change your clothes after smoking, before you return to take care of your child. The irritating chemicals get trapped in your clothes and this alone can trigger an asthma attack

Other irritant chemicals such as hair sprays, cleaning agents, paints, and varnishes can also trigger asthma attacks.

What happens to my child’s lungs when she gets an asthma attack?

The passageways in your child’s lungs become narrow and then air cannot move in and out of the lungs easily. The narrowing of the passageways is caused by a build up of mucus, swelling of the passage lining and muscles contracting and making the airways smaller. The medications your doctor uses to treat asthma are targeted at these 3 problems.

How can I tell if my child’s asthma is under good control?

If your child’s asthma is under good control, he should:

• Cough at night less than 2 times per month
• Use his rescue medicine (Albuterol/Xopenex) less than 2 times per week
• Be able to do his usual sports and activities without problems
• Not need care at an emergency room or need to stay overnight in the hospital

Tell your pediatrician if you do not think your child’s asthma is under good control. Your child may need an additional medication to get his asthma under control.

What are the different medications that my child may take for asthma?

There are several categories of medications for asthma. It’s important to know the difference between the medications which give your child quick symptom relief and those that act more slowly and help to prevent future asthma attacks.

Bronchodilators are your rescue medication. This is what you give when your child is having symptoms of asthma and needs relief right away.

The names of some bronchodilators are Albuterol, Xopenex, and Proventil. These medicines may come in a pump/inhaler or as a liquid for a nebulizer machine. They work the same way regardless of which kind your child uses.

If your child goes to school, make sure your child has a quick relief inhaler for school and one for home. His inhaler can’t help him if it’s not nearby.

Your child may only use this type of medication if he has infrequent, mild symptoms.

Inhaled steroids are the main category of controller medications. These are usually given in an inhaled form through a pump or nebulizer to prevent asthma attacks. The names of some inhaled steroids are Pulmicort, Flovent, and Advair.

Inhaled steroids decrease the mucus and swelling which leads to narrowing of the breathing passages. They need to be given on a regular basis even when your child is well to prevent asthma attacks. Don’t expect to see the difference immediately if your child has just been started on an inhaled steroid. It can sometimes take up to a month of treatment to see the difference.

Steroids can lead to thrush infection of the mouth. To prevent this, it is important for your child to swish their mouth with water and spit or brush their teeth after taking their steroid.

Another category of controller medications are the leukotriene inhibitors. These include Singulair and Accolate. Again, these are pills that your child must take even when she is well to prevent asthma attacks. It may also take up to a month of treatment to see the difference with these medications.

Your doctor may occasionally prescribe oral steroids if your child is having a severe asthma attack. Oral steroids work the same way as inhaled steroids to decrease swelling and mucus production in the air passages. The names of some oral steroids given for severe asthma attacks are Prednisone, Orapred, Pediapred, and Prelone. These medicines take about a ½ day to start working, but can be very helpful in controlling severe asthma attacks. Your child will need to taper slowly off of these medicines if he takes them for more than a week. Pediatricians try not to use oral steroids regularly because they can have serious side effects if taken for a long time.

I have heard that steroids have a lot of side effects and I am afraid to give my child the steroid inhaler that my doctor prescribed. What side effects do short courses of oral steroids and steroid inhalers have?

A lot of the side effects you have heard about with steroids are from steroids taken by mouth over a long period of time. Short courses of oral steroids (5 days or less) will not have any long term affects on your child. You may notice that your child becomes hungrier and more hyper while taking the steroids. This should resolves as soon as they are stopped. Steroid inhalers do decrease growth slightly in children during the first year that they are taken. After that the children catch up in growth and are the same final height as other children. Steroid inhalers do not appear to cause weight gain, osteoporosis, cataracts or glaucoma as steroids taken by mouth over a long period of time can. Taking the steroid inhaler on a regular basis can prevent asthma attacks and frequent treatment with steroids by mouth which may have more serious side effects.

What is exercise induced asthma?

Some children have symptoms of asthma such as cough or chest tightness only after exercising. These children usually simply need to take a bronchodilator, such as Albuterol, 20 to 30 minutes before exercising. This is usually enough to relieve their symptoms.

What is a spacer? Does my child need one?

A spacer is a plastic tube with a mask or mouthpiece which helps your child’s medication get into his lungs. All children who use inhalers need a spacer. The medication will not get to the right location without a spacer. Nebulizers do not need a spacer, but the mask needs to be placed over your child’s mouth and nose or the mouthpiece needs to be in his mouth for the medicine to get to the lungs. If your child won’t tolerate the mask, make sure you hold the mouthpiece as close as possible to his nose and mouth.

How often does my child with asthma need to see the pediatrician?

Children with asthma should see their doctor at least once every 6 months to adjust their medications and check their lung function. If your child has more severe asthma or has had a recent flare up, he may require visits more frequently. Be sure to ask your doctor at every visit when your child should be seen next.

What are some internet resources for children with asthma?

American Academy of Allergy, Asthma & Immunology - www.aaaai.org
American Lung Association – www.lungusa.org
Asthma and Allergy Foundation of America – www.aafa.org/home.html