Asthma In Children: Overview

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Asthma in children: Causes of asthma and how to prevent, treat and manage asthma with and without medication

Asthma in children: It is a chronic inflammatory disorder of the airways that causes an obstruction of airflow.

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There is no single test to diagnose this.

The clinical diagnosis in children involves the consideration of:

  • History of recurrent or persistent wheeze
  • Presence of allergies or family history of asthma and allergies
  • Absence of physical findings that suggest an alternative diagnosis
  • Tests that support the diagnosis (e.g. spirometry in children able to perform the test)
  • A consistent clinical response to an inhaled bronchodilator or preventer

What happens?

  • The lining of the airway tubes become sensitive and swollen
  • When an allergen or infection occurs the muscle lining of the tube contracts, constricting the tube
  • This reduces airflow causing wheezing and cough
  • Usually, it is reversible but recurs
  • It is a common problem but often misdiagnosed condition

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Why is it misdiagnosed?

  • Many children will wheeze with viral infections
  • Most children with childhood asthma do recover by age 6 to 8 years
  • It is highly variable and complex condition
  • No definitive tests especially in children to diagnose this
  • May only present with a cough

Incidence of childhood asthma

This prevalence doubled from 1980 to 1995 and then increased more slowly from 2001 to 2010.

Causes

  • Genetic predisposition
  • Allergy
  • Lung damage due to viral infection

Common triggers

  • Respiratory infections
  • Allergens (including dust, pollens, and furred animals)
  • Irritants (such as tobacco smoke, aerosol sprays, some cleaning products)
  • Exercise
  • Cold air
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Asthma In Children

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How does it present?

  • Frequent coughing spells, which may occur during play, at night, or while laughing or crying
  • A chronic cough (which may be the only symptom)
  • A cough more at night when sick
  • Less energy during play
  • Rapid breathing (intermittently)
  • Complaint of chest tightness or chest “hurting”
  • A viral infection that goes to the chest or persists

Associated conditions:

  • Allergies
  • Sinusitis
  • Gastroesophageal reflux

The two most common triggers in children are colds and allergens.

After infancy, allergies become particularly important, and therefore asthmatic children should have an allergy evaluation to help diagnose and manage their asthma. Avoiding these may help improve his or her asthma.

Management

Uncontrolled asthma leads to emergency room visits, absenteeism from school, and missed opportunities for social interchange. Long term damage lungs due to structural changes. Experts concur that it’s crucial to get treatment as soon as possible.

  • Understanding the recurrent nature
  • Prevention
  • Treatment
  • Monitoring

Prevention

  • Find out allergens and avoid them
  • No smoking in the house by adults
  • Avoid air fresheners
  • Remove or treat dust mites

Treatment

Asthma is not curable but is manageable.

The goals of treatment are to stop the attacks and reduce inflammation of the tubes

  • Controlling and avoiding asthma triggers
  • Regularly monitoring asthma symptoms and lung function
  • Understanding how and when to use medications to treat
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Asthma In Children

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Controller medications

Reducing Inflammation of tube lining and prevent asthma attacks:

  • Through inhaled or nebulized low dose steroids — since they are inhaled and not ingested the side effects are minimal but should be monitored
  • Leukotriene modifiers — A category of medications called leukotriene modifiers are sometimes used as an alternative to low-dose inhaled steroids in children who have mild persistent asthma.
  • Omalizumab — Omalizumab is a medication that targets a specific type of protein in the blood (called immunoglobulin E, or “IgE”). It may be an option for certain children over six years of age whose asthma is not well controlled with inhaled steroids.

Quick relief medication

Reducing muscle constriction

Bronchodilators — Short-acting bronchodilators (also called beta-2 agonists) relieve asthma symptoms rapidly by relaxing the muscles around narrowed airways. These medications are sometimes referred to as “quick-acting relievers.” Children with intermittent asthma, the mildest form of asthma, will require these symptom-relieving medications only occasionally.

Some children feel shaky, have an increased heart rate, or become hyperactive after using a short-acting bronchodilator. The side effects often decrease over time.

Monitoring

This is the most important part of management.

Successful management requires the parent and/or child to monitor regularly. This is primarily done by recording the frequency and severity of asthma symptoms (coughing, shortness of breath, and wheezing).

In addition, the child measures his or her lung function with a test known as a peak flow (peak expiratory flow rate [PEFR]).

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Asthma Diary

Date Symptoms Medications PEFR Notes
  wheezing cough sleep Activities

curbed

Infection Quick Relief

bronchodilators

Inhaled steroids Montelukast    

Key Points

  •  Caused by inflammation of the airways followed by intermittent muscle constriction.
  • Symptoms include wheeze, cough, and shortness of breath. Symptoms can range from mild to severe.
  • Certain ‘triggers’ make symptoms worse – infection and allergies in children
  • Treated with inhalers:
    • Reliever inhalers relax the muscle in the airways.
    • Preventer inhalers reduce inflammation. Most people with this should take a regular preventer inhaler.
    • Make sure you know:
      • How to take inhalers with a spacer
      • Which is reliever inhaler, and which is preventer inhaler
      • What to do if symptoms get worse
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Asthma In Children

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Asthma In Children: Overview was last modified: April 5th, 2017 by Dr. Rajeshree Singhania

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