CHILDHOOD ASTHMA

Asthma is the most common chronic disease of childhood, and yet many parents know little about it. In
the United States, it is estimated that nearly 5 million youngsters under age 18 have this disease. In 1993
alone, asthma was the reason for almost 200,000 hospital stays and about 340 deaths among persons
under age 25.
The numbers of young people and children with asthma is rising. In children ages 5-14 years, the rate of
death from asthma almost doubled between 1980 and 1993. The disease is more common in blacks and
in city-dwellers than in whites and those who reside in suburban and rural areas. A government survey of
young people with asthma (those aged 15-24 years) showed that more blacks than whites died of the
disease from 1980 to 1993. Among children aged 0-4 years in 1993, blacks were six times more likely to
die from asthma than whites. Among children aged 5-14, blacks were four times more likely than whites to
die of the illness.
Although asthma can occur in people of any age, even in infants, most children with the illness developed
it by about age 5. Asthma seems to be more common in boys than in girls in early childhood. The survey
mentioned above showed that in 1993, boys aged 0-4 were 1.4 times more likely than girls the same age
to die from asthma. This increased risk remained in boys aged 5-14, who were 1.3 times more likely to die
from asthma than girls in that age group. By the teen years, the risk seems to even out between girls and
boys.
These numbers can be cause for alarm, but the best defense against childhood asthma begins with
knowledge of the disease. This is the best way to ensure that, if your child does develop asthma, you and
your doctor can work together to control the illness.
What Is Asthma?
Asthma is a chronic (long-term) illness in which the airways become blocked or narrowed. This is usually
temporary, but it causes shortness of breath, trouble breathing, and other symptoms. If asthma becomes
severe, the person may need emergency treatment to restore normal breathing.
When you breathe in, air travels through your nose and/or mouth through a tube called
the trachea (sometimes referred to as the "windpipe"). From there, it enters a series of smaller tubes that
branch off from the trachea. These branched tubes are the bronchi, and they divide further into smaller
tubes called the bronchioles. It is in the bronchi and bronchioles that asthma has its main effects.
The symptoms of asthma are triggered by things in the environment. These vary from person to person,
but common triggers include cold air; exercise; allergens (things that cause allergies) such as dust mites,
mold, pollen, animal dander or cockroach debris; and some types of viral infections.
Here is how the process occurs. When the airways come into contact with one of these triggers, the
tissue inside the bronchi and bronchioles becomes inflamed (inflammation). At the same time, the
muscles on the outside of the airways tighten up (constriction), causing them to narrow. Then the fluid
(mucus) is released into the bronchioles, which also become swollen. The breathing passages are
narrowed still more, and breathing becomes very difficult.
This process can be normal, up to a point. Everyone's airways constrict somewhat in response to irritating
substances. But in a person with asthma, the airways are hyperreactive. This means that their
airways overreact to things that would just be minor irritants in people without asthma.

To describe the effects of asthma, some doctors use the term "twitchy airways." This is a good description
of how the airways of people with asthma are different from those without the disease. (Not all patients
with hyperreactive airways have symptoms of asthma, though).
In mild cases of asthma, the symptoms usually subside on their own. Most people with asthma, though,
need medication to control or prevent the episodes. The need for medication is based on how often
asthma attacks occur and how severe they are. With the treatments available today, most children with
asthma can do almost everything that children without the disease can do.
Who Gets Asthma and What Triggers It?
Some traits make it more likely that a child will develop asthma. These risk factors can alert you to watch
for signs of the disease so that your child can be treated promptly.
Heredity. To some extent, asthma seems to run in families. Children whose brothers, sisters, or parents
have asthma are more likely to develop the illness themselves. If both parents have asthma, the risk is
greater than if only one parent has it. For some reason, the risk appears to be greater if the mother has
asthma than if the father does.
Atopy. Certain types of allergies can increase a child's risk of developing asthma. A person is said to
have atopy (or to be atopic) when he or she is prone to have allergies. This tendency is passed on from
the person's parents. It is not the same as inheriting a specific type of allergy. Rather, it is merely
the tendency to develop allergies. In other words, both the child and the parent might be allergic to
something, but not necessarily to the same thing.
Substances in the environment that cause allergiesthings like dust mites, mold or pollenare known
as allergens. Atopy causes the body to respond to allergens by producing immunoglobulin
E (IgE) antibodies. Antibodies are proteins that form in response to foreign substances in the body. One
way to test a person for allergies is to perform skin tests with extracts of the allergens or do blood tests for
IgE antibodies to these allergens.
What Are Some Asthma Triggers?
It is important to be aware of the things in your environment that tend to make asthma worse. These
factors vary from person to person. Some of the more common factors or triggers are described here.
Allergens. Some allergens (substances that cause allergies) are more likely to trigger an asthma attack.
For instance, babies in particular may have food allergies that can bring on asthma symptoms. Some of
the foods to which American children are commonly allergic are eggs, cow's milk, wheat, soybean
products, tree nuts and peanuts.
A baby with a food allergy may have diarrhea and vomiting. He or she is also likely to have a runny nose,
a wet cough, and itchy, flaky skin. In toddlers, common allergens that trigger asthma include house dust
mites, molds and animal hair. In older children, pollen may be a trigger, but indoor allergens and molds
are more likely to be a cause of asthma.
Viral infections. Some types of viral infections can also trigger asthma. Two of the most likely culprits are
respiratory syncytial virus (RSV) and parainfluenza virus. The latter affects the respiratory tract in
children, sometimes causing bronchitis (inflammation of the bronchi) or pneumonia (inflammation of the
lining inside the lungs). RSV can cause diseases of the bronchial system known
as bronchopneumonia and bronchiolitis. A young child who has wheezing with bronchiolitis is likely to
develop asthma later in life.

Tobacco smoke. Today most people are aware that smoking can lead to cancer and heart disease. What
you may not be aware of, though, is that smoking is also a risk factor for asthma in children and a
common trigger of asthma for all ages.
It may seem obvious that people with asthma should not smoke, but they should also avoid the smoke
from others' cigarettes. This "secondhand" smoke, or "passive smoking," can trigger asthma symptoms in
people with the disease. Studies have shown a clear link between secondhand smoke and asthma in
young people. Passive smoking worsens asthma in children and teens and may cause up to 26,000 new
cases of asthma each year.
Other irritants in the environment can also bring on an asthma attack. These irritants may include paint
fumes, smog, aerosol sprays and even perfume.
Exercise. Exerciseespecially in cold airis a frequent asthma trigger. A form of asthma
called exercise-inducedasthma is triggered by physical activity. Symptoms of this kind of asthma may not
appear until several minutes of sustained exercise. (When symptoms appear sooner than this, it usually
means that the person needs to adjust his or her treatment). The kind of physical activities that can bring
on asthma symptoms include not only exercise, but also laughing, crying, holding one's breath and
hyperventilating (rapid, shallow breathing).
The symptoms of exercise-induced asthma usually go away within a few hours. With proper treatment, a
child with exercise-induced asthma does not need to limit his or her overall physical activity.
Other triggers. Cold air, wind, rain and sudden changes in the weather can sometimes bring on an
asthma attack.
The ways in which children react to asthma triggers vary. Some children react to only a few triggers,
others to many. Some children get asthma symptoms only when more than one trigger occurs at the
same time. Others have more severe attacks in response to multiple triggers.
In addition, asthma attacks do not always occur right after exposure to a trigger. Depending on the type of
trigger and how sensitive this child is to it, asthma attacks may be delayed.
Each case of asthma is unique to that particular child. It is important to keep track of the factors or triggers
that you know to provoke asthma attacks in your child. Because the symptoms do not always occur right
after exposure, this may take a bit of detective work.
What Are the Symptoms of Asthma?
Common symptoms of asthma include the following:

Wheezing is a high-pitched, whistling sound that your child may make during an asthma attack. If
you hear this sound as your child breathes, be sure to let your doctor know. Not all people who wheeze
have asthma, and not all those who have asthma wheeze. In fact, if asthma is really severe, there may
not be enough movement of air through a person's airways to produce this sound.

Chronic cough, especially at night and after exercise or exposure to cold air, can be a symptom
of asthma.

Shortness of breath, especially during exercise, is another possible sign. All children get out of
breath when they're running and jumping, but most resume normal breathing very quickly afterward. If
your child doesn't, a visit to your doctor is in order.

Tightness in the chest is a symptom that you may have to ask your child about. If you notice any
of the signs just described, it's a good idea to ask your child whether he or she feels a tight,
uncomfortable feeling in the chest.
Treatment for Asthma
Because each case of asthma is different, treatment needs to be tailored for each child. One general rule
that does apply, though, is removing those things in the child's environment that you know act as triggers
for asthma symptoms. When possible, keeping down levels of dust mites, mold, animal dander and
cockroach debris in the houseespecially in the child's bedroomcan be helpful. When these measures
are not enough, it may be time to try one of the many medications that are available to control symptoms.
New guidelines from the National Institutes of Health advise treating asthma with a "stepwise" approach.
This means using the lowest dose of medication that is effective, "stepping up" the dose and the
frequency with which it is taken if the asthma gets worse. When the asthma gets under control, the
medicines are then "stepped down."
Asthma medications may be either inhaled or in pill form. These medications are divided into two types
quick-reliefand long-term control. The first group (quick relief) is used to relieve the immediate symptoms
of an asthma attack. The second group (long-term control) does not provide relief right away, but over
time these medications help to lessen the frequency and severity of attacks.
Like any medication, asthma treatments often have side effects. Be sure to ask your doctor about the side
effects of the medications your child is prescribed and what warning signs should prompt you to contact
your doctor.
Quick-relief medications. Medications that provide immediate relief of asthma symptoms relax the
muscles around the airways, making breathing easier. They begin to work within minutes after they are
used, and their effects may last for up to 6 hours.
Most of the quick-relief medications are inhaled through a pocket-sized device that your child can easily
learn to use when he or she feels symptoms coming on. These medications can also be used before
exercise to help ward off asthma symptoms. Commonly used quick-relief treatments for asthma include
albuterol, bitolterol, metaproterenol, pirbuterol and terbutaline. In addition, ipratropium is an inhaled
asthma medication that works more slowly than the above medications. It is not effective for exerciseinduced asthma, but it is helpful in people who cannot tolerate the side effects of the medications listed
above, such as older adults.
Other quick-relief medications are methylprednisolone, prednisolone and prednisone. These oral
corticosteroids are taken by mouth in short bursts to establish initial control or to control symptoms during
a period of gradual deterioration.
Long-term control medications. The long list of long-term control medications for asthma include both
oral and inhaled medications. Unlike the quick-relief medications, long-term medicines do not provide
quick relief in the midst of an asthma episode. Rather, they work over the long term to reduce the
frequency and severity of attacks. Most of these medications take several weeks of regular use to achieve
their full effect, and all work only when they are taken consistently.
The long-term control medications can be divided into four broad categories:

Inhaled anti-inflammatory agents

Oral corticosteroids

Long-acting bronchodilators

Oral leukotriene modifiers

Anti-inflammatory agents prevent and reduce airway inflammation. They also make airways less sensitive
to asthma triggers.
Corticosteroids are the most potent and consistently effective long-term control medications. Children with
moderate to severe persistent asthma take inhaled corticosteroids daily, while those with mild persistent
asthma may take an inhaled corticosteroids or inhaled non-steroids such as cromolyn sodium or
nedocromil.
Inhaled anti-inflammatory medications are taken through a metered-dose inhaler (MDI). This is a device
that delivers a measured amount of medication each time it is used. Most can also be inhaled through
a nebulizer. With this device, medication is turned into a vapor that is inhaled deeply into the lungs.
The non-steroids have very few mild side effects. Potential side effects of inhaled steroids are cough,
hoarseness, oral thrush and perhaps a slowing of the rate of growth. Thrush is a type of yeast infection in
the mouth. To decrease the chance of thrush and other systemic reactions, patients are advised to rinse
out the mouth with water after each use and to use a spacer or holding chamber attached to the MDI. Ask
your doctor about potential side effects in relationship to the goal of adequately controlling asthma.
Long-term oral corticosteroids can have total body (systemic) side effects. Talk with your doctor about
how to minimize these while maintaining adequate control of your child's asthma.
Oral corticosteroids may be given in liquid or tablet form and begin to work within a few hours. They are
given for a short period of time, such as a few days, to control severe asthma episodes and to speed
recovery. These medications may be given for longer periods in patients who have very severe and
recurrent asthma attacks. Patients taking corticosteroids must never stop using these medications all at
once, because this can cause side effects. Rather, their use must be tapered off over a period of a day or
two. It is especially important to take these medications exactly as prescribed by your doctor.
Long-acting bronchodilators relax the muscles around the airways, making breathing easier. Their effects
last up to 12 hours, and like the inhaled anti-inflammatory agents, they continue to work only if they are
taken regularly. These medications can be taken either through a metered-dose inhaler or by mouth, in
tablet, capsule or liquid form. Their side effects may include nervousness, dry mouth or rapid heartbeat.
As with any medications, talk with your doctor about potential side effects.
Leukotriene modifiers are the latest class of medications used to treat asthma. These medications
prevent and reduce airway inflammation and constriction of the airway muscles. They also make airways
less sensitive to asthma triggers and can reduce the need for short-acting reliever medications.
Leukotriene modifiers seem to have fewer side effects than other asthma treatments. Depending on what
type of leukotriene modifier is used, side effects may include upset stomach, diarrhea and changes in
liver function tests. As with any new type of medication, frequent, clear communication between you and
your doctor is required.
Sometimes asthma medications are combined to provide better treatment than any one used alone can
offer. The goals of asthma treatment are to allow restful nighttime sleep, avoid the need for hospital stays,
and allow your child to engage in normal play and school activitiesin other words, to give him or her a
normal life. Many treatment options exist to achieve this goal. The choice of treatment depends on the
details of your child's own case.
Be Involved in Your Child's Care

Asthma is an illness that is best understood, rather than feared. If your child has asthma, learn all you can
about the disease and work with your child's doctor. This will afford your child the best chance of
controlling asthma and allowing him or her to lead a normal, healthy and happy life.

SOURCE: This information should not substitute for seeking responsible, professional medical care. First
created 1995; fully updated 1998; most recently updated 2005.
Asthma and Allergy Foundation of America (AAFA