Childhood asthma
By Dr Banshari Mridha
Childhood asthma is a prevalent chronic disease among children in general. In Bangladesh, according to the National Asthma Prevalence Study, an estimated 4 million children suffer from asthma-related symptoms.
Lungs are composed of air sacs and airway tubes. In asthma, these airways become inflamed, swollen and muscles around them tighten, leading to difficulty in breathing. Also, there is more mucus production which is sticky and clogs the airways, further narrowing the respiratory passage.
Asthma is more common in children and it usually flares up after exposure to certain triggers or allergen.
SYMPTOMS
Asthma may have various presentations such as mild, moderate or severe, with intermediate occasional attacks or persistent attacks hampering daily life.
The most common presentations are:
Wheezing - squeaky whistling sound when a child breathes
Shortness of breath - a child feels he/ she cannot catch their breath or feels out of breath.
Chest tightness - described as something squeezing or sitting on the chest.
Cough - with or without mucus.
Rapid breathing.
Problems sleeping - due to coughing or difficulty breathing.
Systemic flu like symptoms may also be present in certain cases.
Severe asthma attacks may be life threatening for your child and require emergency care. Seek immediate medical attention if any of the following develops:
The child appears very pale or shows blue/dusky colouring in the face, lips or fingernails.
Their skin sucks in between rib bones when breathing.
Unable to complete a full sentence.
Has flaring of nostrils.
Their chest appears expanded, but does not deflate while exhaling due to air trapping in the lungs.
Drowsiness and light headedness
RISK/ TRIGGER FACTORS
Asthma has some genetic predisposition. A child might have a history of atopy/skin allergy/eczema in early childhood.
The following are common triggers that may offset an attack:
Air pollutants such as dust, cigarette smoke, car exhaust and fumes.
Pollens, most troublesome during spring time.
Moulds that grow in damp places, like kitchen, bath and basement, are more problematic in rainy season.
Dust mites, bugs and their droppings.
Dander from household pets.
Bird dropping and feathers.
Air freshener sprays and mosquito coils.
Perfumes and heavily scented items.
Talc/baby powder; paint fumes.
Cold air; exercise.
Some pain relievers, like aspirin or ibuprofen, can also cause asthma attacks, so give your child paracetamol instead.
Extreme emotion, stress or anxiety or excitement.
Common cold/flu or any disease of the respiratory system such as pneumonia or sinus infections.
In many cases, acid reflux may also cause an asthma flare.
Food allergies may cause anaphylaxis (closing of airways with shock).
DIAGNOSIS
Careful history taking is very important to find the trigger that provoked an attack.
Commonly used modalities to diagnose asthma include spirometry to determine the amount of air moving in and out of the lungs and its peak flow; allergy testing using skin patches to find associated allergen and blood antibody level.
TREATMENT
There is no cure for asthma, but symptoms can be controlled with medication to live a normal life. Usually, a large number of children grow out of it as they become older.
Inhalers (also called puffers) with airway dilators, some with or without steroids, are prescribed. Ask a doctor or nurse to check your childs method of application as most kids do not use it correctly. You can also use a spacer/holding chamber or nebulizers for younger children as it is difficult for them to use inhalers. Nebulizers are easier to use and help more medicine to reach the lungs. Oral medication and steroids are given in severe cases or when inhalers fail to control symptoms.
PREVENTION
Make sure your child properly uses an inhaler or takes medications as prescribed.
Pay attention to what triggers the symptoms.
Use air conditioning as it helps filter the air.
Avoid being outside during peak pollen or cold winter times.
Give your child yearly influenza and 5-yearly pneumonia vaccines.
If your child has exercise-induced asthma, he/she should take preventive inhaler before working out. Also, warming up beforehand for about 15 minutes helps.
Avoid contact with someone with flu.
Notify your childs school and keep an inhaler in the school bag.
TIPS
Maintain a clean house and invest in a vacuum cleaner for tricky corners to fight dust and dust mites. Try to keep your home cockroach/insect free.
Remove carpets, rugs, heavy drapes or curtains.
Wash your childs stuffed animals frequently in hot water.
Try to limit kitchen smokes and fumes.
Avoid pets.
Cover pillows and bed sheets with dust proofing covers, or use double pillow covers/ sheets. Wash bedding weekly with hot water.
Clean above and below heavy furniture as there is usually dust collection there which can act like a growing hub for dust mites.
Dried up bird droppings are allergenic to lungs, so clean your sun shades and balconies.
Limit talc/ baby powder usage.
Avoid harsh cleaning products, such as bleach/cleansing powders as their fumes can be toxic.
Remove moulds by detergent/ vinegar spray.
Tobacco smoke is extremely harmful, so avoid smoking in the house.
Teach your child deep breathing exercise by asking them to slowly take a deep breath, hold for 10 seconds, and exhale slowly. Repeat 10-15 times. Doing this 5-10 times a day helps to open up airways.
Cover your childs mouth and nose with a scarf or face mask in unavoidable dusty/ cold environment.
