Asthma in Children

Asthma is a chronic disease in children (and adults) which causes blockage of the smaller bronchial tubes ("small airways") which branch out from the bronchial tree ("large airways"). The blockage is caused by inflammation which then causes constriction of tiny muscles which squeeze down on the bronchial tubes. The inflamed, or irritated, inner lining of the bronchial tubes also produces mucus which can also block the air flow. This makes it difficult to push air out of your lungs, because the smaller airways collapse as you breathe out. You might also hear wheezing, or whistling, noises on breathing out. Sometimes there are wheezing noises as you breathe in, due to mucus in the small or large airways.

By controlling inflammation during childhood, you can greatly reduce asthma during adulthood!

Asthma has been called many names, including Small Airway Disease, Reactive Airway Disease, Asthmatic Bronchitis, or just Bronchitis. The last two terms are misleading, since asthma does not involve the bronchi (large airways) at all! Some children "outgrow" their asthma, but many keep it through adulthood. By controlling inflammation (that means taking medicine every day!), children with chronic asthma can greatly reduce their asthma symptoms as adults!

What is an Asthma Attack?

Children with asthma can get an "attack", or sudden onset of airway obstruction, from many causes, including exposure to an allergen (breathing pollens or eating peanuts, for example) or exercise (exercise-induced asthma) or exposure to chemical irritants (cigarette smoke, perfume, hair spray or cleaning solutions). Sometimes an attack can be due to a subtle cause, such as a change of weather, or a stressful encounter.

How Is Asthma Treated?

There are two basic approaches to the treatment of asthma: (1) treat the muscle constriction with "broncho-dilator" medicines, and (2) treat the inflammation with anti-inflammatory medicines. Broncho-dilators are important in giving quick relief during an attack, and may be the only medicine needed for mild asthma that only occurs every few months or less. The anti-inflammatory medicines are important in treating chronic asthma with more frequent symptoms.

If your child has symptoms of asthma every month, your doctor will prescribe a daily routine of anti-inflammatory medications. Examples would include inhaled steroids, sodium cromolyn, or leukotiene inhibitors. Oral steroids might be used for severe attacks, or more severe chronic asthma. Daily broncho-dilators, such as albuterol, might also be used in more severe cases.

Broncho-dilator medications are considered to be a "rescue therapy", since they are used mostly for treatment of acute attacks. They are also useful in pre-treating children with exercise-induced asthma, when used 15 minutes prior to exercise.

Make sure the medicine is getting into the lungs, not just sticking to the roof of your mouth!

Broncho-dilators, such as albuterol or lev-albuterol, can be given orally, by inhaler, or by nebulizer. When using an inhaler, children (and adults) must make sure that the medication is getting into the small airways, and not just sticking to the roof of the mouth. There are two ways to do this: (1) by using a spacer or large tube between the inhaler and your mouth, or (2) by using a very small particle size medication such as Maxair Autohaler.

A nebulizer puts the medicine into a fine mist so that a child can breathe the mist into the lungs. Be careful to wash the medication cup each time you use it, so that contaminants (such as dust or animal dander) are not being put into your child's lungs.

Clean the nebulizer medication cup well! It might contain dust or animal dander!

When using inhaled steroids, it is a good idea to rinse your mouth afterwards, to avoid side effects such as candidiasis (fungus infection in the mouth). Mouth wash with alcohol base, such as Scope®, works the best, since the medicine is not water-soluble.

Monitoring Peak Flow Can Save Your Life

Children (and adults) with chronic asthma should monitor their asthma by checking the airflow in their small airways. This is done using an inexpensive "peak flow meter" you can use at home every day. When the peak flow (of air from your lungs) gets below 75% of usual, you will use a rescue therapy (the broncho-dilator) right away before the attack becomes severe. This can save lives, and is a good way to know how severe the inflammation is, and if more anti-inflammatory medication is needed.

Find Out the Latest Info on Asthma

Dr Stan Ting of the University of Texas has invented a color-coded treatment guideline for the most effective treatments for asthma. Check his website, Simplified Asthma Guidelines, to download these guidelines in simple one-page forms. Over 1 million copies have been sent to doctors around the world!


© Rick Voakes 1999, Health-bytes LOGO  by Rie Cramer