Asthma in children

child-asthma     ASTHMA_kid

In this disease airways are hyperreactive, which means that there is narrowing of airways which leads to difficulty in breathing.

By definition, Asthma is a chronic inflammatory disorder of the airways, characterized by recurrent, reversible, airway obstruction. Airway inflammation leads to airway hyperreactivity, which causes the airways to narrow in response to various stimuli, including allergens, exercise, and cold air.

Most common symptoms of Asthma is Wheezing but all asthmatic children do not wheeze. Most common symptoms of recurrent airflow obstructions are

  • Recurrent wheeze (wheeze is heard by stethoscope but sometimes audible whistling sounds )
  • Recurrent isolated cough
  • Recurrent breathlessness
  • Nocturnal cough
  • Tightness of chest

Signs are (examination by doctor):

  • Generalized rhonchi (wheezing sounds heard with a stethoscope)
  • Prolonged expiration
  • Chest hyperinflation (on X ray of Chest)

 

The Ten Commandments of Asthma

 

  • Asthma is a chronic condition with episodic symptoms. There is a need for continuous preventer drugs for certain grades of asthma. The drugs used for asthma ‘control’ asthma but do not ‘cure’ asthma.
  • A majority of children outgrow their symptoms as they grow older.
  • There are lots of myths and misconceptions regarding inhaled therapy which need to be cleared. Medications given using inhaled route have their own merits and advantages.
  • Discuss the selected regime and address concerns regarding usage of medications with your doctor.
  • Discuss the usage and maintenance of the inhaler device selected.Carry the inhaler device at each follow up visit.
  • It may take some time taken to note improvement and need for compliance with the prescribed preventer drugs cannot be over-emphasized.
  • Dealing with triggers / precipitants like dust, pollen, fur, smoke, exercise etc can go a long way in controlling the symptoms, and preventing asthmatic attacks. Diet has a small role in causation of symptoms.
  • Maintain a diary of events and carry it at each follow up visit. Record days that there are events such as daytime cough, nocturnal cough, wheeze, reliever medication use, doctor/hospital visits, school absenteeism due to symptoms etc.
  • Learn how to manage acute exacerbations/ sudden asthmatic attacks at home prior to doctor contact.
  • Go for the follow up visit 2-4 weeks after institution of preventer regime. Subsequent visits may be planned 2-8 weekly according to the severity or earlier in case of recurrences, or as your specialist plans.

The eleventh commandment (During follow up)

  • Identify any lacunae in understanding and clarify all doubts in subsequent meetings.

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Advantages of the inhaled route (MDI pump and nebulizers) are

  • ‘Smaller dose’: Contrast the milligram (mg) concentration of syrups and tablets with the microgram (mcg) concentration of the same drug in the inhaled form.
  • ‘Target delivery’ – ‘Quicker action’: Drug is delivered directly to the site of action. Reliever drugs, therefore, act faster.
  • ‘Safer’: Smaller dose and thus, much better safety profile than with oral therapy. This is particularly relevant for steroids.

Misconceptions which need to be cleared

  • Is inhaled therapy addictive?  I want to emphasize that addiction liability is a property of the drug rather than device / route. Example that alcohol, though oral, is still addictive. None of the asthma medications are known to cause dependence.
  • Is inhaled therapy strong? No, as discussed earlier, smaller dose is needed (microgram concentration) of drugs used.
  • Is inhaled therapy expensive? The inhaler device is a one-time purchase. Only drugs need to be purchased subsequently. A few inhaled drugs may be slightly more expensive than oral drugs on a per dose basis but these in the context of the child’s well being, safety and reduced doctor / hospital visits are better option.
  • Are inhalers easy enough for children to use? MDI pumps used with spacer can be given to small children also with ease and technique is very easy.

Typical features of this disease

  • Afebrile episodes (most cases)
  • Personal atopy or skin allergy
  • Atopy / Asthma in a parent or sibling
  • Exercise / Activity: In a smaller child, laughing or crying may provoke symptoms.
  • Triggers: These are usually inhaled irritants or aeroallergens (page 10).
  • Seasonality: Sudden temperature changes, flowering season and harvesting time are risk situations. This feature can be judged only after observation over a sufficient time period.
  • Later onset of symptoms (usually around 3 years of age)
  • Relief with bronchodilator (asthalin )± short-course oral steroid

In children, asthma is a clinical diagnosis, made by evaluation over time, either retrospectively or prospectively.

Investigations help in confirming or ruling out alternative diagnoses, rather than in diagnosing asthma.

Asthma Poster

Classification of asthma, Treatment protocol and whether asthma is well controlled or poorly controlled can be read in detail by reading the below mentioned link.

As per management of asthma, there are plenty of medicines which can be given by different routes . So discuss in detail with your Child Specialist / Pediatrician regarding what is best for your child.

Most of the children outgrow this disease with proper treatment and live symptom free life. There are plenty of sports persons who had asthma and they still compete at international level.

Our positive mind set along with caring attitude and emotional support for children can give them symptom free childhood.

If you are interested in reading in detail regarding this disease (that to especially in Indian scenario), than read the guidelines of Indian Academy of Pediatrics. Below is the link for that.

 

For any queries feel free to contact at Maya Clinic or discuss with your child specialist.

“Healthy kids, Happy family”

Regards

Dr Rahul Varma

 

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