Pediatric asthma

Alternative names
Asthma - pediatric

Definition
Asthma is a chronic condition in which narrowing of the passages from the lungs to the nose and mouth (airways) leads to difficulty breathing. These changes commonly occur in response to changes in the environment, including weather, allergens (such as dog or cat dander, mold, or dust), foods, or respiratory infections (colds).

Causes, incidence, and risk factors

Asthma is a disease of the respiratory system. It is commonly seen in children, although it can also occur in adults. Among children, asthma is a leading cause of hospitalization, chronic disease, and school absenteeism.

In people with asthma, the airways that run from the nose to the lungs are overly sensitive. Asthma is the excessive response of these airways to a “trigger” such as dust in the air. It involves swelling and inflammation of the airways, and reversible tightening of the tiny muscles that surround the airways (bronchospasm). In severe cases of asthma, damage to the lungs can accumulate over time, resulting in permanent narrowing of the airways.

Children with asthma may be able to breathe normally most of the time. When they encounter a trigger, however, an attack (exacerbation) can occur. Below is a list of common asthma triggers.

     
  • tobacco smoke  
  • dust  
  • pollen  
  • exercise  
  • viral infections, such as the common cold  
  • animals (hair or dander)  
  • chemicals in the air or in food  
  • mold  
  • changes in weather (most often cold weather)  
  • strong emotions  
  • aspirin and other medications

In recent years, there has been a worldwide increase in the number of children with asthma. This trend has been linked to environmental factors, including air pollution. However, it is important to understand that indoor triggers can play just as much of a role as outdoor triggers in bringing on an asthma attack.

Children’s airways are narrower than those of adults. This means that triggers that may cause only a slight response in an adult can be much more serious in children. In children, it can appear suddenly with severe symptoms. For this reason, it is important that asthma be diagnosed and treated correctly. For some children, this may mean taking daily medication even during times when the child is not having symptoms of asthma.

Symptoms

During an asthma attack, people may have difficulty breathing and may begin to breathe very fast. They may also feel short of breath, even at rest. The child with asthma may need to use the muscles around the chest to help with breathing. Wheezing and coughing are also important signs that can occur during an attack, or even when a child is feeling well. A persistent night-time cough is one common sign of asthma, even in children without other symptoms.

Signs and tests

Often a doctor can hear the effects of asthma in a patient’s lungs. Sometimes, an instrument called a spirometer is used to test a child’s breathing in order to help make the diagnosis of asthma.

When an asthmatic patient is having an attack, that person must work harder to move air in and out of the lungs. Patients with asthma can use a home monitor called a ‘peak flow meter’ to assess their ability to breathe. A loss of peak flow can signal an asthma attack.

Treatment

Families and their pediatrician or allergist should work together as a team to develop and carry out a plan that includes eliminating asthma triggers and monitoring symptoms, and a plan for what to do when a child’s asthma starts to act up.

There are two basic kinds of medication for the treatment of asthma:

     
  • Long-term control medications - used on a regular basis to prevent attacks, not for treatment during an attack.       o inhaled steroids (e.g., Azmacort, Vanceril, AeroBid, Flovent) prevent inflammation       o leukotriene inhibitors (e.g., Singulair, Accolate)       o long-acting bronchodilators (e.g., famoterol, Serevent) help open airways       o cromolyn sodium (Intal) or nedocromil sodium       o aminophylline or theophylline (not used as frequently as in the past)       o combination of anti-inflammatory and bronchodilator  
  • Quick relief (rescue) medications - used to relieve symptoms during an attack.       o short-acting bronchodilators (e.g., Proventil, Ventolin, Xopenex, and others)       o oral or intravenous corticosteroids (e.g., prednisone, methylprednisolone) stabilize severe episodes

Children with mild asthma (infrequent attacks) may use relief medication as needed. Those with persistent asthma should take control medications on a regular basis to prevent symptoms from occuring. A severe asthma attack requires a medical evaluation and may require hospitalization, oxygen, and intravenous medications.

Although these are the same medications used to treat adults, there are different inhalers and dosages especially for children. In fact, children often use a nebulizer to take their medicine rather than an inhaler, because it can be difficult for them to use an inhaler properly.

Families play a very important role in the control of asthma by helping get rid of the indoor triggers that worsen asthma. For example, it is extremely important to eliminate tobacco smoke from the home. This is the single most important thing that a family can do to help a child with asthma. Just having people smoke “not in the house” is not enough, as family members and visitors can bring residual smoke in on their clothes and in their hair.

Keeping low levels of humidity and fixing leaks can reduce growth of organisms such as molds. Exposure to cockroaches can be reduced by cleaning and by keeping food in containers and out of bedrooms. Bedding can be covered with “allergy proof” polyurethane-coated casings to reduce exposure to dust mites. Detergents and cleaning agents in the home should be unscented.

All of these efforts can make a significant difference to the child with asthma, even though it may not be obvious right away. Your allergist can assist you with a plan for reducing the asthma triggers in your home.

A peak flow meter, a simple device to measure lung volume, can be used at home to help you “see an attack coming” and take the appropriate action, sometimes even before any symptoms appear. If you are not monitoring asthma on a regular basis, an attack can take you by surprise. Peak flow measurements can help show when medication is needed, or other action needs to be taken. Peak flow values of 50-80% of the child’s personal best indicate a moderate asthma attack, while values below 50% indicate a severe attack.

Many children under age 5 can’t use a peak flow meter well enough to make the numbers useful, so their asthma must be managed by an adult who needs to watch carefully for the asthma signs. The age 5 “cutoff” is somewhat arbitrary, however, and can be adjusted based on the abilities of the individual child. It’s a good idea to start using peak flow meters before age 5 to get the child used to them, but not to actually rely on them too much for monitoring the child’s condition.

Expectations (prognosis)

With proper treatment and a team approach to managing asthma (including, most importantly, the family), most affected children can live a normal life. Asthma, however, can be a life-threatening disease. It is important for families to work together with health care professionals to develop a plan for the child with asthma in order to ensure proper treatment and to minimize the impact of this chronic condition.

Complications

The complications of asthma can be severe. Some include:

     
  • chronic cough  
  • lack of sleep from nighttime symptoms  
  • decreased tolerance for exercise and other activity  
  • missed school  
  • missed work for parents  
  • trouble breathing  
  • need for emergency room visits  
  • need for hospitalization  
  • assisted ventilation  
  • chronic lung disease (permanent changes in the function of the lungs)  
  • death

Calling your health care provider
Call your health care provider if you think that your child has any of the symptoms of asthma listed above. It is very important for asthma to be diagnosed and treated early in order to reduce the risk of complications. If your child is having trouble breathing or your think that he/she may be having an asthma attack, seek medical attention immediately.

Prevention

There is no fool-proof method to prevent asthma attacks. The best way to minimize the number of attacks is to follow the asthma plan that you develop with your doctor and to eliminate triggers (especially cigarette smoke) as discussed above. When families take control of their home environment, asthma symptoms and exacerbations can be significantly decreased.

When a child begins to get symptoms, a severe attack can be prevented by a quick response. An asthma action plan can tell a family exactly what to do when symptoms start to increase. Following an asthma action plan can prevent severe exacerbations that otherwise might result in hospitalization.

Johns Hopkins patient information

Last revised: December 2, 2012
by Arthur A. Poghosian, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.