Asthma is a condition of the small airways of our lungs in
which hypersensitive cells are aggravated by environmental substances, leading
to inflammation, swelling and poor air flow. It is estimated that 70% of cases
are caused by allergic substances such as dust, pollen and pet dander. Other causes
include viral illnesses, exercise and cough.
It’s estimated that in the United States, 1 in 10 children
younger than 18 years suffer from asthma. Many children with asthma have
experienced what is known in dermatology as the “atopic march”, which is
essentially a trifecta of asthma, atopic dermatitis (eczema), food allergy and allergic
rhinitis (hay fever). Additionally, having asthma makes airways of children
vulnerable, putting them at increased risk for diseases like pneumonia,
influenza and obstructive sleep apnea.
Signs of asthma in children younger than 2 years old include
noisy breathing, grunting and cough while the classic signs in children with
are wheezing, chest tightness, cough and difficulty breathing.
Pediatricians will attempt to get specific information
regarding the asthma in order to both determine the level of severity and
prescribe the most appropriate course of treatment. Questions asked include
daytime or nighttime cough, possible triggers (such as viral illness, changing
seasons, exercise, etc) and previous episodes. This can reveal special cases
such as cough-variant asthma and exercise-induced asthma. Additionally, the
pediatrician will want to rule out other conditions such as viral
bronchiolitis, cystic fibrosis (CF), bronchopulmonary dysplasia (scarring of
the lungs in premature babies) and aspiration of a foreign body. Tests ordered
may include spirometry in children >5 years old (blowing into a tube to test
lung strength/capacity) and/or a sweat chloride test in children younger than 3
(to rule out CF).
The treatment for asthma depends on the severity. All asthma
patients, regardless of severity, are placed on a short-acting beta agonist
(SABA, an inhaler) on an as needed (prn) basis. The child’s response to the
treatment will be reassessed at follow up in 2-6 weeks.
There are 4 levels of asthma, organized by their level of severity:
Intermittent (episodes < 3 d/week, no nighttime
awakenings)
Mild persistent (episodes 3+ d/week)
Moderate Persistent (daily episodes)
Severe Persistent (episodes throughout the day with weekly
nighttime awakenings)
The treatments for each are as follows:
Intermittent: SABA prn
Mild persistent: SABA + low-dose Inhaled corticosteroids
(ICS)
Moderate Persistent: SABA + medium-dose ICS
Severe Persistent: SABA + high-dose ICS + long acting beta
agonist (LABA)
An oral corticosteroid, such as prednisone, may be added in
very severe cases where the inhaled medication isn’t working well. The reason
for this is that if the airways are severely blocked, the inhaled medication
will not be able to reach the tissues to be absorbed.
If a child experiencing an asthma exacerbation is not
responding to his or her treatment, experiences a late night attack or has had
a severe episode in the past, it’s important to bring them to the emergency
room for monitoring. They may require endotracheal intubation, IV antibiotics
and/or an IV theophylline drip.
The goals of the parent should include both prevention and
preparedness:
- Be sure to limit your child’s exposure to cigarette smoke, pollution, aerosol chemicals and any known triggers
- Some studies have shown that breastfeeding reduces the risk of developing asthma, and others suggest that swimming helps improve lung function and reduce the severity of exacerbations
Reference
Asthma in Children. Dynamed Database. Updated May 7, 2014. Accessed
July 1, 2014.
