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Asthma in Children: Causes, Symptoms, Diagnosis

Asthma is a chronic reversible inflammatory disease of the lungs.Today, it’s prevalence in the USA is 8.4 percent and it is increasing. The condition is more common in kids (9.4 percent) than in adults (7.7 percent). Find out more about asthma in kids in this article by the board-certified pediatrician Iyabo Y Okuwobi. 

What are the types of asthma? 

There are five major types of asthma:

  • Childhood asthma – the most common one. It usually starts anywhere from age one to age five. Childhood asthma is more common in boys, but once you become an adult you're more likely to have it if you are a woman. 
  • Adult-onset asthma, which is actually more common in women. 
  • Occupational asthma that is caused by inhaling chemical fumes, dust or other substances on the job. 
  • Exercise-induced asthma. There are kids who are involved in sports and they have asthma. Their asthma is induced by exercise. 
  • Cough-variant asthma. This type is what we see very commonly in kids. There are some kids who never, or rarely wheeze. They just never stop coughing. They just cough, cough, cough all the time. 

Talking about the types of asthma, you can also have intermittent and persistent. That's very important in the classification of asthma and that's very important for parents to know. Your doctor may tell you that your child's asthma is intermittent, which means it's mild. But if they tell you it's persistent, then it's more serious. 

What factors can cause asthma?

If you have one allergy, it is very likely you will have another one. We call it the allergic triad. If you have asthma, it's quite likely you also have eczema, as well as seasonal allergies. And they are all IgE mediated conditions. 

Genetics also plays a part in asthma. If one or both parents have it, it's likely that some of their kids will have it. 

Another risk factor is smoking. Smoking is a very big risk. Mothers who smoke in pregnancy predispose their kids to develop asthma. And any kind of active or passive smoking is also a risk factor. 

Mothers who smoke in pregnancy predispose their kids to develop asthma. And any kind of active or passive smoking is also a risk factor.

And then we have the occupational hazards involved with the exposure to lung irritants. There are many people who work in factories or work in places where there are a lot of fumes and this can irritate the lungs, and lead to asthma. In areas where there's very high pollution, this also constitutes a risk factor for developing asthma. If you work in some cities where there's environmental pollution, this may place you at high risk. 

Extremes in weather may also trigger asthma. Too hot or too cold weather can bring on asthma symptoms. 

Obesity is a big risk factor, especially with the increasing incidence of obesity all over the world. This may be one reason why in America the prevalence of asthma is increasing. I really feel that the obesity epidemic in America is leading to many more cases of asthma. Our kids are getting more obese. 

Another factor is respiratory infections. If you have a cold, or a lung infection, this may trigger your asthma.

How does an asthma attack happen?

This is an IgE mediated condition. What does it mean?

If you are exposed to an allergen, like a lung irritant or cigarette smoke, those allergens, once they enter the body, lead to the production of an antibody called IgE. This IgE then binds to mast cells and basophils and causes inflammation through a process called degranulation. 

This process then releases histamine and leukotrienes, which lead to narrowing of the airway. Histamine leads to constriction of the muscle in the airway.

 If you can just imagine, that instead of the airway being open and allowing air to flow back and forth, it becomes very narrow. And then another thing that happens, is there is an overproduction of mucus in the airway. 

The airway is already narrowed, there's not much space for the air to go back and forth, and then on top of that, there is mucus occupying the airway. The airway becomes very narrow, and then the patient is not able to breathe. And he starts to wheeze, and have shortness of breath.

What are the symptoms of asthma?

Cough. The most common symptom of asthma is cough, especially in children. And the cough tends to be more common at night. Or the parents will notice whenever he's running around or playing soccer or basketball, he finds it hard to breathe.

The most common symptom of asthma is cough, especially in children. And the cough tends to be more common at night.

The next symptom is shortness of breath - difficulty breathing. 

Wheezing is another very common symptom. 

Chest tightness or chest pain.

How is asthma diagnosed? What signs tell the doctor that the patient has asthma and it's not any other condition?

As I said, if you are seeing a child who's been coughing for several weeks, asthma should be suspected. Or some kind of allergy. A child who's coughing, has intermittent difficulty breathing, chest tightness; you definitely want to think of asthma. 

Once you have the suspicion from your history and your physical exam, there are a few tests that you can do to confirm your diagnosis. 

  • Allergy testing. Even in asthma, it's very important to perform allergy testing. 
  • Spirometry, which is a lung function test. The only limitation with this is that the kids have to be 5 years old and above. 
  • A peak flow test can also be done. This is also a simple test that can be done, but the patient has to be more than five years old. 
  • The bronchoprovocation test is another test that can be used to diagnose asthma but is used less often. This can be done mostly in all ages.

What are asthma treatment options?

I always take time to educate my parents about the treatment of asthma in their kids, because a lot of parents get confused with the treatment options. 

There are two major treatment modalities for asthma. 

You have the short term which is called the rescue medications and you have the long term which is the controller medications. 

Parents and patients tend to switch these treatment options up. The long term ones are the most important ones for the patients that have persistent asthma. The patients have to use their controller medications for months, quite often, even for years. Examples of controller medications are inhaled steroids, leukotriene modifiers, and mast cell stabilizers like Cromolyn. Cromolyn is not used as often anymore. It's an older medication. Many doctors and pulmonologists don't use it anymore. 

Another option is long-acting-beta-agonists. The inhaled steroids, leukotriene modifiers, mast cell stabilizers, and long-term-beta agonists, are for long term control of the more severe cases. 

The next group of medications for asthma is the rescue short term medications, which is the one everybody knows. The short-acting beta-agonist, which is inhaled, Example-albuterol. This is only for short term treatment of symptoms, like wheezing or shortness of breath. This alleviates the symptoms immediately. This group of medications does not help with long term control, or with the prevention of symptoms. The controllers help with those symptoms.

Can asthma be cured?

It can not be cured, but it often gets better with age. I see a lot of kids who have severe asthma and as they get older into their teenage years, it gets a lot better. 

Their symptoms drastically reduce in frequency and severity as they get older. For occupational asthma, if you're still being exposed to the irritant, the only long term solution may be to stop working at that job, to stop exposure.

Asthma can not be cured, but it often gets better with age. I see a lot of kids who have severe asthma and as they get older into their teenage years, it gets a lot better.

The good news is, childhood asthma does get better, and there are also many actions parents can take to help their children who have asthma. 

  • Make sure your kid doesn't gain too much weight because obesity is a very big risk factor for asthma.
  • Make sure that if your kid has exercise-induced asthma, they should use albuterol at least half an hour before exercise. Some parents are scared of their kids doing any kind of sports because they are scared this will bring on their asthma. But I tell them: "No, let them be active. Being active is going to help their asthma, just make sure they use their inhaler before exercise". 
  • Keep your house clean to reduce household dust mites, and cockroaches. 
  • Change bed sheets weekly.
  • Use air purifying mechanisms in the home and read food labels to avoid ingesting allergic foods. 

There are many steps parents can take to support their kids with asthma. Everything really comes back to living a healthy lifestyle.

What I'll say, don't forget that asthma also occurs in babies. There are a lot of babies, who come in in the wintertime, who we diagnose as having bronchiolitis. They come in and they are wheezing, congested, and many of them do go on to develop asthma, especially if there is a strong family history of allergies.

There are many steps parents can take to support their kids with asthma. Everything really comes back to living a healthy lifestyle.

There is a problem with getting parents and patients to use the correct medications for the type of asthma. This is why patient education is so important to avoid this confusion in treatment. Some patients use albuterol long term, instead of using it as a rescue medication. Many patients are scared of using steroid inhalers. They confuse them with anabolic steroids. I always tell patients; inhaled steroids are not the same thing as anabolic steroids. There’s no need to be scared of them. Inhaled steroids are a very important medication for control of asthma long term. It's just funny to me that everybody is just so scared of steroids. We must continue to educate our patients about their illnesses.

What are the symptoms of a severe asthma attack that will indicate that it's an emergency and it's time to go to the hospital?

A child who's at home, who you know has asthma, who's wheezing and who cannot breathe. You should have tried an albuterol treatment first. You should have an inhaler or nebulizer at home. And if your child is saying: "Mommy, I can't breathe!",  the first thing you do is to give the albuterol treatment. 

However, you would know as a parent, if you're asking your child a question and they are not able to talk, then you know that's a severe attack, or if they are not improving after the first treatment, and still struggling to breathe, you have to call 911-emergency services. 

Another sign is if the child cannot sit up straight. If they are constantly saying: "I just want to lay down, and they look drowsy". That's another sign. Or if they are changing color, if they're turning blue around the lips or face- that's definitely an emergency. You have to call 911 immediately. But in the meantime, while waiting for 911, just make sure you start the albuterol inhaler as fast as possible.

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