The Definition and Symptoms of Asthma
Asthma is a common medical condition which is chronic and involves the airway. It is a complex disease which is symptomatized by repeated instances of inflammation resulting in varying degrees of airflow blockage and a hyperactive bronchial response. The way the disease manifests clinically, the level of severity, and the treatment efficacy is determined by the interaction of these features.
The symptoms of asthma are usually preceded by specific triggering events or stressors such as physical exertion, pollutants, or weather changes. Asthmatic episodes may also be seasonal, especially for children who have seasonal allergies (Ege, Mayer, Normand, Genuneit, Cookson, Braun-Fahrländer, & von Mutius, 2011). Treatment for allergies and asthma simultaneously requires careful monitoring of symptoms and it may take a period of time before the best possible treatment options for both conditions when experienced together are determined. Symptoms of childhood asthma include:
- Uncontrollable cough
- Wheezing
- Trouble breathing or shortness of breath (dyspnea)
- A feeling of tightness or in the chest
- Fully or partially reversible narrowing of the airway
- Increased airway responsiveness to a variety of triggers
- Difficulty sleeping due to excessive coughing, inability to breath and wheezing
- Intermittent coughing or wheezing that worsens with respiratory infections, colds and flu
- Longer recovery time from bronchitis and other respiratory infections
- Irritability due to the inability to play and exercise normally due to difficulty breathing
- Tiredness resulting from poor sleep
(Sorensen, 2012).
What Causes Childhood Asthma
While the causes of childhood asthma are not fully understood, it is believed that an oversensitive immune system predisposes child to develop the disease. It is thought that the oversensitive immune system creates an increased vulnerability to the airway swelling and producing excess mucus both of which make it difficult to breathe when in the presence of triggers. Predisposing factors include genetic characteristics, various airway infections experienced at a young age, and chronic exposure to toxins in the air such as cigarette smoke or pollution (Tageldin, Aly, Mostafa, & Khalil, 2014).
The effects of triggers may not be immediate which can make it difficult to determine what tends to trigger asthmatic episodes in your child. It is important to try to determine not only the immediate antecedents of the attacks but also anything that may have occurred at a more distant time. Record whatever you remember about the weather, possible environmental factors such as a high pollen count or pollution density, excessive activity or recent colds or viruses. If you notice a pattern emerging, be sure to notify your child’s doctor who will help you determine the best ways to prevent contact with triggers in the future. Asthma symptoms may also occur in the absence of triggers. Remember that it is a chronic disorder and is more likely to be exacerbated to the point of prominent symptoms being experienced however, it may also result in symptoms as a result of the disorder itself (Fitzpatrick, Teague, Meyers, Peters, Li, Li, & Moore, 2011).
Treatment for Your Child’s Asthma
Although childhood asthma and adult asthma aren’t different but there are specific challenges faced by children, especially young children. Often children are unable to describe or explain their symptoms due to limited cognitive ability and concept formation. Frequently this results in frustration and constant crying which causes parents to worry that their child is having a severe attack. Asthma is the number one reason for childhood hospitalizations, emergency room and loss of school days. While sometimes parents may be overprotective or rush their child to the hospital or keep them home from school unnecessarily, you should not hesitate to make these decisions and seek care for your child if you are concerned they are having an asthma attack. It is better to seek care or let your child remain home from school when it may not be strictly necessary than to fail to do so when it is necessary. Unfortunately, there is no cure for childhood asthma and it is not unusual that symptoms continue across the lifespan. However, with the proper treatment, you and your child can maintain control of asthma related problems and prevent long term or permanent lung scarring.
Inhaled medications are crucial to your child’s health and the control of their asthma symptoms. However, these medicines only work if inhaled properly so that they reach the lungs where they can do the most good. If this fails to happen, your child will not receive the relief from acute symptoms and long term health effects that the medication provides.
Metered dose inhalers (MDIs) are effective for delivering various medications that must be inhaled. A metered dose inhaler is made up of the pressurized medication canister, a meter valve and a mouthpiece actuator. Spacers can be used with young children to help them get the medicine into their lungs. Spacers are attachments for the mouthpiece and they come in different shapes and sizes. Ask your nurse or doctor if you need help deciding which spacer is best for your child. Spacers make it easier for your child to use the inhaler because the medicine first goes into the spacer and not directly into the mouth. He child can inhale the medicine with two or three deep breaths. Spacers make sure that all the medicine is inhaled and none of it is wasted or builds up on the back of the throat which can lead to thrush. Make sure to keep track of your child’s doses on the counter so you know ahead of time when you need to obtain a new canister. This is especially important if your child only uses the medicine device as a rescue inhaler.
Rescue medications help to loosen the mucus around the airways, which opens them making it easier to breath. Controller medications prevent the swelling from occurring to stop problems before they start as opposed to addressing a problem after your child is already experiencing breathing problems. Unfortunately, most children need both types of help from time to time. It is important to remain calm when your child has a breathing problem since they will take their cues from you. As they are already scared when they feel they can’t breath they will become increasingly panicky if you appear to also be nervous. Talk in a calm, soothing voice, reassure them that you are there and won’t leave them and help them remember how to use their rescue medication. Let them know that the medicine should make it easier for them to breath and that it will work quickly if they remember how to use it the best way possible. Think up ways to distract them from their fear and their symptoms as stress and anxiety often triggers asthma attacks due to a tightening of the muscles near the lungs. While this in itself, does not constitute an asthma attack, children often mistake the sensation of constriction in the lungs for an attack. Their panic can often trigger a real attack and maintain the symptoms even when a rescue inhaler is used. When the medication does not have a significant effect right away the panic increases along with the asthma symptoms making it more likely they will respond with increasing fear when they sense any symptoms even if they are only minor. They will not feel confident that the medication will work and this will make the medication less effective as your child becomes increasingly stressed with each subsequent problems. Remember, you know your child best and can best help them maintain a sense of calm so they can use their medication equipment in a way to provide the most relief possible. Be sure to follow all instructions from your child’s doctor and keep the instructions for all inhalers and nebulizers in an easy to find location in case you need to review them again.
Often children are less adherent with control medications than rescue medications since the latter provides immediate relief from scary symptoms while the former often does not result in a noticeable change. Make sure that your child is taking all medication properly. Use reinforcement and charts for weekly rewards for using their medication without properly after being told to do so once. Creativity and remaining positive will go a long way to helping your child and your entire family adjust to the new diagnosis and ensure your child remains as healthy as possible so they can participate in all the fun of childhood.
References
Ege, M. J., Mayer, M., Normand, A. C., Genuneit, J., Cookson, W. O., Braun-Fahrländer, C., &
von Mutius, E. (2011). Exposure to environmental microorganisms and childhood asthma. New England Journal of Medicine, 364(8), 701-709.
Fitzpatrick, A. M., Teague, W. G., Meyers, D. A., Peters, S. P., Li, X., Li, H., & Moore, W. C.
(2011). Heterogeneity of severe asthma in childhood: confirmation by cluster analysis of children in the National Institutes of Health/National Heart, Lung, and Blood Institute Severe Asthma Research Program. Journal of Allergy and Clinical Immunology, 127(2), 382-389.
Sorensen, K. (2012). Childhood Asthma. Journal of Consumer Health On the Internet,
16(4), 409-421.
Tageldin, M. A., Aly, G. S., Mostafa, S., & Khalil, H. (2014). Epidemiological study of
risk factors in pediatric asthma. Egyptian Journal of Pediatric Allergy and Immunology (The), 5(1).
