Asthma/RAD

Take a long, deep breathe, inhale slowly until your lungs can’t hold anymore…now let the air out gradually…Breathing feels so natural that it is easy to take for granted.  Normally, air travels effortlessly through your nose and mouth, down the trachea, through the bronchial tubes into the lungs, and finally into tiny clusters of air sacs, called alveoli.  Here oxygen is exchanged for carbon dioxide in your blood.

Now try something different; run in place for three minutes. Then place a straw in your mouth, close your lips around it, and try to breathe in and out ONLY THROUGH THE STRAW.  Not so easy anymore?  Now narrow the straw by pinching it in the middle, even harder?  That is what it feels like when a child has to breathe during an asthma flare.  During a flare, the airways narrow and become obstructed, making it difficult for air to move through them.  Asthma can be very scary and when not controlled, it can be life threatening.

Facts:

Ø         Asthma is the most common chronic disorder in children and adolescents.

Ø         Each year children with asthma miss an average of 3 times more school than children without asthma.

Ø         Children with asthma often limit activities unnecessarily.

Ø         Children with well-controlled asthma can do these activities quite well.

Ø         Uncontrolled asthma is expensive;

o           Children use more medications when their asthma is uncontrolled

o           Parents lose time from work and regular activities

o           Uncontrolled asthma requires more doctor visits and hospitalizations

What is Asthma?

Asthma is a chronic inflammatory lung disease that causes airways to tighten and narrow.  Anyone can have asthma including infants and children.  The main cause of asthma is unknown, but it is known that the tendency to develop asthma is often inherited.

Many children with asthma can breathe normally for weeks or months between flares.  When flares do occur they seem to happen without warning.  Actually a flare usually develops over time, involving a complicated process of increasing obstruction.

All children with asthma have airways that are overly sensitive or hyper-reactive to certain triggers.  Things that trigger asthma flares differ from person to person.  Some common triggers are exercise, allergies, viral infections, and smoke. 

The sensitive airway linings react to triggers by becoming inflamed, swollen and filled with mucous.  The muscles lining the swollen airways tighten and constrict, making them even more narrowed and obstructed.

So an asthma flare is caused by three important changes in the airways:

Ø         Inflammation of the airways

Ø         Excess mucus that results in congestion and mucus plugs that get caught in the narrowed airways

Ø         Bronchoconstriction: bands of smooth muscle lining the airways tightening up

Together, the inflammation, excess mucus, and Bronchoconstriction narrow the airways and make it difficult to move air through the airway system.

During an asthma flare, kids may experience coughing, wheezing, chest tightness, increased heart rate, perspiration, and shortness of breath.

How do you diagnose asthma?

Diagnosing asthma in children can be very tricky and time consuming because different children can have very different patterns of symptoms.  For example, some children cough constantly at night, but seem fine during the day, while others seem to get frequent colds that just wont go away.  It is not common for kids to have symptoms for months before seeing a doctor.

It is very important that the parents provide as many details as possible; no matter how unrelated they may seem, about things such as:

Ø         Symptoms: how severe they are, when and why they occur, how frequently they occur, how long they last and what makes them go away.

Ø         Allergies: the child’s and the family’s allergy history

Ø         Illnesses: How often the child gets colds, how severe they are, and how long they last

Ø         Triggers: Exposures to irritants and allergens, recent life changes or stressful events, or other things that seem to lead to a flare

Special tests can be performed such as spirometry, Pulmonary function tests, and other tests based on the child’s age that can help verify that the child has asthma and not another condition that just seems like asthma.

Categories of Asthma

A child’s symptoms can be categorized into one of four main categories of asthma, each with different characteristics and requiring different treatment approaches

Ø         Mild intermittent Asthma: A child who has brief episodes of wheezing, coughing, or shortness of breath occurring no more than twice a week is said to have mild intermittent asthma.  The child rarely has symptoms between episodes, with the exception of one or two instances of mild symptoms at night.  Mild asthma should never be ignored.  Even between flares, airway inflammation exists.  The doctor will design an asthma management plan to treat mild symptoms.

Ø         Mild persistent Asthma: Children with episodes of wheezing, coughing, or shortness of breath that occur more than twice a week, but less than once a day, are said to have mild persistent asthma.  Symptoms usually occur at least twice a month at night and may affect normal physical activity

Ø         Moderate persistent Asthma: Children with moderate persistent asthma have daily symptoms and require daily medication.  Nighttime symptoms occur more than once a week.  Episodes of wheezing, coughing or shortness of breath occur more than twice a week and may last for several days.  These symptoms affect normal physical activity

Ø         Severe persistent asthma: Children with severe persistent asthma have symptoms continuously.  They tend to have frequent episodes of wheezing, coughing or shortness of breath that may require emergency treatment and even hospitalization.  Many children with severe persistent asthma have frequent symptoms at night and can handle only limited physical activity

The good news is that for most children, asthma can be well controlled - sometimes so well controlled that a child never has another asthma flare (commonly called an attack). For many families, the learning process is the hardest part of controlling asthma. Between diagnosis and good control, there's a lot to learn and a lot to do. A child might have flares while learning to control asthma, but don't be surprised or discouraged. Asthma control can take a little time and energy to master, but it's worth the effort!

Every child needs to follow a custom asthma management plan to control his symptoms. The severity of a child's asthma can both worsen and improve over time, placing him in a new asthma category that requires different treatment.

A family needs to take the environmental control measures that reduce exposure to a child's allergy triggers. Some require little changes in the home, while others can be costly or fairly time-consuming. Talk with the doctor about starting with environmental control measures that will limit those allergens and irritants causing immediate problems for a child. But know that allergies develop over time with continued exposure to allergens - dust mites may not be a trigger for a child now, but with continued uncontrolled exposure, they can become one. The doctor may suggest taking proactive steps now so your child doesn't develop new allergies.

How long it takes to get asthma under control depends on the child's age, the severity of symptoms, how frequently flares occur, and how willing and able the family is to follow a doctor's prescribed treatment plan. Every child with asthma needs a doctor-prescribed individual asthma management plan to control symptoms and flares.

Step 1:  Identifying and controlling triggers

Children with asthma have different sets of triggers - those things that can irritate airways and lead to an asthma flare. Triggers can vary from season to season and as a child grows older. Some common triggers are:

Ø         allergens, including microscopic dust mites present in house dust, carpets and pillows; animal dander and saliva; pollens and grasses; molds; foods; medications; and cockroaches

Ø         Viral infections, including the common cold and the flu.

Ø         Irritants, including smoke, air fresheners, aerosols, paint fumes, hair spray, and perfumes

Ø         Exercise

Ø         Breathing in cold air

Ø         Weather change

Identifying triggers and symptoms can take time and good detective work, but once patterns are discovered, some of the triggers can be avoided through environmental control measures.

Step 2: Anticipating and Preventing Asthma Flares

Many kids with asthma have increasing inflammation in their airways from everyday trigger exposure - but they just can't feel it. Their breathing may sound normal and wheeze-free when their airways are actually narrowing and becoming inflamed, making them prone to a flare

At home, a peak flow meter - a tool that measures breathing ability - can be used. When peak flow readings drop, it's a sign of increasing airway inflammation. The peak flow meter can detect even subtle airway inflammation and obstruction - even when a child feels fine. In some cases, it can detect drops in peak flow readings two to three days before a flare occurs, providing plenty of time to treat and prevent it.

During the first stages of treatment, the doctor will have a child take peak flow readings every day for two weeks in the morning and at night. The readings help to establish a child's baseline PEFR, or peak expiratory flow rate - his personal best during a time when he has the least symptoms. After establishing a baseline reading, peak flow readings should be taken at least once a day so daily readings may be compared with the baseline.

Another way to know when a flare is brewing is to look for early warning signs (EWS). EWS are little changes in a child that signal medication adjustments may be needed (as directed in a child's individual asthma management plan) to prevent a flare. EWS may aid in showing that a child may be nearing a flare hours or even a day before the appearance of obvious flare symptoms (such as wheezing and coughing).  Kids can develop changes in appearance, mood, or breathing, or they'll complain of "feeling funny" in some way. EWS are not always definite proof that a flare is on the way, but they are signals to plan ahead, just in case. It can take some time to "tune in" to these little changes, but over time, recognizing them becomes easier.

Parents with very young children who can't talk or use a peak flow meter often find early warning signs very helpful in predicting and preventing attacks. And EWS can be helpful for older children and even teens because they can learn to sense little changes in themselves. If they are old enough, they can adjust medication by themselves according to the asthma management plan, and if not, they can ask for help.

Step 3: Taking Medications as prescribed

Developing an effective medication plan to control a child's asthma can take a little time and experimentation. There's no single remedy that works for most children with asthma. The different categories of Asthma are treated differently, and some medication combinations work well for some children but not for others.

There are two main categories of asthma medications: quick-relief medications and long-term preventive medications. Asthma medications treat both symptoms and causes, so they effectively control asthma for nearly every child. Over-the-counter medications, home remedies, and herbal combinations are not substitutes for prescription asthma medication. First, they can be life-threatening to rely upon during a flare because they cannot reverse airway obstruction quickly and effectively (if at all). Second, they don't address the cause of many flares: the hidden inflammation smoldering in a child's airways. As a result, asthma is never really controlled.

Step 4: Controlling flares by following the doctor’s Written, Step-by-Step plan

Mastering the first three steps of asthma control means a child will have fewer asthma symptoms and flares. But any child with asthma can still have an occasional flare, particularly during the learning period (between diagnosis and control) or after exposure to a very strong or new trigger. With the proper patient education, on-hand medications, and keen observation, families today can learn to control nearly every asthma flare by initiating treatment early.

The doctor provides a written, step-by-step plan outlining exactly what to do if a child has a flare. The plan is different for each child. Over time, families learn to recognize when to start treatment early and when to call the doctor for help.