Breathing trouble

CLEARING THE AIR

Proper education on the condition can help in controlling and managing childhood asthma, says Dr M R Shashi Bhushan.

If one were to describe or define asthma in layman terms, it is a chronic disease of the lungs which presents as recurrent cough, chest tightness, breathing difficulty and wheezing (noisy breathing). Childhood asthma is rising at an alarming rate due to worsening air quality.

Proper diagnosis is important because one has to understand that all that wheezes is not asthma. There are many causes of wheezing in childhood, especially in small children, less than five years old. It is possible for your child to get asthma even if there is no asthma in parents or other family members. Therefore, right asthma education is crucial.

It is important to note that parental education about avoiding the triggers, longer duration of treatment, role of steroid medication and knowledge about drug delivery devices (inhaler devices) are crucial to control asthma.

Myths

There are many false beliefs about asthma, such as:

*Asthma always runs in the family. Not always. A child can get asthma even if none in his or her family have it.

*The steroids used to treat asthma have severe adverse effects. One should understand that the benefits of steroids outweigh the side effects if used appropriately.
*Asthma medications are addictive. This is not true.

*Children suffering from asthma should not take part in sports. Not true. In fact they can take part in sports by taking relief medication prior to sports / exercise.

*Oral medication is better than inhalation therapy. One should realise that inhalation therapy delivers the drug directly to lungs, in small doses.
Who gets asthma?

Anybody can get asthma and there are certain risk factors or warning signals that parents should watch out for. Primarily, asthma occurs due to genetic predisposition or atopy or environmental exposure.

*Genetic predisposition: This is when asthma runs in the family. Children whose parents or siblings have asthma are more likely to develop the disease themselves. The risk is more if both parents have asthma. But children can get asthma even if there is no asthma in the family.

*Atopy: Certain allergies increase the risk of getting asthma. Asthma is common in a person with family history or personal history of food allergy, eczema and allergic rhinitis.
nEnvironmental exposure: Various toxic substances can trigger off asthma
Apart from these there are many asthma triggers.

These are substances which make the asthma worse. These elements vary from person to person. The common triggers are: 

*Allergens and irritants. Common allergens that trigger asthma are house dust mite, pollen, molds, cockroaches and dander. Common irritants are, cigarette smoke, strong odours, air pollution and certain pesticides.  

*Respiratory tract infections. Viral upper respiratory tract infections.
*Physical exercise. This is in case of extreme physical exercise without adequate asthma care measures taken by the child.

However, asthma is a health concern that can be managed with team work. With reference to children, team management would comprise of parents, the paediatrician and school staff. For proper management of the condition it is vital that parents get the right diagnosis of the condition. Asthma is diagnosed mainly on clinical grounds.

In some special circumstances, there are special tests that are needed to confirm asthma and also to rule out other conditions which causes wheezing.
Parents can help a child with asthma by controlling and avoiding the triggers. For example, house dust mites can be present in mattresses, pillow covers, carpets, curtains, stuffed toys, etc. Therefore, ensure minimal use of carpets at home or eliminate them completely and keep the floor clean. Get bedding accessories washed in hot water every week. Use dust proof covers on pillows and mattresses and ensure that the asthmatic child is not around when cleaning is undertaken. 

Also, note that second hand smoke or passive smoking is a major risk factor, not only for acute asthma attacks but also for poor control of asthma. Parents need to exercise control on this factor and not allow anyone to smoke near the child.

Another common factor that is relevant in cities is outdoor pollution. This factor can be controlled by avoiding heavy traffic areas. Exercise early in the morning and be ready with an asthma action plan when the symptoms of asthma show up.

Treatment

Medications used in asthma are broadly classified into:
*Quick relief medications, which are used only when asthma symptoms are present and should be used only for a short duration.

*Controller medication. These medications are taken daily for a long duration even when there are no symptoms and these can be tapered down and be stopped depending on asthma control.

Asthma can be prevented and controlled. Make sure to consult a paediatrician who is a specialist and have an asthma action plan from your doctor for the child.

(The writer is a consultant neonatologist and paediatrician at Cloudnine hospitals.)