Childhood Asthma

February 1, 2017

Asthma is the common chronic respiratory disease in childhood. Approximately 6.5million, or 9 percent of children under the age of 18, have asthma; that makes it the most common chronic condition in childhood. In fact, asthma is one of the leading reasons kids are hospitalized.

Unlike a cold or other respiratory illness, asthma isn’t contagious; hence a child will not catch it from his or her friends. It is a chronic inflammatory disorder of the airways, known as bronchial tubes, in which many cells and cellular elements play a role. The bronchial tubes are lined on the inside with mucous membranes and encased by smooth, sensitive muscles on the outside. The chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment.

The inner lining of the bronchial tubes contains special cells, called inflammatory cells, which release chemicals after exposure to irritants. These chemicals cause the bronchial muscle constriction, mucous secretion, swelling of the bronchial tube inner lining, and coughing. Some of these chemicals also tell the body to send more inflammatory cells into the area. The lining of the bronchial tubes of asthmatics contain more of these special cells. In addition, in asthmatics, the inflammatory cells release their chemicals after exposure to things the person is allergic to — for example, after exposure to dogs, or cats, or ragweed.

The result is a wheezing sound that may be more noticeable when a child exhales. Frequent coughing is a common companion of asthma as well as a tight feeling in the chest.

Causes

Asthma results from an interaction between different environmental and genetic factors.

Environmental Factors The environmental influences begin during pregnancy: allergic sensitisation has been described before birth, and several studies have demonstrated reduced lung function in newborn infants of smoking mothers compared to those of nonsmoking mothers. Smoking increases the risk of both asthma and poorer lung function throughout childhood. All children should have the right to an environment free from tobacco smoke products both before and after birth.

Allergens – Allergen exposure may cause acute asthma exacerbations, and even in the absence of an exacerbation, may increase airway inflammation and bronchial hyperresponsiveness. Allergens may be encountered both outdoors and indoors, and house dust mites and animal dander are particularly important perennial indoor allergens. Occupational agents play a minor role during childhood, but several types of allergy may influence the choice of education in relationship to later working life. Kindergartens and schools are the working environment of children, and the need for a healthy indoor environment in such institutions should be emphasised. Special consideration should be given to the increased risk of respiratory infections, especially in kindergartens. In schools, precautions may be taken to reduce allergen exposure for allergic asthmatic children.

Medicine – It is widely accepted that antibiotics play a role in asthma attacks and may contribute to its original cause. Many children are so well protected from germs, bacteria and childhood illnesses that their immune systems don’t develop properly. Instead of acquiring the immune cells specific to certain bacteria and viruses, they retain highly reactive immune cells.

Ampicillin, amoxycilllin cephalosporins, erythromycin, spiramycin and tetracycline, both in prescription form and the antibiotic-treated animal products we ingest, worsen asthma attacks. Acetaminophen, aspirin, ibuprofen and naproxen can trigger or worsen asthma attacks. Other drugs such as betablockers, estrogen, NSAIDs and sulfites can trigger or worsen asthma attacks.

Genetic – Asthma, and one of its major causes, allergy, have strong hereditary traits. During recent years, much effort has been put into genetic family studies in order to identify genetic markers. A large number of markers with possible relationships to asthma and airway inflammation have already been identified, but these vary between populations. There has also been increased focus upon epigenetics: the finding that environmental influences may cause DNA methylation and histone formation, and thus change and inactivate the influence of specific genes, has given insight into how the environment may interact with genes, and has shown that this interaction may even be transferred from mother to child.

Infections – Respiratory virus infections are the major cause of acute bronchiolitis in infancy and of acute asthma attacks among older asthmatic children. From 2 years of age, rhinovirus infections are the most frequent precipitators of acute asthma.

Exercise – Throughout childhood, but increasingly during school age, exercise is an important cause of asthma exacerbations (exercise-induced asthma). It has been reported that 30% of all asthmatic children suffer from restriction of physical activity and it is very important to teach asthmatic children to master exercise, by education, advice related to ‘warming up’ and medical treatment.

Risk Factors

Factors that may increase the child’s likelihood of developing asthma include –

  • Exposure to tobacco smoke
  • Previous allergic reactions, including skin reactions, food allergies or hay fever (allergic rhinitis)
  • A family history of asthma, allergic rhinitis, hives or eczema
  • Living in an urban area with increased exposure to air pollution
  • Low birth weight
  • Obesity
  • A chronic runny or stuffy nose (rhinitis)
  • Severe lower respiratory tract infection, such as pneumonia
  • Inflamed sinuses (sinusitis)
  • Heartburn (gastroesophageal reflux disease, or GERD)
  • Being male
  • Pet dander

Symptoms

Breathing problems are common. They can include –

  • Shortness of breath
  • Feeling out of breath
  • Gasping for air
  • Trouble breathing out (exhaling)
  • Breathing faster than normal
  • When the child is has a hard time breathing, the skin of the chest and neck may suck inward.

Other symptoms of asthma in children include –

  • Coughing that sometimes wakes the child up at night (it may be the only symptom)
  • Dark bags under the eyes
  • Feeling tired
  • Irritability
  • Tightness in the chest
  • A whistling sound made when breathing (wheezing).

Complications

Asthma may cause a number of complications, including –

  • Severe asthma attacks that require emergency treatment or hospital care
  • Permanent narrowing of the airways (bronchial tubes)
  • Missed school days or getting behind in school
  • Poor sleep and fatigue
  • Symptoms that interfere with play, sports or other activities

Treatment

Inhalers – There are different types of inhaler devices, which deliver asthma medication to the airways either in dry powdered form, or as an aerosol form with a propellant.

  • Preventers are used to reduce the inflamed areas of the lungs and to prevent the symptoms of asthma occurring. They contain steroid medication to be inhaled usually once or twice a day, and work as a long term treatment to control asthma.
  • Relievers (bronchodilators) are used to provide immediate relief from the symptoms of asthma when they develop. These inhalers work by opening up the airways to allow more air into the lungs and make breathing easier. They do not help reduce inflammation or prevent symptoms from occurring in the future. Some medicines work as both a preventer and a reliever.

Nebulisers – Nebulisers are sometimes used to treat emergency situations where asthma has become out of control. They used to be used in children experiencing a particularly severe attack of asthma, but research has shown that inhalers used with a spacer are as effective as nebulisers in delivering medicine. Nebulisers continue to be used by ambulance crews, some GPs and in A&E departments, as they allow oxygen to be given at the same time. However, a hospital may use an inhaler with spacer instead as doing so may allow the child to be discharged from hospital sooner.

Steroids – Steroids work by reducing inflammation. In the case of asthma, when a patient uses an inhaler, steroids are taken directly to the lungs, thereby directly treating the area that is affected by the allergy. The steroids then reduce the swelling of the airways which is the underlying problem in asthma. Also, some allergic responses involve a second (late phase) reaction after the initial allergic reaction. Steroids, unlike anti-histamines, can reduce the symptoms of these late phase reactions, by limiting the activity of the cells responsible for releasing further chemicals in the body. In this way steroids not only reduce inflammation, but they can also stop an ongoing allergic reaction.

Anti-leukotrienes – Leukotrienes are chemicals released by the immune system that cause swelling and secretion, and can cause allergy symptoms to persist. Anti-leukotrienes work by reducing inflammation and mucus production, and work in a similar way to steroids, but with fewer side effects.

Lifestyle Changes for Parents –

  • Try to avoid triggers which could makes the child’s asthma symptoms worse (e.g. animal hair) and note down any new ones to discuss with your doctor.
  • Do not smoke around the child or allow the child to stay in smoky surroundings.
  • Exercise can play an important part for the child. Swimming and sport should be encouraged as long as the child’s asthma is under control.
  • Think about any triggers in holiday areas, such as house dust mite or pets. Request a pet-free place to stay if possible, and make sure to give details to any holiday club staff about your child’s condition.

Alternative Treatment

Beta-carotene, the compound that gives fruit and vegetables their orange or red color, reduced asthma attacks in 53% of people in one study. Carotenoids are the basis of vitamin A which is involved in the mucous membranes. Severity of asthma correlates with low vitamin A.

Vitamin B3 and vitamin B12 are commonly low in asthmatics. These nutrients lower antihistamine levels and reduce wheezing.

Folate, or vitamin B9, reduced allergic reactions and inflammation. It lowers wheezing by 40%.

Fish oil – The evidence for using omega-3 fatty acids (found in fish oil) to treat asthma is mixed. At least a few studies have found that fish oil supplements may reduce inflammation and symptoms in children.

Quercetin, a kind of antioxidant called a flavonoid, helps to reduce the release of histamine and other allergic or inflammatory chemicals in the body. Histamine contributes to allergy symptoms, such as a runny nose, watery eyes, and hives.

Coenzyme Q 10 (CoQ10) to act as antioxidants.

Vitamin C is a powerful antioxidant and helps to detoxify the body. Vitamin C reduces wheezing and inflammation.

Magnesium – The idea of using magnesium to treat asthma comes from the fact that people who have asthma often have low levels of magnesium.

Potassium – For healthy immune system.

Coleus forskohlii – Coleus forskohlii, or forskolin, is another herb used in Ayurvedic medicine to treat asthma.

Pycnogenol – French maritime pine bark, called pycnogenol, suggests that it may reduce symptoms and improve lung function in children with asthma

Boswellia (Boswellia serrata) – Boswellia (also known as Salai guggal) is an herb commonly used in Ayurvedic medicine, a traditional Indian system of health care.

Saiboku-to – In three preliminary studies, a traditional Japanese herbal mixture called Saiboku-to has helped reduce symptoms and allowed study participants to reduce doses of corticosteroids.

 

Reference –

http://www.kidshealth.org.nz/asthma

http://acaai.org/asthma/who-has-asthma/children

http://www.childrenshealthfund.org/child-health-care/special-initiatives/childhood-asthma-initiative

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/asthma-and-young-children

http://www.medindia.net/patients/patientinfo/childhood-asthma.htm

http://www.childhoodasthma.org/

http://www.erswhitebook.org/chapters/childhood-asthma/

http://www.nhs.uk/conditions/asthma/Pages/Introduction.aspx

http://publichealth.lacounty.gov/ha/reports/habriefs/v3i6_asthma/asthm.pdf

http://kidshealth.org/parent/medical/lungs/asthma_basics.html

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