The ABCs of Asthma

By Keriya Adem, MD, FAAP

Asthma is the most prevalent chronic disease in children and is the number one cause of frequent school absences. As we approach the winter season, many of these children will need to visit their healthcare provider or the emergency room with an asthma flair up.

For the most part, we don't know what causes asthma. It is a disease that can be controlled but not cured. Therefore, education is the cornerstone of successful asthma management.

Asthma is a disease that affects the airways. It has two major components. The first component is the bronchospasm that occurs when exposed to an allergen or a triggering factor. The smaller airways are lined with smooth muscles and when exposed to an allergen, these muscles contract causing narrowing of airways. This is a quick process that is usually noted by the parents as an acute onset of wheezing, coughing or shortness of breath.

The second component of asthma is the silent process caused by inflammation of airways. This is usually an ongoing process resulting in the swelling and clogging of the airways and excessive mucus production. When this process is not adequately addressed, it can lead to poorly controlled asthma and frequent exacerbation.

If your child has asthma, there are three major elements you should have a good understanding of symptoms, triggers, and management.

Although many parents view asthma symptoms as mainly wheezing or the whistling noise heard when the child is breathing, the reality is most children possess a cough that persists for days or weeks. A majority of these children are thought to have “mild cases” of asthma and actually learn to adapt to their symptoms. These are the children who take frequent breaks during activities.

Depending on the severity, other symptoms of asthma can include shortness of breath, chest tightness, waking up with breathing problems or trouble with exercising. A quick and easy assessment of whether a child is in acute respiratory distress is to evaluate if they can talk to you in complete sentences. A child in acute respiratory distress will only speak in one or two words.

The second element is to have a good understanding of your child's asthma triggers in order to prevent asthma attacks. There are several triggers of asthma, such as change in weather, colds and flu, seasonal allergies, exercise and chemical exposure such as smoke. As a preventative measure, all children with asthma should receive the yearly influenza vaccine.

The third component is medical management. Most parents are familiar with the management of the acute onset of the bronchospasm, which is controlled by bronchodialators or rescue medications, commonly Albuterol and Xopenex.

Children who have persistent asthma are also managed with anti-inflammatory medication to treat the quiet part of asthma. You will not see immediate changes with anti-inflammatory medication, because it takes time for the airway swelling and excessive fluid to clear up. These medications protect against the damaging effects of asthma symptoms caused by inflammation.

By using your child's asthma medications as prescribed by your healthcare provider and routinely following up, your child can achieve an active healthy life.