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Asthma in children: Q&A on diagnosis, treatments, management plans
By Anni Lanigan, ARNP, FNP-C, Pacific Medical Centers
For the Reporter
Whether your child is 15 months or 6 years old, it is still a very scary day when you first realize that they are wheezing and working hard just to breathe.
The good news is that many of these children will outgrow their asthma by late adolescence or early adulthood, even though it is usually called a chronic, or long-standing, lung disease.
What is asthma?
It is a condition that can make it hard to breathe. Sometimes, children with asthma have no symptoms, but if they have an "attack" or flare-up, symptoms can vary from mild to quite severe. Asthma causes constriction or a closing up of the airways and inflammation, which can produce thick mucus and irritate the airways. Together, the constriction and inflammation make it difficult to both move air in and get it out again.
Along with these asthma symptoms are usually a cough (often dry and irritating), wheezing (a musical or squeaky sound), difficulty breathing and a sensation of chest tightness. Asthma attacks—the sudden worsening of symptoms—often occur after exposure to factors known as triggers.
How often do the symptoms come?
Symptoms can happen each day, each week, or less often. Even in the same child, symptoms can vary from mild to severe. Although rare, a severe episode can lead to death.
Why has asthma become more common over the last 40 years?
There have been increasing incidences of asthma diagnoses since the 1960s. Most research shows that genetic changes are not the cause. Rather, multiple environmental factors likely may have played a role.
• One interesting theory points to a decline in physical activity, which removes the protective effect of repeated expansion of the lungs.
• Also there has been an increased indoor allergen exposure from things in our homes, such as increased insulation, indoor temperature and use of wall-to-wall carpeting.
• A decrease in pollen allergen exposure was replaced with an increase in dust mite allergen exposure at around this same time period.
• Two peer-reviewed studies have shown that sitting for more than 2 hours/day can increase risk for both obesity and asthma. Findings in one study showed that 2 hours of TV/day doubled the risk of a 3 year old developing asthma.
How is asthma diagnosed?
There is a test, but it has limitations. Your primary care provider may have your child do a breathing test if he or she is over 5 years old. It is a useful test but if your child is not having symptoms, the test will be normal. A history and exam is usually how the diagnosis is made, and sometimes this takes a few visits, since symptoms come and go, often related to triggers like a viral illness.
How is asthma treated?
Treatment depends on factors such as the child's age and the severity and frequency of asthma attacks. For most children, treatment can control symptoms nicely, allowing them to participate fully in activities and sports.
Successful treatment includes controlling and avoiding asthma triggers; monitoring lung function at home and updating your child's doctors on symptoms regularly. Usually, peak flow meters are used to check lung function.
Medications include inhalers, liquids or pills. They work in one of two ways:
• Quick-relief medicines stop symptoms quickly. They are prescribed when children do not have symptoms often. The most common side effect from this is brief hyperactivity. Most toddlers and young children will use a "spacer" with a quick-relief inhaler to get more of the medicine into the lungs.
• Long-acting controller medicines control asthma and prevent future symptoms. If your child has frequent symptoms or severe episodes, he or she may need to take these each day.
Some children need to use a nebulizer, or vapor machine, for both quick and long-acting medicines.
What are asthma triggers?
Triggers are things, or factors, that set off or worsen asthma. What are your child's triggers symptoms?
Not all patients have the same triggers, but finding out and taking steps to avoid them is an important part of good asthma management. Some children need allergy testing done at a pediatric allergist's office to identify these factors. But most often, parents can discover triggers by paying careful attention to the pattern of their child's asthma symptoms.
The most common triggers are:
• Respiratory infections
• Allergens like dust; pollen from plants, grasses or trees; and furry animals
• Irritants like tobacco smoke, aerosol sprays, some cleaning products, and severe air pollution conditions
Do I need an asthma action plan for my child?
Yes, most definitely. All parents of babies, toddlers, and children with asthma need an action plan.
An action plan is a list of instructions that tell you:
• What medicines (if any) your child should use at home each day.
• What warning symptoms to watch for. (Warning symptoms suggest that the asthma is getting worse.)
• What other medicine(s) to give your child if symptoms get worse.
• When to call your doctor or when to call 911.
Last but not least, teach your little ones—when age appropriate—about their medicines and when they need to use them when away from home. Communicate closely with babysitters, daycare, and school nurses so they know how best to help your child.
Anni Lanigan, ARNP, FNP-C has been a nurse practitioner for 30 years. She is the nurse practitioner at Pacific Medical Centers' Federal Way Clinic. She completed her ARNP program at UC Davis Medical Center in Sacramento, Calif., and she is certified by the American Board of Nurse Practitioners. For more information, please visit www.PacMed.org or call 253-435-3400.