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SYMPTOMS
OF ASTHMA
Recurrent
(repeated) "attacks" of wheezing, coughing, chest tightness,
and/or difficulty breathing Recurrent
coughing mostly at night ("cough-variant asthma") often dry or
hollow Recurrent
coughing during or after vigorous activity ("exercise-induced
asthma")
Sometimes associated with other allergic symptoms, such
as sneezing, hay fever, itchy eyes, eczema
Also called reactive airway disease (
CAUSES Asthma is an
inherited type of sensitive or "twitchy" lung. The airways go
into spasm and become narrow and
inflamed when allergic or irritating substances enter them. This
prevents air from flowing through the airways. Viral respiratory
infections (colds and flus) trigger most attacks. If asthma is caused by
pollens, the asthma tends to flare up during a particular season. Asthma
often occurs in children who have other allergies such as eczema or hay
fever. All these allergic conditions tend to run in families. Although
emotional stress can occasionally trigger an attack, emotional problems
are not the cause of asthma. DIAGNOSIS The diagnosis of
asthma is made mostly by recognizing repeated episodes of wheezing or
coughing as mentioned above. Immediate family members with asthma, hay
fever, or eczema increase the chance of children having similar allergic
tendencies. There are no blood tests that can confirm the diagnosis,
though sometimes the doctor may find evidence of allergic tendencies in
the blood. When someone has episodes of coughing or wheezing that are
consistent with asthma, the doctor may wish to obtain a chest x-ray
(especially on a young child) to check for other causes of these
symptoms. Sometimes the doctor may start a trial of medicines which are
used to treat asthma to see if there is improvement in the cough or
wheeze. Sometimes using a Peak Flow Meter or Pulmonary Function Tests
(which can be done in the office in older children) is helpful in
questionable cases or to follow how a child's asthma medicines are
working. Most often, however, the diagnosis is made by the background
history and the examination, without using other tests. PREVENTING
ASTHMA ATTACKS The list of
causes of asthma attacks is quite long. Ask for the available handout on
Controlling Allergens in the Home.
Try to discover and
avoid the substances that trigger attacks in your child. Even consider
strong odors such as cologne, exhaust fumes, and frying foods. Routinely
avoid common triggers such as feather pillows and tobacco smoke. Try to
keep pets outside or at least out of your child's room. Learn how to
dust-proof your house. Change filters on your hot annealing system or
air conditioner regularly. Any recent contact with grass, pollen, weeds,
or animals may persist in your child's hair and clothing; showering and
putting on clean clothes may help. EXPECTED
COURSE Although asthma
attacks may be frightening, they are treatable. When medicines are taken
as directed and supervision is provided through a physician, the
symptoms are reversible and there are no permanent lung changes. Asthma
can be a long-lasting disease in many children, but some may outgrow it
during adolescence. There is no way of predicting who will outgrow it or
when.
OFFICE
VISITS Asthma is a
chronic disease that requires close supervision and follow-up by a
physician who coordinates your child's treatment program. Routine,
scheduled visits to the physician to discuss your child's treatment
program are an important part of managing asthma. These visits allow
the physician to insure that all that can be done to prevent attacks is
being done. Nowadays, most patients with asthma are treated by general
pediatricians. Allergy or lung specialists are needed only in rare
situations. Most children with asthma should visit their physician 2 or
3 times a year for detailed discussions of their asthma this is
separate from visits when there is wheezing. ALLERGY SHOTS
Most children
with asthma do not need allergy shots. Your pediatrician and you will
decide when such are indicated. When preventative medicines for asthma
fail to work or when other allergic tendencies are poorly controlled,
your physician might discuss using allergy shots as another way to
control asthma attacks or allergies. Testing for allergies (through skin
tests) is mainly worthwhile only when allergy shots are needed; the
testing helps determine which pollens and environmental agents are to be
put in the serum (solution) for the shots. Testing for food and pet
allergies is not routinely done, since avoiding those foods and pets is
usually the best treatment. Flu shots,
however, are recommended for patients with asthma-
They contain strains of the influenza virus that are expected to be
present in the winter season. Influenza can trigger a severe attack in
many asthmatics. Flu shots are given every year since different strains
exist in different years. They are given from mid-October through
early-January. Click here for more information on the flu vaccine. PEAK Peak Flow Meters
(PFM) are simple devices to measure how well one is breathing. Even
before coughing or wheezing is apparent, a change in the peak flow
number can indicate very early on that an asthma attack is coining.
That way the asthma can be treated early before a full-blown attack
happens. Many patients benefit from having a PFM at home/school to tell
them when to start aggressive asthma therapy. Here is how to
use the PFM (your doctor can demonstrate): (1) Bring the
pin down to the lowest marking (2) Take as big
of a breath in as possible and hold it (3) Put the PFM
in the mouth with the lips completely around the mouthpiece to create a
tight seal (4) Blow out as
hard and as fast as possible in one quick breath out (5) Take the PFM
out of the mouth (6) Read and
write down the number next to the pin (7) Repeat steps
(1) through (6) two more times and take the best reading as the one to
write down in the record. Here is how the
record works: First keep a daily log of the peak flow readings at 2 or 3
specific times of the day, everyday, for a period of one to three
months. Other information to include in the record is how the child is
feeling at the time (coughing/wheezing), what the child was doing
immediately before, and if any medicines were given beforehand. Next
make an appointment with the doctor and bring in the record. Together
you and the physician come up with a personalized treatment plan. The
treatment plan will enable you to know what is a good reading and what
is a low reading and what to do when the reading is low.
MEDICINES FOR
ASTHMA The medicines
for asthma (discussed below) are divided into three categories: (1) medicines to
open the airways, (2) medicines to
decrease the inflammation in the airways, and (3) medicines to
prevent asthma attacks.
Albuterol is the
single most effective and most important medicine to stop wheezing fast.
Albuterol has several brand names, eg. Proventil and Ventolin. Xoponex
is a newer version of albuterol that may cause less jitteriness in some
patients. Albuterol comes in
a liquid form, more often used for infants and toddlers with mild
asthma. More severe cases
may require the use of an inhaled form of albuterol.
More common forms of inhaled albuterol are the metered-dose
inhaler (MDI) and the nebulizer ("the machine" or
"breathing treatment" - an electrical device that makes the
medicine into a mist). All inhaled forms of albuterol work almost
equally as well since the medicine is delivered to the lungs directly as
a mist; the medicine is inhaled. Therefore, the patient can interchange
using the MDI and using the nebulizer. In the office, your child might
receive a nebulizer (breathing) treatment and/or might be shown how to
use an MDI at home. Occasionally, your physician may recommend having a
nebulizer at home. Even the youngest of children can use and benefit
from an MDI or nebulizer. Follow the
separate instructions your doctor gave you regarding the proper use of
the albuterol MDI or the nebulizer. When using a metered-dose
inhaler, always use a spacing device, no matter how old or experienced
you are. Spacing devices are the Aerochamber and Inspirease. Whatever form
of albuterol you have, it is the first medicine that should be given in
an attack and should be used aggressively thereafter. It must also be
given throughout the night.
If you have any doubt about whether your child is wheezing or having an
asthmatic cough, just start the albuterol right away! The later
medicines are begun, the longer it takes to stop the wheezing and the
greater the chance your child will need to go to an emergency
department. Once the medicine is begun, your child should keep taking it
until he has not wheezed or coughed at all for at least 48 hours (2
days). Most asthma attacks are treated a minimum of seven (7) days with
albuterol given on a regular basis even if the child seems better. If
your child has one or more attacks of wheezing each month or coughs at
night two or more times a week, he probably needs to be on continuous
preventative medicines and under the routine care of a physician.***
Medicines that
decrease inflammation in the airways are helpful in both treating an
acute wheezing episode and in preventing attacks. Steroids (glucocorticoids)
make up the main category of anti-inflammatory medicines. Steroids come
in several forms, including oral syrups and pills (eg., Prelone,
Pediapred, prednisone, Orapred), inhalers (eg., Vanceril,
Azmacort, Aerobid, Advair), nebulized medicines (Pulmocort)
and injections. If your
physician has prescribed an inhaler, always be sure to use it with a
spacer (eg., Aerochamber).
In a moderate or severe asthma attack, your physician might
prescribe oral steroids over a period of 3 to 7 days, given once or
twice a day. When used in conjunction with albuterol, steroids can help
improve breathing within a few hours. Their side effects are rare when
taken as directed. They are not "anabolic" steroids which have
been abused by athletes in the past; the steroids given for asthma are
different. Nonetheless, steroid usage should be closely monitored by
your physician.
There are many
medicines that are used to prevent asthma attacks. Some of these are the
same medicines that help in an acute attack, but are used in different
amounts than when there is trouble breathing. Medicines that open the
airways can be useful in prevention, such as albuterol. Serevent is
a long-acting albuterol-like medicine which can be used as prevention. Serevent.
however, should not be used to treat an attack. Patients on Serevent who
develop an attack need to use the regular albuterol iust like everyone
else. This is because
while serevent lasts longer than albuterol, it starts working more
slowly. Inhaled
steroids (in
inhalers) are also used in some patients to prevent asthma. They are
taken on a daily basis. While there are no serious risks of taking these
low-dose, inhaled steroids for months on end, their use should be
monitored by a physician. If your child is taking inhaled steroids as
prevention, and then develops an attack, continue with the inhaled
steroids unless directed by your physician.
Advair is a newer formulation that combines serevent (a
long-acting albuterol) with an inhaled steroid and provides good
treatment and convenience. Intal (the
brand name for cromolyn sodium)
is a medicine that works to prevent attacks, but does very little to
help wheezing right away. Because Intal must be taken 3-4 times daily to
be effective and be used on a routine basis for 2 to 4 weeks before any
effect is noticed, it is less commonly used these days. Anytime an
inhaler is used a spacing device (aerochamber) should be used with it..
Any child
or adolescent no matter how old, how intelligent, or how coordinated
will benefit from a spacer. The Aerochamber is a hard, long plastic
tube, like a toilet-paper roll. The Inspirease is a collapsing,
accordion-like bag. The spacer allows the mist of the inhaler to be held
until the patient takes in a deep breath. Without a spacer, the medicine
hits the back of the throat and tongue, can taste bad, and does not all
get down into the lungs where it is needed. Your physician can
demonstrate how to use a spacer and give you a separate handout on using
it during an asthma attack with an albuterol metered-dose inhaler (MDI).
Having an extra spacer at school is often a good idea: wherever
there is an inhaler, there should be a spacer. Here is how to
give one puff of the inhaler with the Aerochamber: (1) Shake the
inhaler well (2) Put the
inhaler into the Aerochamber (3) Depress the
inhaler to spray the medicine (4) Place the
lips over the mouthpiece tightly, or Place the mask over the nose and
mouth to create a tight seal against the face (5) Breathe in
and out five (5) times slowly through
the Aerochamber Remember, a
crying child takes even bigger breathes Repeat all the above for each
additional puff of the inhaler, as prescribed. Repeat all the
above for each additional puff of the inhaler, as prescribed. TREAT ASTHMA
ATTACKS EARLY Many
children wheeze soon after they get coughs and colds. For some children,
itching of the neck or chest or a dry cough means an asthma attack will
soon begin. If this is the case for your child, start the
asthma (albuterol) medicine or inhaler at the first sign of any
coughing or itching. The best cough medicine for a child
with asthma is the asthma medicine. If you are not sure
that your child's cough is from the cold or from asthma, assume it's the
asthma. Always keep this medicine handy; take it with you on trips. If
your supply runs low, get a refill in advance during regular office
hours. EXERCISE-INDUCED
ASTHMA Most people with
asthma get 20- to 30-minute attacks of coughing and wheezing with
strenuous activity. This problem should not interfere with participation
in most sports nor require a physical education (PE) excuse. The
symptoms can be prevented by using an albuterol inhaler 15 minutes
before exercise. Children with asthma usually have no problems
with swimming or sports not requiring rapid breathing. GOING TO
SCHOOL DURING AN ATTACK Asthma is not
contagious. Your child should go to school during mild asthma attacks
but avoid physical education on these days. Arrange to have the
asthma medicines available at school. If your child uses an inhaler
(with a spacer, of course), he might be permitted to keep it with him so
he can use it readily. At the very least, his teachers should be made
aware of the condition and allow him to go to the nurse's station to
take his medicine. COMMON
MISTAKES The most
commop mistakes are delaying the start of asthma medicines or not
replacing them when they run out.
Non-prescription inhalers and non-prescription medicines are not
helpful. Another common error is stopping the medicines too early. Even
though the wheezing and coughing may have stopped, asthma medicines
should be continued to be given on a regular basis (day and night) for
at least 48 hours (2 days) more. Most asthma attacks need to be
treated for at least seven (7) days. Withholding asthma medicines
during an attack will not "strengthen" the lungs; in fact, the
wheezing can become more serious if it's not treated. It is not true
that people who use inhalers frequently per se are at an increased risk
for death, unless the inhalers are abused or used without the proper
supervision of a physician. Do not keep a
pet (such as, a cat, dog, or hamster) that may be triggering allergies
and asthma. Prohibit all smoking in your home and cars; tobacco
smoke can persist for up to a week. Do not even allow smoking in another
part of the house or next to a door or window. The smokes filters
throughout the house. The smoke gets into the carpets, clothing, linens,
and upholstery and can irritate the lungs. Smoking and asthma can
literally be a deadly combination. In addition, don't panic during
asthma attacks. Fear can make tight breathing worse, so try to remain
calm and reassuring to your child. If you are requiring refills of
medicines more than just occasionally, your child should be seeing
his physician on a regular basis to make sure that everything that can
be. done is being done. Don't let asthma restrict your child's
activities, sports, or social life. CALL THE
OFFICE Immediately
if... the wheezing
is severe the
breathing is labored (eg., chest caving in) your child
is unable to sleep or speak the lips are
bluish or dusky pain
develops in the chest or neck the oral
medicines are being vomited
the wheezing is not improving after the second dose of
asthma medicine Within 24 hours
if... fluid intake
is poor your child
has other symptoms, such as fever or severe cold symptoms you are
concerned about side effects of the medicines you feel
your child is slowly getting worse During regular
office hours if... the wheezing
is not completely cleared by 5 days you need
refills on any of the asthma medicines you have
other questions or concerns that can wait
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Wheezing: a high-pitched whistling sound produced during breathing out
