Asthma is perhaps one of the most common illnesses in children. It is one of the most common reasons for accessing care at pediatric emergency rooms, urgent care facilities, and pediatric offices. Asthma has a tendency to run in families and is one of the most frequently named conditions when I ask parents if their child has any chronic illnesses. As a pediatrician, I see first-hand how many misconceptions there are when it comes to symptoms, treatment, and the natural history of this disease. As a parent, I was alarmed when a physical education teacher made my child run extra laps to “build up her endurance” when she developed shortness of breath due to her exercise-induced asthma. What is abundantly clear to me is that despite its pervasiveness, our society is woefully uneducated and misinformed about this disease, and frighteningly enough, what you don’t know about asthma could have dire consequences for your child.
Asthma is a chronic disease of the lungs. Due to a genetic predisposition, the immune system overreacts to various triggers. That overreaction involves a massive release of histamines as part of an inflammatory response in the airways, resulting in spasm of the muscles surrounding the tubes carrying air into and out of the lungs as well as filling of the airways with mucus. The end result is a narrowing of the airways making it difficult for air to get out of the lungs. As the body tries to force air out of the narrowed airways, the characteristic wheezing sound is produced.
This brings us to our first and most common misconception about asthma – that if you can’t hear wheezing, then it must not be an asthma attack. The truth is, most times the wheezing produced by narrowed airways can only be heard with the help of a stethoscope. Further, in the most severe cases of asthma, no wheezing can be heard at all because the airways are so constricted that no air is able to pass through! More readily identifiable symptoms of asthma include repetitive coughing and shortness of breath in response to triggers like dust or exercise. Additionally, children may complain of chest pain or tightness due to the increased pressure in the chest from trapped air. In very severe attacks, parents may notice the skin around the ribs pulling inward or that the child has difficulty talking in complete sentences.
Treatment of asthma is multifaceted. It involves a bronchodilator medicine to relax the muscles in the airway and relieve airway narrowing, antihistamines that help to dry up mucus, and steroids to help control the hyperactive immune system. What asthma management does not involve is nailing your child to a tree, making them drink cod liver oil, or making someone in the throes of an attack run extra laps to build up their endurance. To be clear, mismanaging an asthma attack can result in the death of your child. I state that plainly, not to frighten anyone, but to drive home how important it is to follow the instructions given by your child’s physician on long term management as well as acute exacerbations.
One of the most frequent problems parents encounter in managing their child’s asthma is what medications to give and when. There are some only to be taken during acute attacks and some to be taken daily to prevent attacks. It’s understandable that parents may become overwhelmed when sent home from the doctor’s office with a bag full of medicine. Your pediatrician should sit with you and explain the purpose of each medicine and when it should be used. They should also demonstrate appropriate use of inhalers and spacer devices. Additionally, all parents should be given a written “asthma action plan” that clearly identifies the symptoms of an attack and what and how much of each medication would be appropriate based on severity. It should also have emergency contact numbers and instructions in cases of emergency. A copy of this plan should be kept at home, at school, and anywhere your child spends time in someone else’s care.
Preventing asthma attacks is preferable to having to treat them. For many children, this involves the use of a daily controller medicine prescribed by your child’s doctor. However, the mainstay of prevention is identifying and avoiding triggers. Common triggers include dust mites in carpets, curtains, and stuffed animals as well as second hand smoke. It doesn’t matter if you smoke outside or down the street. If the scent is on your clothes, you are risking triggering your child’s asthma. Strong scents like perfumes and air fresheners can also trigger attacks. Changes in weather in the cooler months and exercise can also trigger attacks. Be sure to have a conversation with your child’s pediatrician about what triggers put your child at risk for an asthma attack.
Asthma, while a very common illness, is not a benign one. Uncontrolled, this disease can severely affect one’s quality of life with fatigue and inability to focus, poor sleep, missed school days, missed work days for parents, and frequent trips to hospital. In the most severe cases, asthma can result in death. If your child has been diagnosed with asthma, talk to your pediatrician about what you should be doing to keep them safe. We’re here to help you raise happy and healthy kids.
• Dr. Tamarra Moss is a pediatrician committed to helping you raise happy and healthy kids. You can find her at Dr. Carlos Thomas & Pediatric Associates in Nassau, Lucayan Medical Center in Grand Bahama, or on Instagram @mykidsdoc242.