Childhood Diseases – On a Mission to Educate: Asthma

My last article, Childhood Diseases – On a Mission to Educate: Pertussis (Whooping Cough) we learned that Whooping Cough is a very contagious disease that can affect individuals at any age. It is caused by a bacterium, Bordetella pertussis and is spread through the air by respiratory droplets from a person coughing, sneezing or person to person contact. In many cases the person with pertussis can have severe coughing attacks for months. Today I will like to move onto another common childhood disease, Asthma.

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What Is Asthma?

Asthma is a chronic lung disease that involves the airways in the lungs. It is a condition in which the airways narrow and swell and along with the production of extra mucus, can make breathing very difficult for the individual with asthma. Coughing, wheezing and shortness of breath get triggered which then makes daily activities especially hard to do. To many people with asthma it is seen as a nuisance because it can occur at any time, disrupting one’s daily activities.

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According to National Institutes of Health (https://www.nhlbi.nih.gov/health/health-topics/topics/asthma) Asthma can affect people of all ages but it usually starts during early childhood. Just in the US there are more than 25 million people with Asthma of which 7 million of these are children.

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Overview of Asthma

National Institutes of Health stated that in order to understand Asthma it is important to know how the airways work. As we know, the airways are tubes that carry the air into and out of our lungs. “People who have asthma have inflamed airways. The inflammation makes the airways swollen and very sensitive. The airways tend to react strongly to certain inhaled substances.” So when the airways react, the muscles around them tighten and the airways become narrow making it difficult for the air to flow to the lungs. Swelling also can occur making the airways even narrower. Because of this the cells in the airways then make more mucus than normal. The mucus is very sticky and is a thick liquid that can make the airways even more narrow thus making less air flow to the lungs.

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Symptoms of Asthma

According to the Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/asthma/basics/causes/con-20026992) signs and symptoms include:

Shortness of breath

Chest tightness or pain

Trouble sleeping caused by shortness of breath, coughing or wheezing

A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)

Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

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Mayo Clinic also stated that there are signs that your asthma is probably worsening:

Asthma signs and symptoms that are more frequent and bothersome

Increasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working)

The need to use a quick-relief inhaler more often

There are also certain situations where asthma symptoms can flare up including exercise-induced asthma (cold or dry air triggers), occupational asthma (fumes, chemicals, dust), and allergy-induced asthma (pollen, mold, spores, cockroach related triggers & dried saliva shed by pets).

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How Is Asthma Diagnosed?

Since Asthma usually starts in childhood, according to Kids Health (http://kidshealth.org/en/parents/asthma-basics.html#) the doctor will first ask questions about a child’s health, problems with breathing and family medical history. They will ask about any allergies, illnesses and exposure to things that may make the child’s breathing better or worse. The doctor will do a physical exam and may have a lung function test done which involves testing breathing with a spirometer (a machine that analyzes airflow through the airways.

Who Develops Asthma?

According to National Asthma Council Australia (https://www.nationalasthma.org.au/understanding-asthma/what-is-asthma) the following is a list of facts that lead to Asthma:

About 1 in 10 adults and about 1 in 9 or 10 children have asthma.

Asthma and allergies are closely linked. Asthma is more common in families with allergies or asthma, but not everyone with asthma has allergies.

Adults of any age can develop asthma, even if they did not have asthma as a child.

Some people have asthma during childhood, but later have very few or no symptoms as adults.

Many preschool children who wheeze do not have asthma by primary school age.

Indoor and outdoor pollution (including molds, gases, chemicals, particles and cigarette smoke) can increase the risk of developing asthma.

Athletes can develop asthma after very intensive training over several years, especially while breathing air that is polluted, cold or dry.

What Causes Asthma?

Most literature states that they don’t know why so many people have asthma but it is most common in the more modern living countries such as the US, United Kingdom, Australia , etc. It is speculated that it is related to changes to the environment, diet, and/or related to exposure to some infections. Most believe that asthma is probably due to a combination of environmental and genetic factors.

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Treatment For Asthma

There is no cure for asthma according to Kids Health but it can be managed to prevent flare-ups. There are two important things in treating asthma: Avoiding triggers and taking Medication.

Triggers of Asthma

According to the Mayo Clinic there are certain things that can trigger asthma but it should be noted that it is different for each individual. Here a list of possible triggers:

Airborne substances, such as pollen, dust mites, mold spores, pet dander or particles of cockroach waste

Respiratory infections, such as the common cold

Physical activity (exercise-induced asthma)

Cold air

Air pollutants and irritants, such as smoke

Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve)

Strong emotions and stress

Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes, beer and wine

Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat

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Medication For Asthma

Most medications for asthma is breathed directly into the lungs (inhaled) but others are in liquid or pill form. There are two types of asthma medicines according to Kids Health:

Quick-relief medicines act fast to open up tight airways. They can be used as needed during a flare-up. Quick-relief medicines act fast, but their effect doesn't last long. These kinds of medicines are also called "fast-acting" or "rescue" medicines.

Long-term control medicines manage asthma by preventing symptoms from happening. They reduce inflammation in the airways, which is the cause of the swelling and mucus. (Quick-relief medicines only treat the symptoms caused by the inflammation.) Long-term control medicines — also called "controller" or "maintenance" medicines — must be taken every day, even when kids feel well.

Kids Health stated that some kids with asthma only need quick-relief medicine while others need both kinds of medicine to keep their asthma in check.

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Risk Factors For an Asthma Attack

There are a number of different asthma risk factors that may increase a chance of developing an Asthma Attack. According to Very Well (https://www.verywell.com/what-are-the-risk-factors-for-an-asthma-attack-201078) the following is a list of factors that can increase your risk:

Have had a serious asthma attack in the past

Required admission to a hospital or intensive care unit to care for your asthma in the last year

Develop symptoms suddenly or asthma attacks seem to creep up on you without you noticing a change in your symptoms

Require frequent use of your rescue inhaler

Have a history of substance abuse

Have a history of significant mental illness

Very Well did go on to state that some asthma risk factors are avoidable such as exposure to smoking and eating certain food. But unfortunately things like family history is not avoidable.

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What Else Should Parents Know?

Kids Health also gave excellent advice regarding an Asthma Action Plan that parents should develop with the doctor. This plan includes a detailed instruction on how to manage asthma including the following:

What medicines your child needs and when

What your child's triggers are and how to avoid them

How to manage a flare-up

When to get emergency medical care

This plan, if followed, can allow the child to do normal everyday activities without having any asthma symptoms. Kids Health also recommended keeping an Asthma Diary which tracks asthma symptoms and medicines. This can help one know when the child is more likely to have a flare-up. They also suggested a Peak-Flow Meter which is a handheld tool that measures breathing ability. When peak flow readings drop, it can be a sign of narrowing airways.

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American Lung Association 2017 Asthma & Children Fact Sheet

Some of this information is repetitive but the following is a synopsis of Asthma & Children Facts which I feel is very important to close this article with. This is by the American Lung Association (http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/learn-about-asthma/asthma-children-facts-sheet) February 2017:

Asthma is the most common chronic condition among children,1 currently affecting an estimated 6.2 million children under 18 years, of which 3.1 million suffered from an asthma attack or episode in 2015.

An asthma episode is a series of events that results in narrowed airways. These include: swelling of the airway lining , tightening of the muscle surrounding the airways and increased secretion of mucus inside the airway. The narrowed airway causes difficulty breathing and the familiar "wheeze."

When a child has asthma, their lungs are extra sensitive to certain stimuli, or "triggers." Triggers range from viral infections to allergies, to irritating gases and particles in the air. Each child reacts differently to the factors that may trigger asthma, including respiratory infections & colds, cigarette smoke. allergic reactions to allergens such as pollen, mold, animal dander, feather, dust, food and cockroaches, indoor and outdoor air pollutants, including ozone and particle pollution, exposure to cold air or sudden temperature change, excitement/stress, & exercise.

Secondhand smoke can cause serious harm to children. An estimated 400,000 to one million children with asthma have their condition worsened by exposure to secondhand smoke.

Asthma can be a life-threatening disease if not properly managed. In 2014, 3,651 deaths were attributed to asthma. However, deaths due to asthma are rare among children. The number of deaths increases with age. In 2014, 161 children under 15 years old died from asthma compared to 650 adults over 85 years old.

Asthma is the third leading cause of hospitalization among children under the age of 15 years. Approximately 29 percent of all asthma hospital discharges in 2010 were in those under 15, however only 20 percent of the U.S. population was less than 15 years old.

In 2010, there were approximately 640,000 emergency room visits due to asthma in those under 15 years of age.6
Current asthma prevalence in children under 18 years old ranges from 5.8 percent in Nevada to 12.1 percent in Massachusetts among the 31 states with data for 2015.

The annual direct healthcare cost of asthma is approximately $50.1 billion; indirect costs (e.g. lost productivity) add another $5.9 billion for a total of $56.0 billion dollars.

Asthma is one of the leading causes of school absenteeism;9 in 2013, asthma accounted for an estimated 13.8 million lost school days in school-aged children with an asthma flare-up in the previous year.

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So in conclusion, Asthma cannot be cured but with appropriate management can help to control this disease and enable people to enjoy a good quality of life. There are short-term medications that can relieve symptoms but people with persistent symptoms must take long-term medication daily to control the underlying inflammation which impact airflow to the lungs, and to prevent asthma symptoms and episodes of exacerbations. It is equally important to avoid any triggers that may elicit an asthma attack.

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I hope you learned something from this article about Asthma. There are many resources on the internet if you need more specific information. There are even many holistic approaches to asthma which I didn't have time to go into. I will continue this series with another childhood disease post. I hope you will continue to join me in this quest to learn about these illnesses that children usually encounter when they are young. Thank-you for reading my article on Childhood Diseases – On a Mission to Educate: Asthma. If you would like to follow me, please check HERE