Pediatric asthma is the most common chronic lung disease in infants and children. It is one of the most frequently cited reasons children are seen in the emergency department, admitted to the hospital, and have parents miss work due to their illness.
Asthma symptoms tend to occur when susceptible children are exposed to their respective triggers. If not managed properly, asthma symptoms can worsen and induce an asthma attack. Once an attack starts, the airways on the way to the air sacs narrow, increased secretions and mucous accumulate, and airflow is greatly reduced. The affected child works harder to breathe and the breaths per minute increase. These symptoms continue until the airways dilate back to normal size and the amount of secretions returns to normal.
There are more than 30 different triggers, or initiating events for asthma, but the most common ones are viral illness, exercise, smoke exposure, allergies, air pollution, and other lung disease(s), such as chronic lung disease associated with premature birth. Many children can have more than one trigger. Once begun, an asthma attack can last minutes to days. Symptoms may include wheezing, cough, chest tightness, and rapid or labored breathing. They may resolve on their own or progress to a severe life-threatening state requiring admission to the hospital or even to an intensive care unit.
The diagnosis of asthma can be difficult to make as the illness often affects infants and children. Sometimes the children’s age limits testing options regularly used to confirm the diagnosis, such as pulmonary function tests. As a result, the diagnosis often is made based on a detailed history and physical exam, including family history and appropriate lab tests.
The exact number of children with asthma is unknown, but most experts believe it is greater than 10 million in the United States. Fortunately, the medical community is continuing to learn more about the biology of asthma, the various triggers, and the genetics of this disease.
As we move further into spring, potential allergic triggers for asthmatic patients abound. Allergy symptoms including sneezing, runny nose, itchy skin, and red eyes can cause asthma symptoms and even trigger an asthma attack. Common allergens this time of year include dust, pollen, mites, grasses, and trees. Allergy testing is sometimes used to help determine the cause of asthma and if specific therapy is needed.
Once a diagnosis of asthma has been confirmed, physicians initiate appropriate therapy, often in accordance with guidelines from the National Asthma Education and Prevention program. Therapy can include environmental controls, pharmacologic treatments, patient and family education, and frequent assessment. Asthma control needs to be closely followed to improve lung function and decrease symptoms over time.
Close observation is particularly important in infants, children, and teenagers as their lungs continue to grow. Once asthma is diagnosed, the patient and family receive an “Action Plan.” This plan includes the daily medications along with what to do during an exacerbation, or flare-up, how to contact the physician day or night, and when to go to the Emergency Department.
Asthma affects children in a variety of ways and symptoms can change as they age. Parents suspecting asthma in their children should consult with a physician. If a diagnosis is confirmed, it is important to maintain a close relationship with a specialist to monitor the disease and make adjustments in treatment as needed.