I thank Dr Venkatesh Chandrasekaran (Associate Professor of Pediatrics, JIPMER, Pondicherry, India) for contributing this article
1. What is Asthma?
Asthma is a type of lung disease in which the person has difficulty in breathing and dry cough, noticed commonly during midnight or early morning, and also some amount of chest tightness. These symptoms can be present for days together or can come and go now and then.
In normal individuals, the time is taken for “breathing out” is usually shorter than that for “breathing in” whereas in children with asthma, the “breathing out” time is typically longer and sometimes has a musical quality which is termed “wheeze”. This is because the breathing tubes of the lungs become narrow suddenly in response to “exposure to” or to “intake of” certain substances in our environment.
2. What causes Asthma?
Asthma is nothing but our body’s response to certain substances in our environment. How we react to substances in our environment depends on our genes. Not everyone with asthma reacts the same way to all substances. Some substances can be more allergenic to someone but not for others.
Allergenic substances are those that cause the release of certain chemicals inside our body which causes swelling and narrowing of breathing tubes and increases mucus (something like sputum) production. Because of the narrowing, the breathing tubes might become obstructed and it is difficult for a person to “breathe out” It takes a longer time for the air to come out of the lungs, and because of that, the person has to put great effort to breathe. If this continues for a long time, there might be difficulty in getting oxygen into the lungs and eventually, it causes tiredness and sleepiness which can be very dangerous.
3. Is Asthma Infectious? Can it spread from one person to the other?
As I already mentioned, how our body responds to substances in our environment depends on the genetic make-up of a person. In other words, it is a genetic disease causing the allergy. If a family member has asthma, their sibling or children might also have it. But it cannot spread from one person to another like flu or cholera.
4. Apart from asthma, what are the other effects of allergy?
Excessive Itching and redness of eyes, sneezing, itching, watering and blocking of the nose, redness, itchiness, dryness, and rash of the skin are some of the other manifestations of allergy involving the eyes, nose, and skin. Rarely, allergy can cause a part of the body (especially lips and tongue) to swell up suddenly or cause someone to faint suddenly. The latter two symptoms can be dangerous and medical attention should be sought immediately.
5. Are there any tests for diagnosing asthma?
Although asthma can be diagnosed based on typical symptoms, the doctor might want to do a test called spirometry or PFT (Pulmonary function tests). It involves voluntary breathing into a device that measures airflow and finds out whether your breathing tubes are obstructed or not. The doctor might repeat the test after giving some inhaler puffs or nebulization to find out whether there is any improvement Sometimes doctors might ask for a blood test and chest x-ray or might prescribe some allergy tests.
The doctor would decide on treating asthma based on the frequency and severity of symptoms. If the symptoms are frequent or there are episodes of sudden worsening, if symptoms disturb sleep or upset the day to day activities of the child, then the child would be started on treatment.
For treating asthma, doctors would recommend medicines that can be given through breathing route through inhalers as a very low amount of medicine is needed through this route and the action is rapid. The side effects are also minimized. Two types of medicines
are usually given-a medicine that gives immediate relief to symptoms and the other which can prevent further symptoms. Ideally, both have to be taken based on the doctor`s advice.
The treatment once started should not be stopped on your own without consulting the doctor as stopping of treatment can lead to dangerous sudden asthma attacks. If such attacks happen, the doctor would advise you to take some medicines and rush to a nearby hospital. In the hospital, oxygen and nebulizations may be given and some times injections through veins may have to be given to stop the attack.
7. Can asthma attacks be prevented?
It is important to find out what triggers asthma attacks and to avoid them. The common indoor allergens are house dust, cockroaches, cats at home, and fungus on damp walls. Common outdoor allergens are parthenium, grass pollen, tree pollen.
Some children can be allergic to food- commonly milk, soy, cocoa, egg, nuts, melons, banana, citrus fruits, and seafood. Air pollution and exposure to tobacco smoke can also lead to worsening of symptoms. So one has to avoid all these if any of the above causes problems to that particular person. In some people, exercise, emotional outbursts like excessive crying or laughter can also cause symptoms and it is important to be aware of it.
The next important thing is to continue medications prescribed by your doctor –especially the inhalers which are used to provide quick relief and also to prevent symptoms. It is also important to follow the correct instructions and proper technique for using the inhalers as incorrectly used inhalers will not produce good treatment results.
It is important to periodically check with the doctor whether you or your child is using the inhaler device correctly. For most children, the inhaler has to be used with a device called spacer and for young children, a face mask might also be additionally needed to deliver the medications properly.
8. Is there cure for asthma?
Asthma cannot be cured but it can be treated effectively so that the child can lead a life free of symptoms. It is also possible that the symptoms of asthma will gradually decrease as the child grows older and can disappear totally when they become adults. For the majority, the symptoms can be controlled with avoidance of allergens, proper use of the inhaler medications, adjusting the dose of inhaled medicines, or adding few drugs to the treatment plan.
Sometimes, the doctor might also treat if you have other allergies especially that of the nose or sinus or if you have heartburn. Also, it is a good idea to prevent excessive weight gain by doing regular exercise and having a healthy and balanced diet. For a very small number of patients, it might be very difficult to control the symptoms and might require more potent and newer therapies.
9. Can children younger than three years develop asthma?
Younger children can have wheezing following common cold or chest infections due to viruses. It is common for most young children to have 1 or 2 episodes of wheezing when they are less than 2 or 3 years old. But if they have more frequent episodes of wheezing or have symptoms in-between times when they have a cold, they have to be assessed by the doctor and the doctor might prescribe medications that are similar to that used to treat asthma.
Most of these children do not go on to develop asthma unless if one of the parents has allergy or asthma and other signs of an allergy are also present in the child. Similarly in children between 3-6 years, some can have frequent wheezing which might require medications temporarily whereas the majority would grow out of it by 6 years. If any child has frequent wheezing after 6 years, it can be asthma and might require long term treatment.
The following are links to home nebuliser and spacer for children