asthma in children

The asthma triggers cause certain cells in the airways release chemical substances. These substances cause the airways to become inflamed and swollen and stimulate the muscle cells in the walls of the airways to contract. Repeated stimulation by these chemical substances increases mucus production in the airways, causes shedding of the cells lining the airways, and enlarges the muscle cells in the walls of the airways; Bach of these responses contributes lo a sudden narrowing of the airways (asthma attack). In most children, the airways return to normal between asthma attacks.

Risk Factors for Asthm : Doctors do not completely understand why some children develop asthma, but a number of risk factors are recognized. A child with one asthmatic parent has a 30% risk of developing asthma; if both parents have asthma, the risk increases to 60%. Children whose mothers smoked during pregnancy are more likely to develop asthma. In the United States, children in urban environments are more likely to develop asthma, particularly if they are from lower socioeconomic groups. Although asthma affects a higher percentage of black children than white, the role that genetic aspects of race play in the increasing rate of asthma is controversial because black children are also more likely to live in urban areas. Children who are exposed to high concentrations of allergens, such as dust mites or cockroach fetes, at an early age are more likely to develop asthma.


 

 

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Symptoms and Diagnosis of Asthma:
As the airways narrow in an asthma attack, the child develops difficulty breathing, typically accompanied by wheezing. Wheezing is a high-pitched noise heard when the child breathes out. Not all asthma attacks produce wheezing, however. mild asthma, particularly in very young children, may result only in a cough; some older children with mild asthma tend to cough only when exercising or when exposed to cold air. Also, children with extremely severe asthma may not wheeze because there is too little air flowing to make a noise. In a severe attack, breathing becomes visibly difficult, wheezing usually becomes louder, the child breathes faster with greater effort and the ribs stand out when the child breathes in (inspiration). With very severe asthma attacks, the child gasps for breath and sits upright, leaning forward and the skin is sweaty and pale or blue-tinged.

Children with frequent severe attacks sometimes have a slowing of their growth, but their growth usually catches up to that of other children by adulthood. A doctor suspects asthma in children who have repeated episodes of wheezing, particularly when family members are known to have asthma or allergies. Children with frequent wheezing episodes may be tested for other disorders, such as cystic fibrosis or gastro esophageal reflux. Older children sometimes undergo pulmonary function tests, although in most children pulmonary function is normal between flare-ups. Children who have bronchiolitis at an early age often wheeze. The wheezing may at first be interpreted as asthma but it is juts a viral infection.


 

 

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One half or more of children with asthma outgrow the condition. Those with more severe disease are more likely to have asthma as adults. Asthma flare-ups can often be prevented by avoiding whatever triggers a particular child's attacks. Parents of children with allergies usually are advised to remove feather pillows, carpets, drapes, upholstered furniture, stuffed toys, and other potential sources of dust and allergens from the child's room. Secondhand tobacco smoke often worsens symptoms in children with asthma. If a particular allergen cannot be avoided, a doctor may try to desensitize the child using allergy shots, although the benefits of allergy shots for asthma are not well known. Doctors usually do not recommend that a child should avoid exercise, but rather use an asthma drug immediately before exercising if needed.

Older children or adolescents known to have asthma often use a peak flow meter-a small device that records how fast a person can blow out air-to measure the degree of airway obstruction. This measurement can be used as an objective assessment of the child's condition.


 

 

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Treatment of an acute asthma attack consists of opening me airways (bronchodilation) and stopping inflammation, A variety of inhaled drugs open the airways like bronchodilators. Typical examples are Albuterol and ipratropiuin. Older children and adolescents usually can take these drugs using a metered-dose inhaler. Children younger than 8 years or so often find it easier to use an inhaler with a spacer or holding chamber attached. Infants and very young children sometimes can use an inhaler and spacer if an infant-sized mask is attached. Those who cannot use inhalers may receive inhaled drugs at home through a mask connected to a nebulizer, a small device that creates a mist of drug using compressed air.

Inhalers and nebulizers are equally effective at delivering the drug. Albuterol also can be taken by mouth, although this route is less effective than inhalation and is usually used only in infants who do not have a nebulilizer. Children with moderately severe attacks a may be given corticosteroids by mouth..
Children with very severe asthma attack are treated in the hospital with bronchodilators given in a nebulizer at least every 15 minutes initially. Sometimes doctors' use injections of epinephrine ( a bronchodilator) in children with very severe attacks, if they are not able to heal enough of the nebulized mist. Doctors usually give corticosteroids intravenously to children having a severe attack.

 

 

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Children who have mild, infrequent asthma attacks usually take drugs only during an attack. Children with more frequent or severe attacks also need to take drugs even when they are not having attacks. Different drugs are used depending on the frequency and severity of the child's attacks. Children with infrequent attacks that are not very severe usually use inhaled drugs, such as cromolyn or nedocromil, or a low dose of an inhaled corticosteroid every day to help prevent attacks. These drugs block the release of the chemical substances that inflame the airways. They also receive one or more other drugs, including long-acting bronchodilators such as salmeterol, leukotrine modifiers such as zafirlukast or montelukast, and inhaled corticosteroids. If these drugs do not prevent severe attacks, children may need to take corticosteroids by mouth. Children who experience attacks mainly during exercise usually inhale a dose of bronchodilator just before exercising.


 

 

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Because asthma is a long-term condition with a variety of treatments, doctors work with parents and children to make sure they understand the condition as well as possible side effects of medicines. Parents and children should learn how to determine the severity of an attack, when lo use drugs and a peak flow meter, when to call the doctor, and when to go to the hospital. Parents and doctors should inform school nurses, childcare providers, and others of the child's condition and drugs being used. Some children may be permitted to use inhalers in school as needed, and others must be supervised by the school nurse.


 

 

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Should children with asthma be given allergy shots? That question was complicated last week after a highly publicized Johns Hopkins University study found no benefit from the shots in treating a group of youngsters with moderate to severe asthma."Parents are wondering what to do and people are asking, Should I quit these allergy shots?' " said Nancy Sander, president and founder of the Asthma and Allergy Network.

Young children are more likely to develop asthma if they enter day care before four months of age, a study released Tuesday concludes. But the asthma may be the type that fades with time and could help those children resist more severe respiratory ailments later on, one of the study's authors said. USC researchers said they could not account for why early exposure to day care increased the risk of asthma, the nation's most common chronic childhood.

 

 

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Many children with asthma suffer because their disease is poorly controlled, causing sudden attacks and unplanned trips to the doctor's office or emergency rooms each year, according to a recent national survey.The survey found that asthma interferes with many aspects of family life. Parents worry about allowing their kids to play at someone else's house or to enjoy vigorous activities. They fear permanent damage to lungs and respiratory system.

Cockroaches may be a major cause of the high level of asthma in children in inner cities, a major national study reports today.Children who were allergic to cockroaches and who lived in roach-infested homes were hospitalized far more often for asthma and made more unplanned trips to a doctor because of asthma than other children, according to the study "They also had significantly more days of wheezing, missed school days, and nights with lost sleep" than children who are not exposed to these pests.

For millions of children with asthma, taking a deep breath is the stuff of dreams. Every breath they take is a struggle to provide their lungs with enough oxygen. They cough and wheeze, attacks brought on by allergies, pollution or secondhand smoke. Asthma is a chronic condition in which the lining of the lungs becomes inflamed when antigens or other stimuli are introduced. Attacks, characterized by wheezing and coughing, can be mild or can be fatal if left untreated.

It's a common dilemma among children with asthma. Fellow classmates, frightened by the lung disease, hesitate to get close to them. Adults, including child-care providers, also approach children with asthma cautiously. Many adults who are highly educated fail to understand that asthma is defnitely not contagious.

 

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A new study has found that 34 percent of Puerto Rican children in Chicago have asthma, the highest rate on record. Twenty-five percent of Chicago's African American kids also have asthma, the study found. The highest rate previously documented, 25 percent, is in New York's Harlem neighborhood. The Chicago study also found a huge racial divide in other health areas.

Poor children with asthma are less likely to be able to control their coughing and wheezing attacks, and all children with asthma tend to be healthier if their families free their homes of such asthma triggers as dusty carpet and cigarette smoke, a new local study shows. Those who are more affluent can buy the things such as a vacuum or special pillow covers that will make a dramatic improvement in a child's health.

 

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