Watching a child with asthma struggle to breathe is terrifying and heartbreaking. I've seen it as a doctor more times than I can count, and it never gets easier. I've experienced it as a mother too; my older son had asthma and would cough and have trouble breathing when he exercised. I worried about him every time he went to swim practice in elementary and middle school and so wished there was something I could do to make the problem go away.
About one in ten kids has asthma, according to the Centers for Disease Control and Prevention, and those numbers are higher in urban areas and among some ethnic groups. But a diagnosis doesn't have to be a daily challenge for your child. In the 20 years I've been a pediatrician, we've come a long way in understanding and treating asthma. Working with their doctor, parents can do a lot to help their children.
When airways act up
To understand the condition, you need to know what lungs look like inside. They aren't big bags that fill with air when we breathe, as I used to think when I was a kid. They are more like sponges, solid structures made up of lots of tubes, called airways. The airways start out big with the trachea, commonly known as the windpipe, and then branch out into smaller airways, called bronchioles. As we breathe, the air goes down into the tiniest airways, where it gets really close to the blood -- and the oxygen from the air gets transferred into the blood.
When a child has asthma, those airways get irritated and swollen, usually as a reaction to something, and the air can't get in. The more irritated and swollen they are, the harder it is for him to breathe, leading to an asthma attack. There are drugs called fast-acting or "rescue" medications that relax the muscles that constrict the airways, and others known as controller medications that try to reduce the inflammation. Sometimes the symptoms go away easily, with medication or rest or avoiding whatever is triggering them. But in other cases they persist, and kids need additional treatment or even to go to the hospital.
It's a relief to learn there are things that you can do to help control this seemingly out-of-control condition.
Know the triggers. For some children, it's the pollen in spring. For others, it's the neighbor's cat, cold air, or cigarette smoke. For many, catching a cold does it -- and exercise can be a problem too. If cats make your child wheeze, ask about pets when arranging playdates, and avoid houses with them.
It's not always easy to know what your child is allergic to -- which is why, when I have a patient whose asthma acts up frequently, I send him to an allergy specialist for testing. The info we get from blood tests or skin-prick testing is invaluable; in many cases, a child is allergic to something nobody expected -- or not allergic at all (which means the family doesn't have to go crazy cleaning or get rid of their cat).
Have an Asthma Action Plan. This written plan details exactly which medications your child should take, and when. The specific plan will depend on your child, but the ones I use have three zones: Green (she's breathing normally), Yellow (she has a cough or other mild symptoms), and Red (she's having trouble breathing or speaking, her rib cage sucks in when she breathes, she has a cough that won't stop). Green-zone drugs are meds that your child takes every day even if she's well, and they may include controller medications. In the Yellow zone, we may increase (or add) controller meds and use albuterol or some other rescue medication. A child in the Red zone will usually take more rescue medication while you're getting her medical attention. But in my experience, when parents are alert to signs that their child is in the Yellow zone and follow the instructions in that part of the plan, it helps stop things from getting worse.
Use controller medications faithfully. These prevent or minimize the body's response to triggers, and they can make a big difference. They're usually inhaled corticosteroids taken through an inhaler or a nebulizer. (A nebulizer is a machine that works sort of like a humidifier, putting medication into a mist that your young child inhales.) Some parents worry when I say the word "steroid," but the doses we use are generally too low to cause problems. If a child has a severe asthma attack, we often have to treat it with higher doses of oral steroids to stop the wheezing. These are far more likely to cause side effects and we can avoid them by consistently using lower-dose controller meds. In kids with allergies, taking daily antihistamines or using a nasal corticosteroid spray helps.
It's the daily part that's key with these kinds of medications, and yet taking something every day can be hard. Parents may start thinking the medicine's no longer necessary -- which is easy to do when your child seems totally healthy. I often have to remind them that it's exactly because of the controller medications that their child is doing so well!
Learn to give medicine correctly. If your child uses an inhaler, you should have an aerochamber or "spacer." This is a wide tube that attaches to the inhaler and funnels the medicine so that it gets into your child's lungs instead of her mouth or the air around her. For a younger child, it's best to use one that has a mask that fits over her mouth and nose. Then all she has to do is take some deep breaths, and voil?: The medicine is where it needs to be.
A mask is also important when using a nebulizer with a little kid. Learn how to clean the tubing and how often to change it, as well as how to know if the machine isn't working right (usual first clue: It takes longer than normal for a treatment to finish). Ask your pediatrician to demonstrate how to use an inhaler or a nebulizer.
See the doctor regularly. Go at least every six months, or more often if your child's asthma acts up frequently. That way your doctor can monitor symptoms and see whether more, less, or different medication is needed -- and work with you to find ways to figure out and manage triggers. You can also be sure that your child is getting treatments or tests (such as spirometry, to measure exactly how and how well she breathes) that will help her live a normal life.
After all, that's the goal. We don't want children to have to worry about something as simple and fundamental as breathing. We -- doctors and parents alike -- want all kids to be able to be, well, just kids.
Prevention and When to See a Specialist
Can You Prevent Asthma?
Although there's no proven way to steer clear of asthma, there are steps you can take to reduce your child's risk of developing it. They are particularly important if there is a history of the disease in your immediate family.
- Avoid smoking -- during pregnancy and after -- and don't expose your child to smoke.
- Breastfeed for at least four to six months, and longer if possible, to strengthen your baby's immune system.
- Know that pets are not necessarily a problem. Children born into a home with a dog -- especially more than one -- or a cat, to a lesser extent, appear to be at a lower risk of developing asthma. (But if your child develops asthma later, you'll need to find another home for your animals.)
- Wait until at least 4 months before you start solids, and begin with just a tablespoon of pureed food or cereal once a day.
- Reduce your child's exposure to allergens in the air, particularly dust mites. Use dust-mite covers for pillows and mattresses; try to limit the use of rugs and curtains because they trap dust; and wash bedding well weekly in hot water.
- Try not to spend time outdoors on days when the air quality is poor (check airnow.gov). Children who are exposed to high levels of air pollution are more likely to have asthma.
- Keep your home free of mold and cockroaches.
- Minimize the use of antibacterial products and antibiotics. Many experts theorize that our reliance on these has caused our immune system to develop in ways that make allergies and asthma more likely. It's for similar reasons that kids who grow up on farms are less likely to have asthma and allergies. We don't understand this fully, but certain germs seem to be good for us. I'm not sure that having a dirty kid or making regular trips to the petting zoo will help, but at least you don't have to go nuts about sanitizing everything.
When It's Time for a Specialist
Your child should meet with a pulmonologist or a specialist in allergy and immunology, preferably one with pediatric training, if:
- He has a known lung problem -- such as one related to having been born prematurely.
- Allergies are suspected and not easily controlled with antihistamines.
- He often has sinusitis, ear infections, or pneumonia.
- He needs to use his rescue inhaler more than twice a week, has either frequent symptoms (a few days a week or more) or severe attacks, even with treatment.
- You want more help learning about and managing your child's asthma than your pediatrician is able to give you.
Originally published in the May 2013 issue of Parents magazine.
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