Inhale, exhale ... inhale, exhale ... Breathing is supposed to be easy and automatic. So when your child starts wheezing, coughing fitfully, or struggling for breath, it gives even the most mellow parent high anxiety. And if your child is one of the 9 million kids in the United States who has been diagnosed with asthma, you might wish you could watch him 24/7 or be tempted to limit his activities to prevent a flare-up.
Asthma, an inflammatory disease of the airways (the tiny bronchi of the lungs), is the most common chronic condition in children. No one knows exactly why asthma is so prevalent among kids, but there are a few leading theories: Some experts blame rising levels of pollution. Others point to the fact that kids today are being raised in a more sterile environment than past generations, which leads to their immune system being more easily compromised. Another possible cause is the buildup of greenhouse gases, which are boosting production of pollen. This is significant because 70 percent of people with asthma also have allergies, according to the American Academy of Allergy, Asthma & Immunology. The current obesity epidemic may be contributing too: Kids who are overweight and have elevated levels of C-reactive protein (a marker of inflammation in the body) tend to have more severe asthma, according to a recent study from Duke Children's Hospital, in Durham, North Carolina.
But the higher rate is also because doctors are now recognizing that even very young kids can have asthma. "In the past, doctors were reluctant to make the diagnosis before age 5 or 6," says Michael Welch, M.D., clinical professor of pediatrics at the University of California, San Diego. "Now, it's more common for doctors to diagnose a preschooler, a toddler, or even a baby with asthma."
In light of how much has changed about the condition in recent years, we've gathered seven surprising key facts that will be news to many parents -- even those whose children have been diagnosed.
If your young child is exposed to certain environmental factors, she may develop asthma.
Being near traffic-related pollution is one such factor, found new research from the University of Southern California in Los Angeles. And a recent study by the Centers for Disease Control and Prevention suggests that chronic exposure to high levels of ozone and particulate matter can increase the risk of asthma in kids.
Meanwhile, research in Pediatrics has shown that kids who participate in an infant swimming program in a chlorinated indoor pool might experience changes in their airways that can lead to asthma. "Indoor pools present a higher degree of chlorine exposure because the chemical is released into the air," says Dr. Welch, editor-in-chief of the American Academy of Pediatrics' Guide to Your Child's Allergies and Asthma. This doesn't mean you need to avoid indoor pools if asthma runs in your family or if your child already has it, says Dr. Welch. But it's a good idea to steer clear if your child is having a flare-up of asthma, and you may be better off with outdoor pools in general.
One concern you can cross off your list of worries: day care. In a recent study that tracked kids from toddlerhood until age 15, researchers at the University of Virginia School of Medicine, in Charlottesville, found that toddlers who were around more children had a lower chance of developing asthma. You may not necessarily need to avoid pets, either. New research has shown that when young children grow up with a cat or dog in their home, they are somewhat protected from developing asthma and allergies.
This is partly because the pets expose young children to more germs, and this keeps the immune system from having an allergic reaction to what's in the child's environment. In fact, a study involving 13,524 children under age 11 found that those who grew up on a farm had up to a 78 percent lower risk of developing asthma, possibly because of all the bacteria they're exposed to from animals and their manure. Of course, kids who are allergic to cats or dogs can have asthma symptoms triggered by exposure.
Your child could have asthma even if he doesn't wheeze.
Instead of writing off an ongoing or recurring cough as a persistent cold or a sign of allergies, take your child to a doctor. Sometimes kids have what's known as cough-variant asthma, meaning they may have a dry cough when they lie down, when they're active, or when they go out into cold weather. Recurrent bronchitis can also be a sign of underlying asthma. Coughing is a symptom of asthma, but other things can cause a cough so an accurate diagnosis is key, explains Parents advisor William E. Berger, M.D., an allergy and asthma specialist in Mission Viejo, California, and author of Asthma for Dummies. To do this in kids ages 5 and up, doctors may administer a test (called spirometry) to measure the volume of air a child can exhale forcefully into a tube. They'll listen for wheezing, which means the airways are narrowing, or coughing and shortness of breath, which comes from the muscles in the airways tightening and from the lining swelling.
A doctor might call your child's symptoms "reactive airway disease" instead of asthma.
That may be because your child is too young to perform tests that would help diagnose asthma. Or it could be because a child under 5 has mild symptoms or overly sensitive airways but the doctor isn't sure whether it's asthma, and it may be something she could outgrow before adulthood. In other words, reactive airway disease might not lead to asthma.
"The doctor may be trying not to say the word asthma, to avoid alarming parents and because the diagnosis is not certain," says Marjorie Slankard, M.D., clinical professor of medicine at Columbia University. "But regardless of what it's called, it means that the airways are overreacting to the environment." Even if your doctor refers to your child's condition as reactive airway disease when talking to you, he or she may need to call it "asthma" or "bronchiolitis" on health-insurance forms in order to get reimbursed for treatment.
If your child had eczema as a baby, she is at higher risk for developing asthma later.
"Most parents don't know about the link between eczema and asthma," says Dr. Welch, "and it's even surprising to many physicians that there's a strong connection between a condition that affects the skin and one that affects the airways."
In what doctors call the "allergic march," many kids who have eczema as a baby go on to develop allergies (often food allergies in the toddler years and/or airborne allergies in later years) and then asthma. Eczema often disappears by age 5, though. "And if you treat hay fever early, especially with allergy shots, it may lessen a child's risk of developing asthma later," notes Dr. Slankard. After your child is evaluated with skin tests or blood tests and found to have allergies, you can then minimize her exposure to what she's allergic to, start using medicine, or consider allergy shots (immunotherapy).
Asthma doesn't need to limit your child's activities.
Many parents who have a child with asthma sometimes put restrictions on their kid to try to prevent asthma attacks -- and they often feel guilty about it. Experts stress that the best way to control your child's asthma is to use the right medication strategies at the right time, not to limit what your child does. "That includes exercise, camp, and sports," says Nathanael Horne, M.D., clinical assistant professor of medicine at New York Medical College, in Valhalla.
Even if your child has only mild asthma, you shouldn't let your guard down.
Allergic triggers can lead to serious asthma attacks in children who've previously had only mild asthma, according to new research from Connecticut Children's Medical Center, in Hartford. Once a child has developed asthma, upper-respiratory viruses and allergies are among the most common triggers of symptoms, which is why some doctors recommend that kids with asthma be tested for allergies by age 5. Exercise, cold air, and exposure to smoke and irritants such as cleaning products can also bring on symptoms of asthma. So can emotional anxiety, certain medications (such as acetaminophen or ibuprofen), or foods containing sulfites (like packaged baked goods, jams, dried fruit, and canned vegetables). Even low blood levels of vitamin D are associated with lower lung function in children, according to research from National Jewish Health in Denver. But don't worry that everything under the sun could spark symptoms for your child; some kids are just especially sensitive to certain triggers.
Your child's treatment plan should be reevaluated every three to six months.
"Kids who have persistent asthma need a written asthma action plan," says Bradley Chipps, M.D., a pediatric pulmonologist and allergist in Sacramento, California. The plan -- which should be reviewed with your child's doctor two to four times a year -- ought to include strategies for what to do as soon as symptoms begin as well as how to modify treatment if necessary. Kids ages 6 and up should also use a peak flow meter (which doesn't require a prescription) to help determine how well their asthma is being controlled, Dr. Horne says. Each morning, before your child takes her medications, record the best of three measurements, and then show the doctor the log so she'll be able to adjust your child's plan accordingly.
The Mistake: Relying regularly on quick-acting rescue medication to treat your child's asthma
The Solution: If your child needs to use his bronchodilator more than twice a week, he probably needs a different preventative (controller) medication to relieve the inflammation in his airways.
The Mistake: Expecting that your young child can properly breathe in the medicine with an inhaler alone
The Solution: Your child may not be getting enough of the medicine into his airways with each dose. Use a spacer, or a spacer with a mask that has a tight seal against the face, to help him get an adequate dose.
The Mistake: Reducing or even stopping your child's controller medicine because her asthmas has improved
The Solution: To keep your child healthy, stick with the prescribed protocol. If you suspect he could do as well with less medication, talk to your doctor before tinkering with the dosage or frequency.
There are two types: those that ease asthma symptoms quickly by relaxing the smooth muscle in the airways ("rescue" medications including bronchodilators like ProAir and Ventolin) and ones used for long-term prevention that reduce inflammation in the airways ("controller" meds including inhaled corticosteroids such as Flovent or Pulmicort). "Kids with persistent symptoms should always be on controller medications," says Dr. William E. Berger. "If the inflammation that comes with asthma is untreated, airway function can deteriorate." To assess whether your child's asthma is under control, your doctor should consider how often he is experiencing wheezing, coughing, breathlessness, and nighttime awakenings, how often he needs his rescue meds, how the asthma affects him, and how well his lungs are functioning.
Originally published in the April 2011 issue of Parents magazine.
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