What is Asthma?

Asthma is the most common chronic disease of childhood (5 million children) and has been increasing steadily since the 1970’s. Asthma is a lung disease of the airways that can make it hard to breathe. Anyone can develop asthma at any age. Asthma symptoms can be mild, moderate or severe at different times in your child’s life. Some children will have only occasional episodes and others will have problems every day.

Asthma often begins in childhood. For some children, asthma becomes less severeas they get older. But some children have asthma all their lives. The exact causeof asthma is not known, but it does seem to run in families. You can not catchasthma from other people.

Uncontrolled asthma symptoms often interfere with school, work, play, sleep,and other activities. Your child may have less staying power or seek to limitor avoid physical activities to prevent coughing, shortness of breath or wheezing.Asthma symptoms may also effect energy levels and concentration.

Asthma goes by many names: wheezy, bronchitis, chronic bronchitis, asthmaticbronchitis, bronchial asthma and reactive airway disease (RAD). The words “asthmaepisode”, “asthma attack” and “asthma flare” all have the same meaning when yourasthma is out of control.

Asthma affects the lungs. During normal breathing, your lungs bring in freshair and push out the used air. When people have asthma, the airways in theirlung react to things that usually don’t bother people without asthma. These thingsare known as triggers such as smoke, pollen, weather changes, exercises, andstrong smells.

During an asthma episode, air has trouble getting in and out. It is hard to getrid of the used air and bring in fresh air. The linings of the airways swell.Muscles around the airways tighten making the airways smaller. The airways producemore mucus causing the airways to become even smaller. This makes it more difficultto breathe. Your child may begin to cough, wheeze, chest tightness and shortnessof breath. This may be preferred to as “twitchy airways”.

Some asthma attacks are mild. Some asthma attacks can get very serious. About5,000 people can die from a bad asthma attack when they do not seek medical care.Most asthma deaths are preventable as well as the long-term effects of asthma.

You can not cure asthma but you can control asthma. Children with asthma canhave normal active lives when they learn to control their asthma. Children canwork, play, and go to school. All over the world many children and adults haveasthma and many of them are athletes.

How can I control my child’s asthma?

Your child’s asthma medications will depend on their symptoms. Children withasthma should always have a quick relief medicine (bronchodilator) availablefor immediate use no matter whether they are at school, work or play during anasthma attack. If your child uses quick-relief medicine more than twice a weektell your health care provider. They may need a controller (anti-inflammatory)medicine as well.

Bronchodilators (beta-agonists) act to relax muscles that tighten around airwaysduring asthma attack. There are two types short and long acting bronchodilators.Quick relief bronchodilators start working within five minutes after use. Thelong acting bronchodilators help prevent episodes of asthma and should not betaken for treatment of sudden symptoms. Ipratropium can also be used to relaxmuscles that can tighten the airways. Bronchodilators may make your heart ratebeat faster and sometimes cause tremors of the hands and fingers but these wearoff with use.

Inhaled Corticosteroids are anti-inflammatory agents or controllers prevent andreverse inflammation in airways and swelling of the airways. This makes the airwaysless sensitive and keeps them from reacting as easily to triggers. In short thecontrollers prevent asthma episode and are the preferred treatment for mild asthmato severe asthma. Inhaled steroids work locally within the lungs and have verylittle effect on the rest of the body. These steroids are not the body buildingkind. These medications must be taken every day for them to work well. Peoplewho have asthma symptoms more than twice a week should take anti-inflammatoryagents. Sometimes you can develop thrush to avoid this rinse mouth after usinginhaled steroid or by using a spacer. Or if using a mask wipe your face off.

Cromolyn and Nedocromil are anti-inflammatory agents are important in preventingand reducing inflammation and swelling of the airways. They take longer to workthan bronchodilators. Usually 4-6 weeks to see the maximum effect. Cromolyn maybe used 20-30 minutes prior to exercise to prevent an asthma attack on a regularbasis.

Leukotriene modifier medications are long-acting oral medicines that block partof the asthma reaction and help reduce symptoms. These medicines that taken everyday to control asthma and help prevent attacks. These should not be used forquick relief.

Oral Steroids are used during acute asthma attacks to reduce the inflammationin the airways and mucus during an asthma episode. They are usually only continuedfor 5 to 7 days to avoid side effects. These medications are different (thoughchemically related) to the anabolic steroids used illegally by some athletes.

Remember: bronchodilators relieve symptoms, but they cannot reduce or preventthe airways swelling that causes the symptoms to return or persist. When youuse your bronchodilator frequently, it can be a sign that the swelling in yourchild’s airways is getting worse. Your child will probably need another kindof medication. In addition allergy medicines may be prescribed. These may helpprevent asthma attack by controlling your reaction to allergy triggers.

If you take more than one inhaler medicine, use the quickrelief medicine (that opens airways) first. Often the same medication is available in several forms--- inhaler, pills, capsules or liquid. Many healthcare providers prefer to prescribeinhalers because you breathe the medicine directly into your lung, where it goesdirectly to work.

Inhaler (MDI – metered dose inhaler) is a device in which the asthma medicineis contained under pressure in a canister. It delivers medication in a sprayform. Using an inhaler is a good way to take asthma medicines. There are fewerside effects because the medicines go right to the lungs and not to other partsof the body. A spacer attaches to the metered dose inhaler and holds the medicationin a chamber while your child inhales slowly. It does not require the coordinationnecessary for an inhaler and makes it easier for the inhaled medication to godirectly into lungs. A mask can be added to the holding chamber for small childrenand sick adults. It takes about 2-3 minutes. Dry powder inhalers may also beused and a spacer is not required.

Nebulizer is a machine that turns the medicine into a mist inhaled through mouthpieceor mask. This method is especially useful when the child is either too youngor too sick to use other devices. Depending on nebulizer it will take 10 to 15minutes.

What are peak flows?

Watch out for the earliest sign that your child’s asthma is getting worse suchas drop in your peak flow meter reading. The peak flow meter is a small, hand-heldtool that measures the amount of air you move in and out of your lungs (PeakExpiratory Flow Rate - PERF). During an asthma episode the airways begin to narrowslowly. Your child’s peak flow numbers will begin to drop before a stethoscopecan hear the changes. It is like a thermometer or blood pressure cuff for yourlungs. Everyone with asthma should have a peak flow meter and know how to useit.

An asthma episode is easier to stop if your child take the medication as soonas symptoms start. If you find your child’s medicines are not working as wellor for as long as it previously had, this may be a sign that your asthma is gettingworse. Discuss this with your healthcare provider.