Dealing with childhood asthma
Of the nation's 22 million people with asthma, six million are children, according to the National Institutes of Health. In Baltimore, as many as one in five children suffers from the condition and many go untreated. Dr. Keyvan Rafei, head of pediatric emergency medicine at University of Maryland Hospital for Children, oversees a program for children with asthma that refers patients to a team of experts that continues their care after their emergency room visit.
How is asthma diagnosed in children? What are some symptoms that parents can look for?
Asthma can be a difficult diagnosis to make in young children because the symptoms can be very varied, sporadic and nonspecific. Many children who have asthma go undiagnosed because their symptoms are misidentified as a common cold or other respiratory problem. In order to care for a child with asthma, parents need to first understand what asthma is. Asthma is defined as a chronic disease of the airways or breathing tubes that involves both bronchospasm, twitchy or tightening muscles that wrap around the breathing tubes, and inflammation, buildup of mucus and swelling on the inside of the breathing tubes. Bronchospasm causes shortness of breath, chest tightness, wheezing and/or cough. Inflammation can make bronchospasm worse and also lead to a mucus filled, "wet" sounding cough that is very characteristic of children who have an asthma attack. Other hallmarks of asthma are symptoms such as cough and difficulty breathing that are "triggered" or set off by certain events or exposures. Among the most frequent triggers are colds and upper-respiratory infections.
How do you know if a child is suffering from asthma or if the child has an allergy?
Environmental allergies can affect both children who have asthma and those who don't — most symptoms of environmental allergies tend to be upper respiratory and include itchy and runny nose, sneezing and itchy red eyes. Children who have asthma not only frequently suffer from environmental allergies but also are at risk of an asthma attack that is triggered by these allergens. These children will frequently complain of cough, chest tightness and/or difficulty breathing in addition to the local allergy symptoms.
What can parents do to help manage their child's asthma?
The best way a parent can manage a child's asthma is to understand the disease — that is not so easy. The problem is that even though we don't frequently feel unwell during the intervals between asthma attacks, there is a great deal happening in our breathing tubes that can make our asthma attacks worse. This concept is a very difficult one to appreciate since the "control" of asthma frequently requires adherence to daily medications. It is hard enough for most of us adults to take daily medications regularly; it is even harder for a parent to make sure their child keeps up with their daily medications, especially when they seem "fine" and are not having any symptoms.
Other important things parents can do to manage their child's asthma is to learn what specifically triggers their child's asthma and what they can do to avoid these triggers. For example, for the many children who have their asthma triggered by a cold or the flu, washing hands often, getting a flu shot every fall are simple things that can help keep them healthy. Similarly, for those children with dust or dust-mite allergies, washing linens in hot water, covering pillows and mattresses with dust-mite allergy covers and removing stuffed animals from the bed are things that can make a big difference in their asthma control.
What happens when children do not get care for this chronic condition?
The biggest problem that arises when chronic asthma is not controlled is a child is at risk of frequent and life-threatening asthma attacks. That is why we place great emphasis not only on treating the symptoms that led a child to seek care in our hospital but also to educate the family and the child on this disease and even prescribe the daily controller medications right from the [emergency department] if that has not already been done by the primary care provider.
What should parents do if their child has an asthma attack?
One of the best tools parents can have to help them manage an asthma attack is what is called an 'asthma action plan.' These customized step-by-step plans help families recognize symptoms of an asthma attack and list specific medications that need to be taken if a child has an attack. Asthma action plans should be communicated to all members of the family and community that care for a child and should be frequently updated to ensure that most appropriate medications are listed and adjustments are made as needed. If a child has very severe difficulty breathing, families should immediately give their children the rescue medication and at the same time call 911 or seek immediate medical care.
Should children with asthma limit their physical activity?
If a child's asthma is well controlled, there is no reason why a child with asthma cannot enjoy the same physical activities as other children. However, if a child has symptoms of difficulty breathing or exercise intolerance, it is important to discuss this with their physician so treatments can be started to address these.
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