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Asthma: A To Z by: BARRY A. COHEN, M.D. Asthma is a very common illness. Textbooks estimate that between 5-15 percent of children have asthma. Definition A simple definition of asthma is recurring episodes of wheezing that respond to bronchodilators. Asthma is a complex disorder with several possible genes interacting with the environment to yield disease. The critical characteristics of asthma are airway hyper-responsiveness and inflammation. Simply put, the tubes that conduct the air to our lungs over-react and become narrow, making it difficult to breathe. The most recognized symptom of asthma is wheezing. Wheezing is a whistling noise while breathing that is caused by narrowing of the airways. Another symptom is persistent, recurrent cough that is often uncontrollable. Exercise limitation, sleep disturbance, and even heartburn may occur. Having poor control of your child’s asthma generally translates into missed school, emergency room visits and even hospitalizations. A goal of the physician is to educate the patient on how to recognize symptoms and modify their treatments accordingly.
Another air quality issue is furry pets, the worst being cats. Cat dander stays in the air for hours and represents indoor air pollution in addition to being an allergen. Dander from dogs generally stays on the furniture or the floor and if the dog is restricted from the bedroom and the furniture then allergen exposure is not as severe. If a child has dust allergy, then making the bedroom a safe environment is a priority. This includes covering the mattress and pillows with a hypo-allergenic barrier, washing pillows, removing dust, cleaning closets, discarding stuffed toys and treating or removing carpets. Prevention of mold and mildew in the house is also important: control the moisture, treat walls if mold is present, clean air conditioners and heating ducts. Influenza vaccines are an important part of asthma control and should be given every October. Other family members should receive the vaccines if their child has significant asthma symptoms. Not every wheeze is asthma. It is important to see your child's physician and have a differential diagnosis. If asthma is identified, proper treatment planning and education can control your child's condition. Medications
Rescue Medications Short-acting bronchodilators generally relieve airway obstruction within several minutes and last for 3-6 hours. The most common rescue medication is albuterol. A patient who relies on bronchodilators several times weekly generally requires preventive medication. Since the asthma condition exists in the airway, the airway is best reached by inhaling medications. Metered-dose inhalers work better with valvedholding chambers. These chambers catch the puff and allow the medication to be inhaled slowly and more effectively. They also trap the larger particles of medication that would end up in the mouth, further minimizing side effects. Nebulizers are available for some medications. Studies have shown that the valved spacer devices are equally effective and certainly have quicker use. There are also breath-actuated metered-dose inhalers. For severe attacks, oral steroids are given for 3-5 days. Most commonly Prednisone is prescribed. Very few patients have a long-term need for oral steroids. Many physicians will provide Prednisone tablets or liquid for their patients to self-administer if they are able to recognize a severe asthma attack. This may prevent the need for an emergency room visit. Other less-common rescue medications include anticholinergic drugs and theophylline. Preventative Medications Steroid inhalers are the mainstay of our preventive medications. They work topically on our airway and do not have absorption to cause significant side effects. They are quite effective and safe and have been used in millions of patients. Inhaled steroids might include Fluticasone, Budesonide and Beclomethasone. These medications relieve inflammation, improve the airway health and can prevent symptoms. Another class of preventive medications is leukotriene inhibitors. Practically speaking, only a minority of asthmatics receive excellent relief from these drugs. Antibiotics do not treat asthma. They can be used to treat pneumonia, sinus infections, ear infections or bronchitis with productive sputum on a regular basis. Most of the infections that trigger asthma attacks are caused by viruses which would not respond to antibiotics. Nasal inhalers are often used to treat a runny nose and postnasal drip. Nasal congestion and dripping can trigger coughing which can worsen asthma. Cold and cough medications generally do not play a role in curing an asthma attack. They may worsen the side effects of asthma medications and may worsen an asthma attack. Allergies and Asthma Allergy testing can be helpful to help identify asthma triggers. A common misconception is that a patient says, "I am wheezing because I am allergic and I don't have asthma." The correct interpretation would be that the wheezing represents asthma and a trigger for the asthma attack might be the allergies. It is important to treat the asthma appropriately. Allergy is very common in patients who have asthma. The lung exhibits allergy through wheezing and coughing. Common triggers include viral infections, air pollution, smoke, pets, dust, mold and other allergies, exercise, cold air, humidity, foods, gastroesophageal reflux, postnasal drip and sinus problems. For an appointment with the department of Pediatric Pulmonology, please call (973) 322-7600.
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Prevention Air quality issues are very important, and the biggest would be exposure to cigarette smoke. Infants are frequently bothered by the smell of smoke on parents' hair, clothing, furniture, automobiles, etc. and often have chronic cough from this exposure. It is felt that, particularly in the first year of life, exposure to smoke can damage the developing lungs. Smoking cessation programs are strongly recommended.
