Childhood Asthma or bronchial asthma is a chronic inflammatory disease that obstructs the airways. But it is a reversible disease. Your airways consist of bronchioles, which are small tubules surrounded by smooth muscles. When a foreign body enters the bronchioles, the body responds by a protective mechanism called inflammation. In people with bronchial asthma, the airways have hyper-responsiveness, so the inflammation persists longer.
The inflammation brings white blood cells into the bronchioles that lead the way to airway obstruction, along with the contraction of the smooth muscles that narrow the bronchioles. And due to this inflammation, mucus secretion and mucus plugging (accumulation of mucus) is increased. This mucus plug also causes airway obstruction.
An acute asthma attack is frightening for children and adults and can even be life-threatening. Childhood asthma affects 15-20% of children globally, and asthma attacks are the commonest reasons for emergency department visits, hospitalization, and missing school. Thus bronchial asthma can affect a child’s growth, education, playing, and sleep. But only a few children with bronchial asthma carry it to adult age.
There are two types of childhood asthma:
- Recurrent wheezing – Happens in early childhood and resolves in preschool age. Viruses usually cause this.
- Chronic asthma (Allergic asthma) – Is associated with allergy and persists into later childhood or adulthood.
Symptoms Of Childhood Asthma
- Wheezing on more than one occasion – Children have a whistling from the chest when they breathe out.
- Dry cough from time to time
- Breathlessness
- These symptoms worsen at night and in the early morning
- Symptoms increased when exposed to triggers
- Cyanosis – Bluish discoloration in tongue, lips, and hands
- Difficulty to talk
- The child looks exhausted
If the child has chronic asthma, they may have the following features:
- Low body weight – Their growth is delayed due to the chronic disease
- Take large breaths – Hyperinflation of the chest.
- A groove below the lowest rib in inhalation – Called the Harrison’s sulcus
- Clubbing of the fingers
- Rashes on the skin
Signs Of Childhood Asthma
- No mediastinal displacement
- Normal chest movements
- Vesicular Breathing – But prolonging expiration
- Vocal resonance normal
- Expiratory polyphonic wheeze can be seen
- Postnatal drip
- Allergic Rhinitis – Rhinorrhea, Morning Sneezing, Postnatal drip, Watery eyes
When to see a doctor?
An asthma attack can be moderate or even life-threatening. Consider it an emergency. If your child has the above features of an asthma attack, quickly bring them to a hospital.
In an asthma attack, they may also have these life-threatening signs:
- Rapid breathing
- The chest is silent, and chest expansion is reducing
- Child’s consciousness is altered
- Tongue becomes bluish
If they already have a bronchodilator inhaler prescribed, see if the child responds to it. If not, rush to a hospital. When going to the hospital, take the previous medical records and the asthma inhalers the child uses.
Apart from an asthma attack, if your child has mild signs and symptoms like wheezing for a long time, you can take him to a doctor.
Causes of bronchial asthma
Asthma is caused by a combination of genetic and environmental factors. In a person with genetic factors and an allergy to an allergen, asthma attacks can happen when the allergen enters the respiratory tract.
Some of the triggers are:
- Pollens (Tree, grass)
- Dust
- Cold air
- Wood burning smoke
- Tobacco smoke
- Perfumes and hairsprays
- Some drugs, like beta blockers, aspirin, and NSAIDs, can trigger asthma attacks.
- Exercise
Risk factors for bronchial asthma
- Allergies such as allergic rhinitis, previous food allergies, or inhalant allergies
- Pneumonia or bronchiolitis can lead to bronchial asthma as a complication
- Males have a higher risk than females of having bronchial asthma
- Children who were born with low birth weight or lung conditions are at higher risk
- Children who live in environments with tobacco or cigarette smoking can have allergic asthma
- A family history of bronchial asthma is suggestive that a child can have it in the future
Diagnosis and investigations
When you bring your child to the hospital during an asthma attack, the doctors will assess the severity of the asthma attack. An asthma attack can be mild, moderate, severe, or life-threatening due to respiratory arrest.
To assess it, they will check for the,
- Respiratory rate and pulse, oxygen saturation
- Auscultate and see if there are any wheezing sounds or if the chest is silent
- The consciousness of the child
Other than that, there are some tests to confirm the diagnosis of childhood asthma,
- Lung Function test with reversibility
- Peak expiratory flow rate
- Skin Prick Test
- Histamine or methacholine bronchial provocation test
Chest X-Ray is not used in asthma diagnosis. But X-Rays are used to see the following things.
- in chronic obstructive asthma can cause air trapping
- in acute severe asthma complications like pneumothorax, consolidations due to infections
Management of Asthma
Management of chronic bronchial asthma
The goal of therapy:
- Achieve a good symptom control
- Minimize future asthma-related mortality and exacerbations, persistent airflow limitations and side effects of treatments.
1. Controlar medications – Inhaled corticosteroids
Reduce airway inflammation, Reduce Symptoms and reduce future risk of childhood asthma.
eg:- Steroids (Budesonide, Beclometasone, Fluticasone, Prednisolone), Theophylline
2. Reliever Medications – Broncho dilators
These drugs dilate the airways and help airflow. They do not cure the child’s allergic asthma condition. (During worsening of asthma and exacerbations) Therefore they are called relievers for childhood asthma.
eg:- Salbutamol, Terbutaline, Ipratropium bromide, Long-Acting Inhaled beta Agonists (Salmeterol, Formoterol)
3. Combine therapy
Long-acting beta-agonists and inhaled corticosteroids.
4. Add on therapy
For patients with severe childhood asthma. When a patient has persistent symptoms and/or exacerbations, despite optimal Treatment with high dose controller medications and treat for modifications risk factors.
other than medical treatments,
- Regular assessment and monitoring
- Avoiding allergens
- Educating the child and the parents about the risk of childhood asthma
Management of an asthma attack
The doctors will give bronchodilators that dilate the airways so air can easily enter the lungs (Salbutamol), steroids, and oxygen.
Maybe the child will be nebulized, or an inhaler will be given. When nebulizing, in addition to a bronchodilator like Salbutamol, Ipratropium will be added.
Sometimes the doctors will give oral steroids like prednisolone. They may also give medicine to treat any other infection the child has. In rare occasions, intravenous drugs will be given. If so, be alert if the child develops seizures or vomits as side effects.
When the child’s condition improves, the doctors will discharge the child and ask you to review the child in the pediatric clinic for asthma prevention. They will also prescribe asthma inhalers with guidelines to use them. Sometimes you will be given a chart to document the child’s improvement.
Asthma inhalers
With the medicine, asthma inhalers also will be given as treatment for childhood asthma. There are many asthma inhalers, but two asthma inhalers are most commonly used.
- Dry powder inhalers (DPI) are given to children above four years of age.
- Pressurized metered dose inhalers (PMDI) are given to little children.
They are usually given with a spacer. Additionally, a face mask is given to use if your child is less than two years of age.
Other asthma inhalers are soft mist inhalers, breath-actuated metered dose inhalers, and nebulizers used to treat childhood asthma.
With pressurized metered dose inhalers, a spacer will be given. It improves medicine delivery from the asthma inhaler to the mouth and decreases their depositing in the throat and mouth.
It’s essential to practice the techniques of correctly using asthma inhalers. During clinic visits, the doctors must assess them and advise the parents.
Avoiding allergens
Avoiding the triggers of asthma is essential for childhood asthma prevention. To identify the trigger skin prick test is done.
- Eliminating environmental exposures such as animal danders, and dust
- Removing or distancing from the animals (Pets, rats and mice, dust mites, cockroaches)
- Avoiding dust, wood-burning smoke, chemical odors, etc.
- It’s also important to treat comorbid conditions like rhinitis, sinusitis, and gastroesophageal reflux.
- Avoid cigarette smoking
- Adjust the household to prevent passive smoking of wood-burning smoke
- keep the home clean of dust.
- Using dust mite impermeable mattress covers is useful.
Clinic visit
A clinic visit is essential for treating childhood asthma. During the clinic visit, the doctors will aim to do several things like the assessing child’s condition, the effectiveness of treatments, and the side effects of the treatment.
- Adjust the childhood asthma medication and doses and the asthma inhalers. Therapy is stepped down if asthma is controlled for the last three months.
- If a step-up is needed, check the inhaler technique, adherence, control of environmental exposures, and comorbid conditions, and then conclude the step-up treatment.
- Teach and demonstrate proper techniques for using asthma inhalers and the spacer
- Investigate environmental exposures and comorbid conditions for allergic asthma
- Help to develop a two-part asthma management plan for daily management and an action plan for asthma exacerbation/ acute asthma attack.
- Schedule the next follow-up visit
Exercise-induced asthma
In some children, exercising can cause asthma. But because this can be treated with appropriate therapy, there is no need to stop routine exercise. The signs, symptoms, and other risk factors are the same as chronic childhood asthma.
Management and prevention of Exercise-induced asthma
The aim of management of exercise-induced asthma is asthma prevention. Long-Acting Inhaled beta Agonists, a group of bronchodilators with a longer action time than generally used drugs, are used when treating exercise-induced asthma. Eg: Salmeterol, Formoterol
Steroids are used along with it. It is important you take both the bronchodilator and the steroid inhalers together. They should be used before the exercises.