Wheezing and breathlessness caused by reversible narrowing of the airways in the lungs. More cases of asthma are being reported than ever before. Is this because we’re all more allergic than we were? Is it because, in towns at least, there’s more pollution? Or is it because we don’t understand what we have to do to prevent asthma? There’s quite a lot of evidence that it is the latter.
Asthma In Babies
In children, asthma is primarily an allergic disease that affects air passages (bronchi) that are extra sensitive to triggers.
When the allergic reaction takes place, the bronchi constrict and become clogged with mucus, making breathing difficult. The muscle around the walls of the airways tightens so that inhaled air can’t be forced out. An asthma attack can be very frightening for a child because the feeling of suffocation can cause panic, making breathing even more laboured.
The initial cause of the allergic reaction, the allergen, is usually airborne – pollen or house dust, for example. Once asthma is established, emotional stress or a mild infection such as a cold can also bring on an attack.
Asthma doesn’t usually begin until a child is about two years old. The condition tends to run in families and may, unfortunately, he accompanied by other allergic diseases, such as eczema, hay fever and penicillin sensitivity.
However, the good news is that most children get better as they get older.
Wheezing In Babies
Many babies under one year wheeze if they suffer from bronchiolitis, when their small air passages become inflamed. These babies aren’t necessarily suffering from asthma; as they grow, their air passages widen and the
wheezing will stop. Infection and not an allergic reaction is the usual cause of this kind of wheezing.
Is It Serious for the Child?
Asthma attacks can be frightening but, with medication and advice from your doctor, your child should suffer no serious complications.
Symptoms of Asthma in Babies
- Laboured breathing: breathing out becomes difficult and the abdomen may be drawn inwards with the effort of breathing in.
- Sensation of suffocation.
- Persistent cough, particularly at night.
- Getting short of breath – a child doesn’t run around as much as usual.
- Blueness around the lips (cyanosis) because of lack of oxygen.
Steps You Should Do
- Consult your doctor immediately if your child is having any kind of difficulty with breathing.
- If the attack occurs when your child is in bed, sit him up, propped up with pillows. Otherwise, sit him on a chair with his amis braced against the back to take tile weight off his chest; this allows the chest muscles to force air out of the lungs more efficiently.
- Stay calm; a show of anxiety would only make your child more fearful.
- While waiting for the doctor, try to take your child s mind off the asthma attack. Sing to him, for example, to try to help him forget about the
- Put a humidifier in the room to ease his sensitive air passages.
- Give him lots of reassuring cuddles.
Consulting Your Doctor
- The mainstays of treatment arc reliever drugs to relieve an attack of asthma and preventer drugs to stop an attack from happening. Preventer drugs must be taken all the time to keep a child free of asthma symptoms.
- Your doctor will treat the attack with a reliever drug, usually a bronchodilator, which opens up the bronchi by relaxing muscles in the lining of the air passages. This drug is inhaled directly into the bronchi and gets right to the site of the obstruction. A severe attack may need treatment in hospital, where bigger doses of bronchodilator drugs may be given by inhalation or by intravenous drip.
- If there’s evidence of a chest infection, your doctor will prescribe antibiotics.
- Your doctor will want to prevent further attacks. He may, for instance, try to determine the allergen, so that your child can avoid it, probably by performing skin tests for the most likely allergens, such as pollen and house dust.
- He’ll give you a supply of a bronchodilator drug, usually as an inhaler used with a “spacer” that is easy for children to use, to be taken as soon as an attack begins.
- Your doctor will ask you to inform him if your child has a severe attack, or if an attack doesn’t respond to two doses of the bronchodilator.
- Your doctor may prescribe a steroid drug if other simple measures don’t stop further attacks. Don’t be afraid, steroids for asthma are nearly always inhaled into the deepest parts of the lungs, and are quite safe. A small dose of steroid may be inhaled three or four times a day.
Things You Should Do
- If your doctor has not pinpointed the allergen, try to track it down yourself. Notice when the attacks occur and at what time of the day or year. Avoid obvious allergens such as feather pillows and keep the dust down in your house by damp-dusting and vacuuming floors rather than sweeping them.
- Many asthmatics are allergic to animals -their hair, fur and saliva. If you have a pel, ask a friend to look after it for two weeks and see if your child’s attacks reduce in frequency.
- Make sure your child has the prescribed drugs nearby at all times.
- Inform his school about the possibility of attacks occurring.
- It’s vital your child takes his preventer medicine continuously and does not stop just because he’s feeling fine. Never stop a preventer without consulting your doctor.
- Ask to be referred to a physiotherapist so your child can leant breathing exercises to help him to relax during an attack.
- Encourage your child to stand and sit up straight so that his lungs have more space. Don’t let him gel overweight, as this will put an extra burden on his lungs.
- Moderate exercise can help his breathing, bur loo much can bring on an asthma attack. Swimming, however, can he especially helpful tor children with asthma.
Common Causes of Asthma
For oxygen to enter the blood stream and carbon dioxide to leave it, blood has to come into close contact with inhaled air. Within the lungs this takes place in innumerable tiny sacs reached by ever narrower tubes. Here inhaled air passes over blood vessels and the exchange of gases takes place – the stale carbon dioxide passes out of the blood stream and oxygen passes in. The walls of these tubes contain muscle, which, if it contracts, squeezes the tube narrow and conversely lets it widen as it relaxes. In asthma, this muscle is abnormally sensitive and so the walls can be squeezed narrow unusually easily, thereby obstructing the free flow of air. Often, these small airways are also oversensitive to irritants in general, so asthmatics frequently also suffer from hay fever and eczema.
The easiest way to gauge this obstruction to airflow is called pefr (peak expiratory flow rate). This is measured by blowing hard into a meter that shows how much air you can shift in litres per minute. This measurement is useful in deciding the diagnosis and in monitoring treatment.
Just why certain individuals are affected by asthma is not known. However, about 10-15% of children get asthma and a high percentage of adults, too. These numbers are increasing as a result, it is believed, of worsening air pollution as well as commonly found irritants such as cigarette smoke and the house dust mite. It may also be that mild asthma is now being recognised more readily by doctors.
Common Symptoms of Asthma
During an asthmatic attack, people become increasingly wheezy and feel breathless; their rate of breathing rises and they literally have to force their lungs hard to get air in and out, which can be exhausting. An asthma attack is a dramatic event but fortunately is relatively rare as a first sign of asthma.
A common early symptom of asthma is a persistent cough with a little wheezing, especially during the night – frequently the first symptom in children. They may feel fine until they exert themselves, which brings on the wheezing. These symptoms are made worse by anything that irritates the lungs; this includes dust, fumes, emotional excitement, temperature changes, furry pets and pollen. Certain drugs can also bring on attacks in susceptible people, for example beta-blockers (for high blood pressure) and anti-inflammatory drugs.
In babies with asthma simple colds will always ‘go to their chest’ and any cough is complicated by accompanying wheeziness. If the baby also has eczema it is highly likely that the child is susceptible to these allergic ailments and will develop true asthma as he or she gets older.
There is often a period of uncertainty before the diagnosis is definite. The key to making the diagnosis is to show that the obstruction to airflow – the wheezing – can be reversed quickly by treatment. This is where the peak flow test is useful. During even mild asthma there will be a measurable reduction in peak flow. For example, an adult woman who should have a peak flow of around 550 litres per minute may achieve only 350 but after a couple of puffs of an inhaler the peak flow rises back to normal. Thus both the doctors and the individual can keep a record of how effective treatment is. It is frequently a question of trying out various antiasthmatic treatments to sec how the individual responds.
Treatment of Asthma
The modern treatment of asthma has three strands. These are removing irritants, reducing the sensitivity of the lungs and treating acute problems.
All asthmatics should stop smoking. It is more difficult to control household dust but measures can include fitting special bags to vacuum cleaners to filter dust and wiping surfaces frequently so dust does not build up. Many people wony about the house dust mite, an insect found in enormous quantities in even the cleanest home. Asthma is made worse by sensitivity to its droppings. It is impossible to eliminate these mites but regular cleaning helps and very sensitive individuals can cover pillows with polythene before placing them in pillowcases. Think carefully before you buy a furry pet as people with asthma may develop sensitivities to animals, especially cats, and it is hard to remove a much-loved pet.
Preventive treatments consist mainly of inhaled steroid drags, which have revolutionized the treatment of asthma in the last 20 years. They deliver very small quantities of steroids straight into the lungs, where they reduce the sensitivity ol the lining of the lungs. Understandably, people worry about the side effects of steroids, such as weight gain, diabetes and poor growth. These are possible only where large quantities are taken by mouth over many months. Inhaled steroids are very safe and have not been shown to carry any significant risk. Drugs include beclomethasone and budesonide. There are many devices to deliver these drugs – all rely on producing a fine spray of gas to be breathed deep inside the lungs.
Cromoglycatc is an alternative non-steroid preventive drug, very effective in some people. Again, it works by reducing the irritability of the linings of the lungs.
Drugs called bronchodilators are used to treat acute attacks. They have a direct action on the muscles in the walls of the airways, forcing them to relax, allowing the airway to open up and so ease the flow of air. Drug names include salbutamol and tcrbutaline. These drugs are given by inhaler, injection, nebulized line spray or tablet. Long-acting forms relieve night cough, such as salmctcrol. New drugs called leukotrienes can further reduce symptoms in children and adults.
In severe attacks it is normal to add a steroid by mouth; this delivers a very high dose with the aim of reducing inflammation rapidly. Typically this would be given for five to ten days. Even young children can benefit from a short course of steroids during a severe attack.
In-hospital treatment might include oxygen and broncho-dilating drags given directly into the blood stream via a drip.
The most difficult to treat are young children, because their lungs do not respond to treatments in the same way as the lungs of older people. Even so, nebulized bronchodilators can help from about nine months of age. Syrups arc also available.
Measuring the effectiveness of treatment
Treatment should allow the individual to follow a normal life, which includes exercise and sport. This may not be achieved in the most severe cases, but it is the goal for the great majority and if their treatment docs not achieve this then it needs reviewing. Regular pri k measurement helps show how good treatment is and also warns of any deterioration.
People with severe asthma may have to adjust their lives by giving up jobs involving dust or fumes and giving away pets.
Commonly Asked Questions Regarding Asthma
Is allergy testing useful?
Generally it is not, because most asthmatics will prove to be sensitive to predictable things such as the house dust mite or pollen. It can be useful if asthma occurs in certain settings or is of recent severe onset, which suggests something very specific is responsible. Allergy testing might help establish whether or not to keep a pet.
Do people grow out of asthma?
A large percentage of mildly wheezy children grow oul of it by late childhood. People who still have asthma by late childhood or who develop it as adults are likely to have it lifelong.
Do not abandon conventional approaches. Chinese and Western herbalism both offer herbs to reduce the oversensitivity of the airways – experienced practitioners will advise. Homeopathy can be extremely effective, but it is impossible to generalize about treatment, which depends on many variables.
The Alexander Technique is particularly effective in dealing with breathing difficulties and chest problems. It encourages a release of undue muscle tension in the neck and chest, which can lead to a gradual increase in chest capacity. Diet – consult a nutritional therapist or a naturopath for advice. Chiropractic manipulation in the upper back can help loosen the chest area and aid breathing. Ayurveda offers panchakarmu detoxification, yoga breathing exercises, dietary advice and marina therapy. Hellerwork improves breathing dramatically, and eases tension caused by difficulty in breathing. Other therapies to try: chakra balancing; acupuncture; healing; autogenic training; hypnotherapy; tai chi/chi kutig.
Ayurveda offers panchakarmu detoxification, yoga breathing exercises, dietary advice and marina therapy. Hellerwork improves breathing dramatically, and eases tension caused by difficulty in breathing. Other therapies to try: chakra balancing; acupuncture; healing; autogenic training; hypnotherapy; tai chi/chi kutig.