Asthma is one of the leading respiratory conditions affecting children. In most of the developing world, most people, and very few medical specialists know how to properly manage asthma. When not properly managed, asthma results in a lot of difficulties for growing children and occasionally results to severe illness and death.
Victoria is a 4-year-old living with asthma and her mother Muthoni would like to better understand what she can do to help.
Muthoni: What exactly is Asthma?
Doctor: Asthma is a medical condition, mostly genetic, that results in one having an exaggerated response in their breathing system to common every day environment. In the environment there are small particles that we take in as we breathe. They are too small to be seen and are commonly called antigens. These then enter the upper and lower airway, and engage with special cells in the airway- call them receptors. The reaction in asthmatic persons is that their breathing pipes tighten and they produce excessive mucus in the airway. This makes it difficult to breath.
Muthoni: Why does this happen?
Doctor: It is an allergic reaction. We know there is a genetic component, but there are many other factors that influence the severity and varying presentations.
Muthoni: Does this reaction last forever?
Doctor: No. In many circumstances, it will resolve on its own. However this could take quite some time. Medication is given to make it resolve faster.
Muthoni: How come then that some children have died from asthma?
Doctor: In some children, the disease can be severe (even in adults). They can have this reaction and develop complete blockage of the breathing system. They can suffocate. Why this happens depends on many factors such as how severe the illness is on one person, how severe a reaction the antigen triggers, other illnesses that the child might be having on that particular day, such as flu and how fast they can access treatment.
Muthoni: Therefore what can be done to intervene?
Doctor: When the child is having an attack, they need to be treated with a medication called a bronchodilator which relaxes the breathing pipe. It works very fast, and is best given as an inhaler. The tablet and syrup options are not for use during an active attack. This medicine works in seconds to minutes, and in about 15 minutes, the body has cleared most of it out of the system. For this reason, repeated administration might be required, and this is what is done for a severe asthmatic attack treated in hospital.
Those who have moderate to severe asthma are given other medicines that change the way their body works. Long-term medicines reduce the “locks” in the persons breathing system. This then results in the child having less frequent and less severe attacks. These medicines are called steroids. When used for asthma they must strictly be guided by a qualified medical doctor and given only via inhalation route (not as tablets or syrups).
Muthoni: Are you therefore suggesting that an asthmatic child should have both immediate and long term treatment options?
Doctor: Yes. The acute medication, such as ventolin inhaler should be kept ready and handy. This inhaler if used on time would prevent many of the severe cases and deaths from an acute asthmatic attack. Then the long term treatment with steroid inhaler is required for those with moderate to severe asthma.
Muthoni: Should my daughter stop playing sports?
Doctor: This is a common misconception. What most people see is that in poorly managed asthma, the children develop bouts of coughing in doing physical exercise or playing. Therefore the impulse is to avoid the activities. This is the wrong approach. In fact, it is medically proven that regular challenging exercise strengthens the breathing system of asthmatic. However, one must be careful because the asthma must be well managed first, otherwise the exercise could trigger a severe asthmatic attack. When well-managed, almost all asthmatics, even those with severe asthma, can engage in active sports. Many Olympians are actually asthmatic.
Muthoni: What can I do to reduce the incidence of asthmatic attacks?
Doctor: Frankly not much, because you cannot control the air your child is breathing. If there is an identified antigen, such as a specific food that triggers an attack, this can be avoided. If it is pollen, you might want to avoid having fresh flowers in the house every week. General cleanliness of beddings is necessary, to remove house dust mites.
Muthoni: What are the complications of asthma?
Doctor: There are the common complications due to a destructive cough or difficulty in breathing. The child might not be able to sleep well, or eat properly. This might lead to general dullness, sleepiness in class, and consequently poor performance, or poor growth and development. Poorly managed asthma will also be complicated by repeated upper and lower airway infections.
Muthoni: Will my child outgrow asthma?
Doctor: Yes, this is possible. Many asthmatics present only in specific times in their lives, either early childhood, or after the age of 65 years. There are also many children who are not asthmatic, but tend to show symptoms similar to those of asthma at certain times, such as when they have flu. Many asthmatics will also have changes in severity of symptoms through their years of growth. You will have to wait and see how your daughter progresses as she gets older.