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Tuesday, April 9, 2019

Childhood Asthma

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How to help your child breath easy

Asthma is one of the leading chronic disease in children, which is characterized by inflammation (swelling) and narrowing of the airways, and increased mucus production resulting in obstruction to breathing. Asthma has a genetic basis but greatly influenced by environmental factors. Currently, about six million children under the age of 18 have asthma in the United States. Asthma attacks can be scary, often requiring treatment in an emergency room, hospitalization and sometimes admittance to the intensive care unit. Proper treatment and control of asthma are crucial to have a healthy and happy life for our children.

Symptoms of asthma include wheezing, cough, trouble breathing and chest tightness. Typically, a child will have recurrent episodes of wheezing, coughing or both. Parents who have or had asthma are a major predisposing factor. Other conditions commonly associated with asthma include eczema, allergies and/or chronic rhinitis symptoms. The constellation of all these is called atopic diseases. The National Asthma Education and Prevention Program (NAEPP) has published guidelines on approach, diagnosis, classification and management of asthma in adults and children.

The diagnosis of childhood asthma is mainly clinical. A lung function test or breathing test is performed to measure the severity of asthma. This test is known as spirometry and can be done at a specialized pediatric pulmonary center that takes care of children with lung diseases. We attempt to do spirometry from the age of 5 years old. Good patient effort and cooperation are required for this test. Spirometry helps us to understand children’s lung health and is an important tool to monitor the effectiveness of asthma treatment. If asthma is suspected based on the typical presentation as mentioned above, we need to classify the severity of asthma. Based on the frequency of day/night symptoms, need of rescue medications, activity limitation, spirometry when available, and the number of recent asthma exacerbations, asthma will be classified as intermittent or persistent. Persistent asthma is further classified into mild, moderate or severe types.

Once asthma is diagnosed and classified, we will initiate appropriate management for the child, which will be discussed in detail with the family, and a comprehensive “asthma action plan” will be handed over. This helps families to provide the long-term asthma care, as well as emergency treatment at home in case of asthma exacerbation. Mild exacerbations can be managed at home as per recommendations given by the asthma care team, which helps to avoid taking the child to an emergency room or urgent care. However, there are certain warning signs that should prompt the parents to take the child to the ER immediately. All these are explained in detail in the action plan.

Asthma management is very comprehensive as recommended by the childhood asthma care team, which involves medical providers, nurses, respiratory therapists and a social worker if required.

Medications:

Medications include controller and rescue medicines. Controllers work over time to decrease the airway inflammation and to prevent asthma attacks. Rescue medications are used for immediate symptoms relief. These medications can be given as a mist through a machine called a nebulizer or via an inhaler. The inhaler should always be used along with a chamber known as a spacer device to avoid the medication getting deposited into the mouth and throat. In infants and small children, the spacer is used with a facemask, and in older children, it is used with a mouthpiece. Proper technique of using the inhaler is essential to ensure adequate delivery of the medication to the lungs. A detailed demonstration of this is usually done in the asthma care center.

Triggers:

Finding and avoiding asthma triggers are another essential aspect of care. Common triggers include viral respiratory infections, cold weather, dust, smoke exposure, mold or pollen. Many children with asthma and allergies may have exacerbations during pollen season, so parents are advised to be careful and be prepared about this. Secondhand tobacco smoke exposure is one of the common asthma triggers in children, and even the smell of tobacco from a person’s clothes can elicit symptoms, so parents are strongly advised to avoid any kind of smoke exposure to their child.

Co-morbidities:

There are certain conditions seen in association with asthma. Finding and addressing these are very important for achieving adequate asthma control. These conditions include allergies, eczema, chronic rhinitis and sinusitis, acid reflux, obesity or sleep apnea. Sleep apnea usually presents with snoring, observed pauses in breathing, and episodes of choking or gasping for air.

After assessing and addressing all of these, a detailed asthma management plan is formulated which will be discussed with the child and the family. The asthma action plan will then be handed over, and the child will be followed up with frequently until adequate asthma control is obtained. Medications will be adjusted up or down according to symptoms and lung function testing when available. Strict adherence to the medication regimen as prescribed is crucial as missing several doses of controller medication may lead to asthma exacerbation.

The Pediatric Pulmonology Asthma Center at the Ochsner LSU Health Shreveport Academic Medical Center has a dedicated team to take care of infants and children with asthma. Our goal is to help children achieve adequate asthma control, prevent exacerbations and educate families about all aspects of asthma care. We are equipped to perform lung function testing in children (age 5 and older based on the child’s cooperation), provide comprehensive asthma education, and teach techniques of inhalation devices.

Sasikumar Kilaikode, MD, is chief of the Division of Pediatric Pulmonology and an assistant professor of pediatrics at LSU Health Shreveport. He is also the associate director of the Pediatric Cystic Fibrosis Center. He is certified by the American Board of Pediatrics in general pediatrics and pediatric pulmonology and is certified in neonatal resuscitation and advanced pediatric life support. For more information, please call 318-675-6094.

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