Many parents are terribly afraid of asthma. The diagnosis makes them think of children gasping to breathe, children who are permanently disabled. But the reality for most children with asthma is much less dire. They can go to school and run around like all of their friends. They can compete in athletics. They can sleep comfortably at night.
The key to good outcomes for children with asthma is education. If you are caring for a child with asthma, either as a parent, grandparent, or teacher, you'll want to learn everything you can. Children with asthma also need information, so that they can take more and more responsibility for their own care.
Here are a few key points I think everyone ought to understand:
- A pattern of recurrent wheezing or coughing ought to raise the question of asthma. Coughing or shortness of breath after exercise or exposure to cold air, could be asthma. So could a chronic nighttime cough, even without wheezing. A child who wheezes for several weeks at the same time every year, or with every viral "cold," may well have asthma. A family history of asthma or allergies could be a tip off.
- Asthma should be diagnosed by a well-trained doctor. Other diseases can look like asthma, but require very treatment. For instance, a wheezing four year old may have swallowed a quarter, and might not remember having done it!
- It's important to figure out what triggers a child's asthma. Cigarette smoke is a very common trigger. No parent should smoke, but parents of children with asthma have an especially strong reason to stop. Many children are allergic to house-dust mites, cockroaches, and molds. Simple allergen control measures often help, such as covering the child's pillows and mattress with tight-sealing plastic covers, and vacuuming frequently using a HEPA filter. Filters on furnaces need to be checked regularly. Children who are allergic to pollen should sleep and drive with the windows closed.
- Most asthma medicine is delivered either by a nebulizer or a metered-dose inhaler (a "puffer.") Many parents assume that nebulizers work better than puffers, because nebulizers are "breathing machines." Actually, nebulizers put out big water droplets that tend to collide with the mouth and the back of the throat. Inhalers (puffers) put out a fine mist that carries the medicine deep into the lungs, where it does the most good. Puffers are also convenient and fast. But using a puffer correctly takes training and coordination, and most children less than about 3 or 4 can't manage the task.
- The most common asthma medicine is albuterol. It acts by relaxing bronchial tubes that have clamped tight in response to an asthma trigger. Albuterol is fine as a "rescue medicine," to reduce symptoms that have come on suddenly. But for more persistent asthma symptoms -- wheezing or coughing more than once or twice a week, or nighttime cough more than once or twice a month - other medications are more effective. These medicines reduce the chronic, ongoing inflammation and swelling in the lung tubes.
In the old days (when I first learned pediatrics), we only used powerful anti-inflammatory medicines for very severe asthma. These drugs were effective, but they also had serious side effects. Now we have anti-inflammatory medicines that are much safer, and we've learned to give them earlier, before asthma has damaged the lungs. The result is that many children whose asthma would have kept them indoors, on the sidelines, or in the hospital, now live full, normal lives. With better medical care and more informed parents, we should be able to get closer and closer to this goal for all children with asthma.