Asthma

What is Asthma?

As defined by the World Health Organization (WHO), Asthma is a long-term condition affecting children and adults. The air passages in the lungs become narrow due to inflammation and result in the tightening of the muscles around the small airways. This causes asthma symptoms: cough, wheeze, shortness of breath, and chest tightness. These symptoms are intermittent and are often worse at night or during exercise. Other common ‘triggers’ can make asthma symptoms worse. Triggers vary from person to person but can include viral infections, dust, smoke, fumes, changes in the weather, grass and tree pollen, animal fur and feathers, strong soaps, and perfume.

A variety of factors have been linked to an increased risk of developing asthma, although it is often difficult to find a single, direct cause. Asthma is a condition with no known cure but whose symptoms can be effectively managed with the right treatment.

Asthma Symptoms

The symptoms of asthma include the following:

  • Breathlessness (rapid breathing) – The medical term for shortness of breath is Dyspnea. An asthmatic will not be able to get enough air in and out of their lungs and will find it difficult to breathe. This is caused due to the inflammation of the airway lining. It can be experienced even after light or moderate physical activity.
  • Wheezing – This high-pitched noise can be experienced while breathing. A whistling or squealing sound is often heard when breathing. In asthma, wheezing is caused due to narrowing of the lower airways.
  • Continuous coughingCoughing occurs due to the bronchial secretions of mucus and is related to airway inflammation and direct sensitivity to trigger. Asthmatics experience continuous severe coughing that stays for a longer period. This symptom can also occur at night or even after exercising. At times coughing can be accompanied by a wheezing sound.
  • Tightness in the chest – Chest tightening is many times described as a heavy feeling of weight on the chest. The tight feeling in the chest is due to the contraction of airway muscles. It can feel like a dull ache or a sharp stabbing in the chest. This makes it difficult for a person to take deep breaths.

The Pattern of Asthma Symptoms

Usually, asthma signs and symptoms have a pattern. So, an asthmatic may experience symptoms during a particular time, physical activity, or exposure to certain triggers.

  • Symptoms can come and go over time, or within the same day
  • They get worse with viral infections, such as a cold
  • They get worse particularly at night or morning
  • Symptoms are triggered by exercise, allergies, cold air, or strong emotions

Not every person with asthma shows all of these signs and symptoms. It is important to monitor these symptoms so that the doctor can diagnose the condition accurately. Studying the symptoms helps to detect the severity of the condition. The criteria to recognize the severity of asthma can be physical and symptoms’ examination.

Asthma Triggers

Asthma symptoms are caused due to various triggers such as respiratory infections, allergens, chemicals, odours, physical activity, etc. To avoid these triggers and prevent worsening of symptoms, asthmatics must make sure to avoid the triggers altogether. The daily controller medications prescribed by your doctor will help to prevent the patient from frequently experiencing these symptoms.

These symptoms can be experienced simultaneously and it is possible for an asthmatic to show one, more than one, or all of the above symptoms at a time. The symptoms of asthma, as well as the exacerbation of one’s asthma, can be caused due to asthma triggers. An asthma trigger is anything that can intensify or bring about the symptoms of asthma, and can be classified into two categories

  1. Allergic triggers
  2. Non-Allergic triggers

The allergic asthma triggers include:

  • Dust Mites: Dust mites are typically found in and around the bedding, mattresses, upholstered furniture, carpets, or curtains at home. They feed on dead human skin cells found in dust. These insects can cause the immune system of the individual to overreact, thus resulting in the individual experiencing an asthma attack.
  • Cockroaches: Cockroaches are another insect that could result in the intensifying of asthma symptoms. The shedding body parts of the insect, along with the feces of the insect, trigger the asthma symptoms of the individual.
  • Pet Dander: Pet dander or the fur of pets can act as an asthma trigger and intensify the individual’s asthma symptoms leading to an asthma attack.
  • Mould: Found commonly in moist areas like sinks, bathrooms, etc., mould can produce several allergens or toxic substances. When inhaled, these allergens can cause the hypersensitive airways to react negatively thus resulting in an asthma attack.
  • Smoke: Exposure to smoke of any kind (tobacco smoke, second-hand smoke, smoke caused by fire, etc.) can irritate the airways of the individual which could lead to the intensification of the asthma symptoms and cause the individual to experience an asthma attack.
  • Perfume and Other Strong Odours: It is not uncommon for an individual’s asthma attacks to be triggered by different perfumes and strong fumes. This could be because of the particles that are released by the perfumes that could cause the airway of the individual to get irritated, resulting in the individual experiencing an asthma attack.

Other non-allergic triggers include stress, anxiety, air pollution or poor air quality, changes in weather, dry air, etc. One of the main non-allergic asthma triggers is exercise. Exercise, if not done correctly or in moderation can trigger an asthma attack. However, regular physical activity can decrease asthma symptoms by improving lung health. Gentle, low-intensity exercises are ideal as they do not overwork the lungs, and are less likely to cause asthma symptoms. Although, some types of exercise can reduce or prevent asthma symptoms. They make your lungs stronger without worsening inflammation. The key here is - the right kind and amount of exercise. These activities minimise symptoms as they help build endurance, reduce inflammation, improve lung capacity and cardiovascular fitness. You can determine the right type and duration of exercise in consultation with your doctor.

Severity of Asthma

Asthma can vary in severity which differs from person to person and can also change over time. Classification severity of symptoms is useful when decisions are being made about its effective and timely management. The severity of asthma falls under these categories:

  1. Intermittent Asthma - For people suffering from intermittent asthma, the symptoms may usually occur fewer than two days a week, and there will be no difficulty in performing routine activities. Symptoms occurring at night can be rare. The individual may also experience brief exacerbations. The peak expiratory flow rate (PEFR) varies less than 20% from morning to afternoon.
  2. Mild Persistent Asthma - If a person has persistent asthma, the symptoms will be experienced often and these flare-ups can affect the performance of daily activities. Experiencing asthma symptoms at night may happen two to four times a month. They may also be more than once a week but less than once a day. Persistent asthma is severe as compared to intermittent asthma. Exacerbations may affect activity and sleep. Nocturnal symptoms more than twice a month. Lung function test results in 80% or more of the expected value and might vary slightly. FEV1 or PEF ≥ 80% predicted PEF or FEV1 variability < 20 – 30%.
  3. Moderate Persistent Asthma - In this category, asthma symptoms will be experienced throughout the day. The night symptoms occur more than once a week and flare-ups may interfere with the performance of daily activities. Exacerbations may affect activity and sleep. Nocturnal symptoms more than once a week. Daily use of inhaled short-acting 2-against FEV1 or PEF 60-80% predicted. PEF or FEV1 variability > 30%.
  4. Severe Persistent Asthma - In severe persistent asthma, the symptoms can be experienced throughout the day, and it can be extremely difficult to carry out daily activities, with frequent exacerbations. The night symptoms can occur almost every night. FEV1 or PEF ≤ 60% predicted. PEF or FEV1 variability > 30.

Types of Asthma

Based on the symptoms and trigger factors, asthma can be classified into:

  1. Nocturnal Asthma - Nocturnal asthma refers to the type of asthma wherein the asthma symptoms get worse during the night-time. Night-time asthma occurs due to the activation of the parasympathetic system at night which causes bronchoconstriction. Frequent nocturnal symptoms are an indicator of poor asthma control.
  2. Occupational Asthma - Occupational asthma can result from consistent exposure to a sensitive substance, causing an allergic or immunological response. It is generally caused by immunological sensitisation to a (specific) agent inhaled at work. A large, and growing – number of causative agents have been identified. These occupational ‘asthmogens’ may be macromolecules of biological origin, metallic agents, or synthetic chemicals. This can be caused by breathing in chemical fumes, gases, dust or other substances on the job. Industries that expose workers to a number of irritants in large quantities put them at risk of developing occupational asthma. Occupational asthma is largely caused due to chemicals, wood dust, grain dust, animal proteins, fungi, cobalt, nickel, etc. Irritants present in the workplace could also lead to the individual experiencing an asthma attack.
  3. Exercise-Induced Asthma - Exercise-induced asthma is narrowing of the airways in the lungs triggered by strenuous exercise. This type of asthma is mainly found in athletes, and could also result in the injury of the epithelium caused due to poor breathing during long periods of strenuous exercise. The condition is usually also related to the dehydration of the airways and can cause shortness of breath, wheezing, coughing, and other symptoms during or after exercise. Additionally, severe hyperpnea (increased rate and depth of breathing) in addition to exercise, diesel exhaust particles, nitro oxide, irritants and various other gases can result in hyper-responsive airways leading to exercise-induced asthma.
  4. Adult-Onset Asthma - Adult-onset asthma refers to the type of asthma wherein the asthma symptoms appear at a later age, generally between the ages of 12 - 65 years. This type of asthma is characterized by a poor prognosis, a severe and persistent airflow limitation and a faster decline in lung function. The major causes of adult-onset asthma include workplace irritants, environmental pollutants, hormonal changes, respiratory infections, upper airway diseases, obesity, aspirin and paracetamol intake, and stressful life events.
  5. Cough Variant Asthma - While the symptoms of asthma usually include coughing, wheezing, shortness of breath and a tight feeling in the chest, individuals with cough variant asthma tend to have dry, non-productive cough as their major symptom of asthma. They also tend to experience a lack of other asthma symptoms such as dyspnoea, wheezing, and a tight feeling in the chest and instead have a heightening cough reflex sensitivity with an unproductive cough.
  6. Aspirin-Induced Asthma or Aspirin-Exacerbated Respiratory Disease - Aspirin-Exacerbated Respiratory Disease or AERD is aspirin-induced asthma, aspirin-sensitive asthma, and aspirin hypersensitivity. This is manifested by sensitivity to aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) and naproxen . Generally, symptoms of AERD don't show until people have reached their 30s or 40s, but AERD can occasionally occur in children.
  7. Obesity-Induced Asthma - Obesity and asthma share some common factors for occurrence such as genetic, developmental conditions, physical activity and diet. Obesity may result in important changes in the mechanical properties of the respiratory system which could explain their association. There are also biological factors like diseases such as gastric reflux, sleep disorder, breathing pattern, inflammatory condition, and hormonal factors which are seen in diabetes and can either cause asthma or worsen it.
  8. Neutrophilic Asthma - Neutrophilic asthma is a type of asthma that is very severe and persistent, with frequent exacerbations, and characterized by fixed airway obstruction. The presence of airway dysbiosis is what makes this type of asthma different from other types of asthma. Neutrophilic asthma phenotype is an adult-onset disease and usually starts after 12 years of age.

The types of asthma listed here can be overlapping due to the symptoms and their similar patterns. For example, allergic asthma could have a nocturnal asthma component, which means a person suffering from allergic asthma can often experience worsening of symptoms at night and it might be difficult to classify this type of asthma.

Asthma Diagnosis

There is no single test to diagnose asthma, but the doctor can decide if a person has asthma based on the information provided by the patient. Doctors are able to diagnose asthma by going through the case history of a person and at times to confirm if a person is asthmatic or not, few breathing tests may be recommended. Here is what you can expect:

  • The doctor will try to understand the health condition after the patient gives his/her medical history and informs about the symptoms he or she is experiencing. The doctor will examine the person, and perform some breathing tests.
  • It is important for a person to share accurate information about symptoms, medication, allergies, and other health-related problems he or she is experiencing or has experienced in the past. The doctor may recommend tests needed or prescribe the appropriate medication, based on the type of asthma diagnosed and the pattern of symptoms observed.
  • Asthma tends to run in the family and family history is a crucial factor that is often overlooked. Asthma is caused by different genes inherited from parents. Studies have shown that a person’s risk of developing asthma is higher if he/she has a parent and a sibling with asthma. Knowing and providing details like these will help the doctor to look a little deeper into a patient’s complaints and determine whether he or she needs to be tested for asthma .

These are some important tests that can help diagnose asthma:

  • Spirometry is a simple and widely available tool for testing the lung’s function. Under a technician or physician’s guidance, a person blows into a machine that measures how fast he can breathe out and how much air he can hold in his lungs. This test helps to know the air holding capacity of the lungs, and how good a person’s breathing function is. Such measurements characterize the patient ’s condition, identify heterogeneity and allow treatment to be personalized. This is one of the most reliable ways of diagnosing asthma and it can be used to test other lung diseases as well. It takes approximately 10 minutes for the test and sometimes it is repeated after taking the asthma medications. For someone who is already diagnosed with asthma, spirometry can be useful to determine if the current treatment is working.
  • Peak Flow Test: A peak flow meter is an inexpensive, easy-to-use portable, handheld device used to measure the ability of a person to push air out of their lungs. By blowing a quick blast of air through a mouthpiece on one end, the device can measure the force of air in litres per minute and present a reading on a built-in numbered scale. This test may be done several times to see if results change over time. Several types of peak flow meters are available and one must consult with the doctor to know which should be used by them .
  • FeNo is a test that can help determine how much inflammation (irritation or swelling) you have in your airways (the tubes that carry air in and out of your lungs). A FeNO test does not directly test for asthma, but it can help your health care provider confirm an asthma diagnosis in adults and children ages 5 and older. You might be given a FeNO test if you are age 5 or older and the diagnosis of asthma is unclear after your health care provider has reviewed your medical history, performed an examination, and used a standard lung function test, known as spirometry. Your health care provider may also recommend a FeNO test if spirometry cannot be performed.
  • Impulse Oscillometry (IOS) provides a rapid measure of airway impedance. For this test, the patient needs to perform simple tidal breathing maneuvers that require less effort and cooperation than spirometry. It can be used in the diagnosis and management of diseases of the airways in children. Also, this test has a much higher sensitivity to detect airways obstruction. This test is not performed commonly since the equipment used is not easily available.

Advantages of Inhalation Therapy

Inhalation therapy is used for treating respiratory disorders and conditions like asthma, bronchitis, emphysema COPD. This therapy is beneficial in improving lung functioning and alleviating chronic respiratory diseases, as it allows conveying drugs directly into the airways.

  1. Advantages of inhalation therapy - This treatment route makes use of different types of inhalers to effectively manage symptoms. The inhaled route helps deliver the medicines directly to the lungs, which shows an impact on symptoms quicker as compared to other methods of delivering medicines. This is primarily because the drug is directly delivered to the lungs and does not need to be ingested and then absorbed into the bloodstream. It includes the use of asthma inhalers and a machine called a nebulizer that helps asthmatics to inhale medicines easily.
  2. Comparison with oral medication - Oral medication, on the other hand, includes oral pills and syrups, which have more side effects in comparison to inhaled medication. This is because a larger dose is consumed. Oral medications have a slower onset of action and their action is not specific to the lungs.
  3. Parenteral route - Parenteral delivery is drug administration by injection, infusion, and implantation or by a route other than the alimentary canal. Compared to oral administration, parenteral administration has control over the dose and rate. This is given by injection into a vein (intravenously, IV), into a muscle (intramuscularly, IM), under the skin (subcutaneous), and round the medulla spinalis (intrathecally).

Asthma Management Plan

An asthma action plan is a written plan developed with a doctor’s help. The asthma treatment and management action plan show how to control asthma daily, what kinds of medicines to take and when to take them. This further explains what medicines are needed and steps to follow if asthma symptoms worsen. This action plan is different for every asthmatic according to the type of asthma, their pattern of symptoms, and different triggers. Generally, the plan will have three zones:

  • Doing well (Green): In this zone, you have no asthma symptoms and you feel good. In this situation, controller medications must be taken and the symptoms can be easily controlled. The peak expiratory flow rate must be at least 80% or 80%-100% of your personal best.
  • Asthma is getting worse (Yellow): This zone indicates that you are experiencing symptoms. The symptoms get worse in this situation, therefore quick-relief medicine must be taken. The peak expiratory flow rate must be 60% to 80% of the personal best.
  • Medical Alert (Red): This indicates that you are experiencing severe asthma symptoms or an asthma flare-up, and can be a life-threatening situation. After taking quick-relief medicines, one needs to visit the doctor immediately. The peak expiratory flow rate is below 50% of the personal best.

The asthma control plan can be shared with the family and friends of an asthmatic so that they are prepared to take care in case of emergencies. This gives clear instructions on when to call the doctor or go to the nearest hospital.

Aspects of managing asthma

Avoid Asthma triggers

Asthma is an allergic reaction and that is why, when an asthmatic comes in contact with certain allergens, it triggers asthma symptoms or flare-ups. Everyone’s asthma is different, and so, their triggers are different as well. To control the problem, it’s important to identify the triggers and avoid them.

Regular medication

Asthma medicine is usually given via inhalers so that it reaches the lungs directly and causes minimal side effects. The doctor may prescribe different types of Inhalers - for long-term & regular use (controller/maintenance therapy), quick relief (reliever or rescue inhaler), or a single inhaler that has both components (controller and reliever) - termed as SMART and serves both purposes.

  1. Controller - Control Long-Term Persistent Inflammation : It is used to provide long term control over underlying inflammation & related symptoms and is taken to prevent symptoms and asthma attacks. Controllers are taken only once or twice a day as they have a prolonged effect.
  2. Reliever - Relieve Acute Asthma Symptoms: These medications relax the airways and make it easier to breathe. They provide immediate relief and are used during the flare-up of symptoms. These are basically bronchodilators that dilate the ‘bronchus’. It is essential to take these medicines as prescribed, to keep your asthma under control. Using the controller medicine regularly can also help in reducing the need for reliever medicine. These medicines can be taken 3 to 4 times a day but its frequent use means that the asthma symptoms are not under control or that the controller medicines are not effective
  3. SMART - Single inhaler maintenance and reliever therapy (SMART) reduces exacerbation risk and increases the likelihood of controlling asthma more often, and sooner . The strategy of employing a single maintenance and reliever therapy (SMART) offers more convenience to patients. this is often known to supply better improvements in several outcomes as compared to the normal combination therapy approach of constant maintenance dosing with a separate reliever.

Using the Peak Flow Meter

A peak-flow meter is a small hand-held device, which helps to monitor asthma. This device measures the peak expiratory flow rate, which gives an idea of the obstruction in the lungs.

  • Peak Expiratory Flow Rate (PEFR) is the maximum speed at which a person can exhale air from the lungs.
  • Forced Expiratory Volume (FEV) is the maximal amount of air breathed out in the first second of a forced expiration after a full inspiration/breathe-in.

The peak flow meter will help an asthmatic to know if the symptoms are in control, and also help to determine the effectiveness of prescribed controller medications. This device must be kept clean and used only by one person. If a decrease is seen in the peak flow, one can refer to the asthma management plan and know about the action that needs to be taken. Healthy people show a peak flow of approximately 350 and 650 l/min . However, this varies based on height, weight, age, gender etc. People with asthma have peak flows between 200 and 400 l/min. In severe attacks, peak flow may even fall below 100 l/min.

Regular doctor visits

It’s important to visit the doctor on a regular basis, irrespective of whether the asthma symptoms are in control or not. Asthmatics must describe in detail the symptoms they experience so that the doctor can optimize the asthma action plan along with prescribing effective medications. This way, the doctor can help a person control and manage asthma symptoms and prevent asthma attacks. The best outcomes are seen when both the doctor and asthmatic are committed to the diagnosis and treatment of asthma.

Follow A Healthy Lifestyle

The choice of diet and daily activities have a significant impact on asthmatics. It is important to adapt to a lifestyle that can help to prevent asthma symptoms or attacks. Therefore, asthmatics must follow:

  • A healthy diet - A healthy diet is important for an asthmatic as it can improve the overall health status. The diet must include food with vitamins D and E, which is present in milk, salmon, eggs, almonds, raw seeds, broccoli, hazelnuts, etc. Asthmatics must avoid food that contains sulfites and salicylates , such as canned vegetables, jams, pickled foods, potato chips, etc.
  • Exercise - It proves beneficial to prevent asthma symptoms. Precautions need to be taken while performing any exercise or physical activity. Inhalers must always be kept near while exercising. One can start routine exercise only after consulting the doctor. It is good to start with exercises like stretching and low-impact cardiovascular workouts such as walking.
  • Yoga – Certain Yoga Asanas (poses) such as Savasana, Sukasana, forward bend, seated spinal twist, side bend, and cobra pose are the yoga asanas that can benefit the lungs. Also, there are few breathing exercises called (Pranayama) that can help to improve breathing.
  • Other physical activities – An asthmatic must consult the doctor before doing any other physical activities. Activities such as cycling, swimming, and walking provides a cardiovascular workout that expands lung capacity and engages each muscle of the body. Another activity to follow for better breathing is cycling. It helps to build lower body endurance, and this is a key component of physical therapy programs.

The goal of asthma treatment is to ‘Achieve and Maintain Asthma Control’. Asthma management has advanced with the diagnosis and ways of monitoring asthma. This can help physicians optimize the treatment for an asthmatic. To manage asthma successfully, the person must stay committed to the asthma treatment required. This will help to ensure a favorable outcome and an enhanced quality of life.

Asthma Attack

An asthma attack is a sudden worsening of asthma symptoms that requires immediate medical attention. It can be triggered by various things, from allergies to various lung infections. The most common triggers of an asthma attack include:

  • Exposure to an allergen, such as dust mites, animal dander, or pollen
  • Irritants such as smoke, chemical fumes, and strong odours
  • Respiratory infections
  • Rigorous exercise, which can lead to exercise-induced asthma attack
  • Cold weather, dry air or excess humidity
  • Gastroesophageal reflux (GERD)
  • Intense emotions or stress
  • Aspirin-induced asthma attack
  • Improper treatment regimen or adherence to the prescribed medications

Symptoms of a severe asthma attack can be:

  • Inability to talk more than short phrases
  • Marked breathlessness (extreme difficulty in breathing)
  • Drowsiness
  • Use of accessory muscles
  • Discoloured (blue or grey) lips, face, or nails
  • Extreme difficulty in breathing
  • Difficulty talking or walking
  • Extreme anxiety or panic caused by breathing difficulty
  • Chest pain
  • Rapid pulse rate and a pale, sweaty face
  • Oxygen level below 94%

We can prevent asthma attacks by administering the correct asthma treatment that includes prescribing the right inhalers with the right medication (controllers and relievers). However, the symptoms of an asthma attack can vary from person to person. One can make sure to consult a doctor regarding their particular symptoms and know what actions must be taken when they experience those symptoms. To note down these actions, the asthmatic has to prepare an asthma action plan with his or her doctor, to control and prevent the symptoms, and act immediately during emergencies. By recognising the symptoms early, one can stop an asthma attack, or prevent it from getting worse. A severe asthma attack can be dangerous to one’s life and therefore, delay in treatment will only worsen it more.

An asthma attack can be mild, moderate, severe or life-threatening. If a person is experiencing a severe asthma attack, quick-relief medicine can be taken but immediate medical attention is required after that. It is important to visit the nearest hospital without any delay, as it can be a life-threatening asthma attack. Here are some steps that can be followed, as immediate actions for someone experiencing the symptoms of an asthma attack.

What To Do During An Asthma Attack

As mentioned previously, every asthmatic must have an asthma action plan that includes information on what must be done in emergency situations. This action plan will guide the person through what medicines can be given or what action needs to be taken. It will also have to include the contact of the nearest hospital, the doctor, and the caregiver of the asthmatic patient. This action plan should be shared with family and close friends, so they are prepared for emergencies.

An asthmatic can also follow these four steps if he or she is experiencing the symptoms of an asthma attack:

  • Sit upright and loosen the clothes.
  • Take a prescribed reliever inhaler without any delay.
  • If no relief is seen in 5 minutes after using the Reliever reliever inhaler, take more doses of the reliever inhaler only as prescribed by your doctor.
  • If there is still no relief, it is important to call the doctor or visit the nearest clinic/hospital without delay. Do not exceed the Reliever reliever inhaler dose without consulting a doctor.

If a person comes across anyone experiencing the above-mentioned symptoms of an asthma attack, it is important to take immediate action. Recovery of an asthma attack depends on what was the reason/trigger of the attack. These triggers worsen the symptoms of asthma, but rescue inhalers can be used for symptomatic relief.

Asthma in Children

The patient may start experiencing the symptoms of asthma at any age. When diagnosed at an early age, it is known as childhood onset asthma. Asthma is one of the leading causes of long-term illness in children and the rate of occurrence is steadily increasing. Children who are diagnosed with asthma early in life might stop showing symptoms after puberty. It is possible for the symptoms to be seen again later in life at any stage. Also, there are cases where people are diagnosed with asthma for the first time in old age.

What Makes a Child More Likely To Develop Asthma

In children, asthma can be caused due various reasons. The most common cause of asthma in children below the age of 5 is frequent upper respiratory tract infections (URTIs) such as a common cold. The risk factors and common triggers for developing childhood asthma are:

  1. Allergies such as eczema (allergic skin rash)or nasal allergies (hay fever)
  2. Airway infections such as cold, pneumonia, and sinusitis
  3. Exposure to triggers such as smoke or tobacco before or after birth
  4. Family history of asthma, atopy or allergies
  5. Living in an area with higher air pollution
  6. Obesity

Asthma Symptoms in Children

All children may not have the same symptoms because asthma symptoms vary from person to person. Symptoms can vary in each child from episode to episode as well. The patterns of experiencing the symptoms are also different for each asthmatic child. Most asthma symptoms occur at night and these are also called nocturnal symptoms which cause loss of sleep. Even for a child with stable asthma the quality of sleep diminishes, and it can affect the daily activities and performance of a child at school. Asthma can be characterized as severe or mild, and the doctor shall be able to examine this after diagnosis. The symptoms of asthma in children include:

  1. Frequent coughing spells, which may occur while playing, laughing, or at night or right after waking up. Coughing may be the only symptom.
  2. Difficulty in performing daily physical activities while at play, or running, climbing stairs, etc
  3. Rapid breathing
  4. Chest tightness
  5. Wheezing (whistling sound) while breathing in and out
  6. Shortness of breath (Dyspnoea)
  7. Tightened neck and chest muscles
  8. Feelings of weakness or tiredness

These symptoms can be effectively managed after the diagnosis of asthma which will also help the doctor to prescribe the medications for further treatment

Diagnosis of Asthma in Children

Asthma is typically diagnosed with some tests that measure the flow of air in the lungs, but younger children may not be able to complete these tests as it requires the person to blow hard into a tube. Skin or blood tests can be recommended by the doctor to check whether the child has allergies that may trigger asthma symptoms.

An early asthma diagnosis is important for the treatment of young children with respiratory symptoms. It might not be possible to diagnose children with conventional tools. Diagnosis can be difficult for children below the age of 5, but in late childhood (7-10 years) spirometry and Impulse oscillometry tests can be reliable and help as a diagnostic tool. Diagnosis and tests for children is the same as they are for adults.

Treatment for Asthma in Children

  • Using an inhaler - Asthma inhalers help in delivering medicine into the lungs, through the inhaled route. Inhalation is the most effective way to deliver medicine to the lungs. To make it easier for children to use inhalers, a spacer can be used along with it. With metered dose inhalers, a spacer can be attached to the inhaler that holds the mist of medicine in the spacer (between the inhaler and mouth). The spacer will let the child breathe in when he or she wants and this can effectively deliver medicines directly to the lungs. A mask with a spacer is recommended for children below 4 years. Another type of inhaler known as dry powder inhaler contains powder that needs to be quickly and deeply and needs no spacer.
  • Oral medication - Oral medication, on the other hand, includes oral pills and syrups, which have more side effects in comparison to inhaled medication. Quick-relief medicines (fast-acting medicine) help to open up the airways and make it easier for a child to breathe. However, when symptoms worsen, use your prescribed controllers (long-term control medicines) help to daily control and prevent asthma symptoms.
  • Using a nebulizer: For younger children, it can be difficult to use inhalers. An easier way to take asthma medicine for these children is by using a machine called a nebulizer. This machine turns liquid medicine into a mist for the child to breathe in.

Management of Asthma in children

An asthma action plan is the first step towards managing asthma symptoms for asthmatics and it plays a significant role in management of asthma in children. This sheet includes the guidelines for emergencies, the contact of parents/caregiver of the child, contact of the nearest hospital etc. This action plan must be shared with the day caregiver and teacher of the child. The sheet will also include the medications or asthma inhaler used for the purpose of relieving asthma symptoms of the child. Here are some additional tips that can help in preventing and managing asthma symptoms in children:

  • Know the asthma triggers and avoid them
  • The child must get flu shots every year
  • Children can take part in daily activities, like sports by always keeping the inhaler with them
  • Use and adjust medications to control symptoms with few or no side effects
  • Don’t let anyone smoke in the house or the car
  • Clean carpets and bedding to keep away dust mites
  • Keeps pets away from the child’s bedroom, and use the air filter or humidifier
  • Get regular pest control done in the house
  • Avoid using scented cleaning products or candles if the child is allergic or sensitive to it
  • The child must take controller medications every day
  • Use a peak flow meter to monitor asthma symptoms at home
  • Keep updating the asthma action plan under doctor’s guidance as to when necessary

Once the airways of the lungs of a child become sensitive, they stay that way for life. However, with a well controlled asthma by using inhalers regularly the child can have an almost normal life like other children. Parents can try to learn about asthma and how to control it so that they can take the essential steps towards managing their child’s condition. Parents can closely work with the doctor to plan their child’s asthma action plan and make sure that their child’s asthma is effectively managed and controlled.

Reference links

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