By Dr Naveen Saradhi Pillarisetti
This article is to revisit the management of asthma in children, and also discuss common myths and facts about childhood asthma.
Asthma is a common medical condition in children characterised by airway inflammation. It usually presents with coughing, wheezing and shortness of breath. Asthma in most children can be managed by simple treatments, but symptoms can be severe and presentations very frequent in some children, needing a specialistâ€™s input.
A preschooler with wheezing visiting a pediatric clinic or emergency is very common. About 40% of children are known to wheeze in the first five years of life, but most children outgrow their symptoms after preschool age. Family history of allergies and asthma in the parents increases the risk of future symptoms and hence a careful evaluation and follow-up is needed. An episode of severe asthma needing hospitalisation increases future risk of hospitalisation, and these children need a careful review.
If the child presents with very frequent symptoms, needing frequent use of medications, then a medical review is needed to see if we can reduce the frequency, by identifying triggers, and starting or modifying specific treatments. If your child has symptoms like a regular wet cough, poor weight gain, shortness of breath, or has symptoms when well, this requires careful evaluation, and an alternative diagnosis should be explored.
Urban air pollution, allergen exposure and frequent infections are all possible triggers in children with asthma. In most children, we donâ€™t need to investigate further and the illness can be managed with simple treatments. However, a small number of children need tests and careful monitoring of symptoms. Tests such as pulmonary function tests (with a pre- and post-bronchodilator therapy) blood test and skin prick test will help.
Treatment for asthma includes a step-wise approach. We commonly use medicine in the form of an inhaler or nebuliser in treating children with asthma. One form of this is a reliever such as salbutamol, which reduces airway obstruction. The other form of treatment is using a preventative agent which reduces airway inflammation.
There are many myths about asthma.
Myth 1: Certain foods cause asthma.
Fact: While some foods can trigger asthma in some children who are allergic to them, there is no evidence to support a blanket avoidance of certain foods in children. Usually, children with asthma are allergic to inhaled allergens called aero-allergens. Allergies to both aero-allergens and suspected foods can be tested.
Myth 2: Asthma treatments such as inhalers and nebulisers lead to dependence.
Fact: There is no evidence to support this. While some asthma therapies can go on for a longer duration in some children, there is no evidence to suggest drug-dependence with use of inhaler therapies.
Myth 3: Asthma treatments are life-long.
Fact: While some children need treatment for a bit longer, most treatments are based on a step-up or step-down approach. Medications are reduced/stopped when needed, or increased when symptoms are bad. Many children outgrow the need for treatment when older.
Myth 4: Steroids are bad and have unwanted side-effects.
Fact: Steroids in inhaler and oral form are used often in asthma treatment and are a mainstay. If used in the correct doses, the side effects of these medicines are minimal.
Myth 5: My child with asthma should not exercise.
Fact: In fact, we would encourage children with asthma to be very active and participate in all forms of physical activity. With the correct treatment, this can be achieved. Use of these medicines in the correct dose is important and the benefits far outweigh the risks.
How to know if your child has poorly controlled asthma:
If your child has a daily cough/wheeze, despite regular treatment.
If your child coughs at night regularly.
If your child needs inhalers frequently, more than twice a week.
If your child gets breathless or coughs with simple exercise.
If your child has frequent worsening of symptoms i.e. more than four times a year.
If your child has frequent or uncontrolled symptoms of cough and wheeze, it is good to seek a paediatrician or a paediatric pulmonologistâ€™s opinion.
We now have international standardised guidelines to investigate and treat children with asthma. However, each child is different and increasingly we use a personalised approach in managing asthma.
Poorly controlled asthma may lead to a poor quality of life and also lead to life-threatening hospital presentations in children, and hence the need to be vigilant. Most children with asthma can have a perfectly normal life as long as they manage their symptoms well.
This article has been produced in association with Rainbow Childrenâ€™s Hospital.
MD, FRCPCH, FRACP, CCT (UK)
Consultant - Senior Pediatrician and Pediatric Respiratory Specialist