Asthma

Preventative care key to managing asthma

 

icordle@MiamiHerald.com

Liz Olguin noticed that her 8-year-old son Grant would cough in colder weather, and when he exerted himself during a Caribbean cruise, he couldn’t catch his breath.

So Olguin took him to Dr. Juan C. Martinez, a pediatric pulmonologist, who diagnosed him with asthma.

“It was the muscle bands going around his airways that were contracting,” said Olguin, 50, who lives in Davie.

Now on medication, Grant’s asthma is under control, and the family has made adjustments at home to reduce allergens, like mold, that can trigger an attack.

Asthma is a chronic inflammatory condition of the airways associated with recurrent episodes of coughing, wheezing and shortness of breath, said Martinez, director of the division of pulmonary medicine at Joe DiMaggio Children’s Hospital in Hollywood.

Asthma tends to peak in children, particularly in those under 10 — as well as in the elderly, he said.

In fact, according to the Centers for Disease Control and Prevention, 9.5 percent of children under 10 suffer from asthma.

“Not everyone recognizes the symptoms,” Martinez said. “It is very under diagnosed. They think it is an infection or a cold and they don’t understand why the cold lasted three weeks, and they don’t understand why they are short of breath or coughing for months on end.”

In children 6 or older, doctors can diagnose asthma using a breathing test, called a spirometer. For those younger than 6, diagnosis is based on clinical analysis, including checking for cough, wheezing and shortness of breath, as well as the child’s response to medications and environmental control.

When school starts, doctors say they often see an increase in the incidence of asthma attacks, which can be triggered by viruses passed among children, or even from dust mites that linger in classrooms.

Asthma also can be triggered by other environmental factors, particularly tobacco smoke, as well as by outdoor air pollution, cockroach allergen, pet fur, mold, chemicals and fragrances, humidity and physical exercise, according to the CDC.

When a child suffering from an asthma attack winds up in the emergency room, the staff at Joe DiMaggio will create an asthma action plan and refer the child to a physician to seek preventative treatment.

“The cornerstone of this disease, of treating it properly, is educating the parents,” Martinez said. “Education goes into what medicines they are taking, why they are taking them, and what that medicine does so they won’t get them confused.”

Miami Children’s Hospital also offers evaluation, education and access to doctors in its specialized asthma center.

“The most important thing for a patient that has asthma is to have access to healthcare professionals 24 hours a day,” said Dr. Maria E. Franco, a pediatric pulmonologist and director of the cystic fibrosis center at Miami Children’s Hospital.

Educating the family includes teaching them what is needed to support the child and how to identify the signs and symptoms that indicate that the child is not doing well, Franco said.

Also vital is teaching parents what to do at home, particularly eliminating smoke in the house, avoiding chemicals and perfumes that will irritate the airways and avoiding humidifiers and vaporizers, because increased humidity can lead to mold and dust mites.

Franco also advises patients who are allergic to dust mites to use covers for pillows and mattresses, to eliminate items that collect dust like stuffed animals and books, and to avoid using a fan, which moves dust around.

To treat asthma, doctors use both rescue therapies and preventative therapies, Martinez said. Rescue therapies include bronchodilators, like Albuterol, used to relax the bronchial tubes and relieve the spasm in the airways when a child is having an asthma attack.

Others medications are preventative, such as inhaled corticosteroids — including Flovent, QVAR, Pulmicort and others, which are designed to be used every day.

Corticosteroids can also be used in the acute stages of asthma, and can modify the severity of an attack if used early enough, said Dr. Andrew Colin, a pediatric pulmonologist who is the Batchelor professor of cystic fibrosis and pediatric pulmonology at the University of Miami and is the director of the program of pediatric pulmonology at UM/Holtz Children’s Hospital in Miami.

“We have modified the face of asthma from a disease that was landing children in the emergency room and hospital in the hundreds with no appropriate response, to one that is entirely treatable outside the hospital,” Colin said.

“The appropriate preventative approach, and keeping track of the child over time with the appropriate modification of the medication, can make asthma a very tolerable disease,” he said. “They don’t miss school. They sleep at night and can participate in games and participate at sports.”

Diagnosis and treatment are key, and can prevent the child from becoming an inactive adult, Colin said.

“It is the very mild asthmatic that is the risky kid because it will impact the way they perceive themselves, that they not able to run,” he said. “And they will not participate in sports, and will not become athletes, and will change their lifestyle from one that is normal and active to one that is sedentary — and they will watch TV all day and become obese.”

Doctors say that for a child with asthma, ongoing follow-up with a physician is crucial.

“Asthma is a condition that can have a lot of ups and downs and it’s very important for it to be evaluated periodically,” Martinez said. “It’s not the type of treatment that you treat once and it goes away. You have to monitor it regularly, and that is the best way to optimize control.”

Today, it is only an exceptional asthmatic that cannot be effectively treated, Colin said.

“Many times by doing the right medications, the right education, the access to healthcare and compliance with medication, they can have a very normal life,” Franco said. “That is the goal — to have a very normal life.”

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