Every season carries the risk of asthma flare-ups in children. Parents dread seasonal changes, anticipating the loss of their child’s asthma control: the start of the school year with exposure to upper respiratory tract infections, winter with its cool, crisp air and increased exposure to viral infections, spring with its pollen and summer with its heat and humidity, in addition to increased participation in physical activities. These are all strong triggers and culprits for asthma attacks. So, how can a parent assess his or her child’s asthma control and be prepared to face the triggering challenges?
Asthma is defined as a chronic — meaning long-lasting — inflammatory disease of the airways. It is, in fact, the most common chronic disease of childhood. So, if you have a kid with asthma, you are not alone. In children susceptible to asthma, inflammation causes the breathing tubes to narrow periodically. This narrowing, in turn, produces coughing, wheezing and breathlessness that sometimes causes the child to gasp for air. Obstruction to air flow either stops spontaneously or responds to a wide range of treatments, but continuing inflammation makes the airways hyper-responsive to stimuli mentioned earlier.
Some children have only exercise-induced asthma. In these cases, exercise can cause coughing, wheezing, shortness of breath, chest pain or tightness, tiredness and difficulty keeping up with others. These symptoms may occur with minimal exercise and become more prominent when the child engages in more strenuous activities. Symptoms can occur five to 10 minutes after completing the activity and recur many hours later. The severity of symptoms is also influenced by the environment in which the child is exercising. An allergic child’s exercise-induced asthma symptoms may be triggered or exacerbated with outdoor activities that expose him or her to pollen, grass and other environmental allergens.
The question of prevention of exercise-induced asthma is an ongoing discussion with parents. Families are advised to identify their child’s exercise-induced asthma triggers to better target with control, to ensure that the child takes pre-treatment asthma medicine, warms up before exercise and ends with a cool-down exercise. This is especially true for children participating in a structured physical activity.
There are several medications that can be used prior to exercise. Bronchodilators, which people recognize as their rescue therapy, work on opening the airways by relaxing the muscles around the breathing tubes. The most recognized bronchodilator is albuterol, which should be given 15-30 minutes before exercise and has an effect that lasts two to four hours. The other category of medications is anti-inflammatory, which can be steroid or non-steroid based and are recognized as controller or maintenance therapy that the child receives regularly. They work by controlling the inflammation and preventing swelling of the breathing tubes.
Adherence to therapy and avoidance of triggers continue to be key in asthma control. Even though exercise is a known trigger for asthma, it should definitely not be avoided. Children are encouraged to be active without limitation, which can only be achieved if your child’s asthma is well controlled.
Studies have shown a discrepancy between what parents consider adequate control and what health care professionals mean by control. This discrepancy suggests a communication gap between pediatricians and families that may contribute to underutilization of effective asthma treatments. Make sure you communicate with your pediatrician or asthma specialist about the plan of care for your child’s asthma.
An asthma action plan is a set of individualized written instructions, designed with a doctor, which details how a child’s asthma should be managed at home. The plan includes:
▪ A list of what triggers symptoms and how to avoid these triggers.
▪ A list of symptoms to watch for and what to do should they occur.
▪ The names and doses of medications the person needs and when to use them.
▪ Emergency telephone numbers, locations of emergency care and instructions on when to contact the doctor or when to go right to the emergency department.
If the plan is kept up to date and followed closely, asthma symptoms can be prevented or treated, and your child’s asthma can be well controlled.
Shatha Yousef, M.D., is an assistant professor of pediatrics and Director of the Pediatric Cystic Fibrosis Program at UHealth – University of Miami Health System, which is nationally and internationally acclaimed for education, research, patient care and biomedical innovation. For more information, visit UHealthSystem.com/patients/pediatrics.