A cough that drags on forever. Wheezing or rattling noises in a child’s chest. Frightening episodes of unusually heavy or fast breathing. These are some of the stories we hear from parents who bring their children to pediatric pulmonology. Asthma is one of the most common causes of these symptoms, but fortunately, asthma is also one of the most treatable.
An Asthma Overview
Although it is normal to cough and develop inflammation in the airways after an infection or exposure to an irritating inhaled substance, in asthma this response is exaggerated. The tissue lining the airways is swollen, and the airways are filled with secretions. The situation is worsened by sudden bronchial spasms that temporarily constrict airways. This constriction or shrinking of the airways, in addition to the inflammation, blocks airflow. Breathing becomes more difficult, and children may complain of chest tightness. This is an asthma attack.
Different infectious and environmental substances can trigger an asthma attack, and different people have different triggers. Respiratory viruses, dust, air pollutants, pollen, cockroaches, mold spores, potent fumes or odors, and smoke are a few examples of potential asthma triggers. Asthma exacerbations also differ in severity. Some are mild while others are a very serious emergency and require hospitalization.
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Asthma is the most common cause of chronic cough and wheeze, but the diagnosis is not always clear-cut. If a child does not seem to respond to standard asthma therapy or if there are other symptoms beyond those typically seen in asthma, other medical issues, such as post-nasal drip or acid reflux, should be considered. There are also rare conditions such as cystic fibrosis, primary ciliary dyskinesia and certain immune disorders to be considered.
Depending on your child’s medical history, additional testing may be done. However, a detailed history is often the most informative piece of information. Parents can help by keeping a diary of symptoms and noting any patterns that help identify asthma triggers.
Children with asthma often receive a guide called an asthma action plan. This outlines what needs to be done on a daily basis, what signs and symptoms are concerning and how to respond to an asthma attack.
The management of asthma has two goals. The first is to keep asthma well controlled by avoiding triggers and minimizing chronic inflammation of the airways by treating with “controller medications.” There are different kinds of controller medications, but most commonly, a type of inhaled steroid is used.
The second goal is to know how to respond to an asthma attack when it does occur. Bronchodilator medication is given as a rescue treatment. Bronchodilators immediately counteract an attack by relaxing the muscle spasms that cause airway constriction.
It is important to remember that bronchodilators do not replace a controller medication. They offer quick relief, but they do not have preventive effects. Bronchodilators are in a class of medications related to caffeine. Just as coffee can lose its effect when you drink it regularly, bronchodilators lose their effect if they are taken too frequently, and dangerous side effects can occur.
Both bronchodilators and inhaled steroids can be given as a mist that is nebulized or in an inhaler. All inhalers should be used with a spacer. A spacer is a small plastic tube connected to the inhaler. Drug particles are best delivered to the small airways when the medication is administered with an inhaler and spacer, so this is the preferred method.
If you or your child are not clear on how to use the inhaler or spacer, ask your doctor to explain it again.
With appropriate treatment, asthma is usually one of the most easily manageable of the different conditions that produce symptoms of frequent coughs and wheezing. If you do not see improvement with treatment, you may want to discuss with your doctor other diagnoses and whether additional evaluation and testing might be needed.
Natalie Shilo, M.D., is a pediatric pulmonologist and Luz Juliana Barahona, M.D., is a second-year pulmonology/pediatrics fellow at UHealth – the University of Miami Health System. For information, visit UHealthSystem.com/patients/pediatrics or call (305) 243-6162.