Pediatric Asthma

Armen Hareyan's picture

Asthma is the most common chronic illness affecting children -- nearly 5 million (1 in 15) in the US. The American Academy of Pediatrics reports that asthma is the leading cause of school absences, pediatric visits, and treatment of children at emergency rooms.

Among those children who are susceptible to asthma, 80% will develop the condition before they are 5 years old. Symptoms of asthma, which should prompt consultation with a physician, include shortness of breath, wheezing, cough, and chest tightness. Asthma is diagnosed based on the presence of wheezing and confirmed with breathing tests.

Asthma is a chronic inflammation of the bronchial tubes (air passages) that causes swelling, narrowing, and constriction of these passages. Asthma involves only the bronchial tubes and does not affect air sacs or lung tissue.

The bronchial narrowing that occurs in asthma is believed to be caused by three primary factors: inflammation, bronchial tube spasm, and hyper-reactivity to allergens or irritants. Allergens or irritants might include such things as cat dander, cigarette smoke or dog hair, but physical exertion can also be an irritant triggering what is referred to as exercise induced asthma. Allergy can play a role in some, but not all, asthmatic children.

An asthma attack is marked by a sudden, violent episode of labored breathing, wheezing, coughing, gasping for air, and constriction of the chest. Attacks can be so severe, hospitalization and mechanical ventilation may be required.

The combined features of an asthma attack, especially in severe cases, can prompt an instinctual fear that suffocation and death are imminent. The experience of such a sudden, violent, and limited supply of oxygen is accompanied by a desperate feeling of panic. This, in turn, causes even more muscle constriction surrounding breathing passages. Clearly these are feelings we don't want our children to experience. That's why monitoring and managing the symptoms of asthma are so important. The necessity for continuous monitoring is also one of the reasons why an asthma diagnosis is difficult news for both children and parents. Controlling this illness presents behavioral challenges for both.

Many people make the mistake of only reacting to the asthmatic attack when it strikes. It is, however, possible to a great extent to control the likelihood of asthma attacks. Children and their parents need to become engaged in efforts to control, rather than only cope with, asthma.

In the case of young children, or newly diagnosed older ones, the responsibility for monitoring and managing a child's asthma falls upon the parents. However, because this is a chronic condition, teaching and coaching an asthmatic child to share in and, eventually, assume this responsibility is a crucial aspect of treatment.


Managing Asthma and Preventing Attacks

Environmental allergens and irritants can stimulate an asthmatic response in some children. After diagnosis, your first step in monitoring and managing your child's asthma is to watch for any such responses. The irritant must be removed from your home environment. As much as possible, you will also want to restrict contact with these irritants when your child is elsewhere.

The current view is that inflammation plays a major role in all forms of asthma. Consequently, ongoing use of anti-inflammatory medications has become a primary form of treatment, especially in more severe cases. In many instances, children are prescribed a combination of anti-inflammatory drugs, steroids or beta2-agonists. With consistent drug treatment, bronchial narrowing can be either totally or partially reversible.

Following your physician's complete prescription for controlling your child's asthma is the most important element of treatment. Unfortunately, with asthma, this prescription may not be as easy as simply swallowing a daily pill. For example, studies have shown that children who are monitored daily for "peak air flow", with medications adjusted accordingly, have fewer hospitalizations and a better quality of life than those who are treated only on an emergency basis when they have an asthma attack. With very young children who are unable to use peak air flow meters, monitoring can be more labor intensive requiring parents and/or care givers to keep a daily diary to track respiratory complaints and episodes, as well as responses to irritants. The good news is that after being faithful in monitoring for several months, it is likely that your physician will have the valuable information needed to determine an appropriate regime to follow.

Technological advances, such as digital peak airflow monitoring devices, are being developed to aid asthmatic children and their parents. The best news of all about asthma is that the illness and effective methods of treatment have never been more understood than they are today.

For information on pediatric services at Newton-Wellesley Hospital, including MassGeneral Hospital for Children at Newton-Wellesley, call 1-866-NWH-DOCS (866-694-3627).


This material is intended to provide general educational information and to help users arrange more easily for health care services. This site is not an attempt to practice medicine or provide specific medical advice and should not be used to make a diagnosis or to replace or overrule a qualified health care provider's judgment. Nor should users rely upon this information if they need emergency medical treatment. We strongly encourage users to consult with a qualified health care professional for answers to personal questions.

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