Disease and Illness
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The condition of asthma (also called reactive airway disease) may be an occasional annoyance or a disruptive, frightening and at times life-threatening illness. During childhood as many as 10 percent of girls and 15 percent of boys will be affected at least once by this problem, which is the most common reason for children’s admissions to hospitals in the United States. Of those affected, some will have had their first episode by the first birthday, and nearly 90 percent experience it by the age of 5.
The majority of children with asthma have occasional episodes that can be treated relatively easily. But some develop severe and persistent symptoms that can be stressful for everyone in the family. Usually the more seriously afflicted children have a family history of asthma and/or allergic disease and show signs of trouble during their first year of life. At least half of all asthmatic children become symptom-free eventually — at least in part because their airways enlarge as they grow.
Unfortunately, despite more sophisticated treatments now available, deaths from asthma have risen over they past few years. Treating this disease diligently and pursuing avenues of prevention should be a high priority in any family in which one or more children are affected.
Asthma is characterized by a tendency of the muscles surrounding both large and small airways to undergo spasmodic contractions, resulting in coughing, wheezing or both.
The events that trigger wheezing vary from person to person but can include:
- illness (especially colds, bronchitis and sinusitis)
- exercise
- emotional upset
- exposure to smoke, dust, pollen, mold, air pollution, animal danders
- cockroach infestation
- certain foods
Some teenage girls may wheeze during the days prior to their menstrual periods. Wheezing may also be provoked by certain medications such as aspirin. An important characteristic of asthma is that this spasm of constriction is reversible; with medication or time, the airway will return to normal.
Another important component of asthma is inflammation. Even when not in spasm, the inner lining of an asthmatic child’s airways may be chronically inflamed with swelling, increased mucus production and large numbers of inflammatory cells. Treating the wheezing while ignoring the inflammation will usually result only in temporary improvement.
Symptoms
Certain respiratory problems serve as signals that reactive airway disease is present. A dry, tight cough that occurs for no apparent reason or in patterns (such as during the night or after exertion) may be the only sign.
In more intense episodes, overt wheezing may be audible from across the room. Some sounds that resemble wheezing, however, can actually arise from upper airway infections such as croup, and a physician’s exam may be necessary to make the distinction.
If the airways are particularly tight, the child may show more obvious signs of distress:
- rapid respirations
- labored breathing with minimal exertion or when at rest
- noticeable use of muscles in the rib cage and neck with each breath
In severe cases, he may have:
- the inability to walk or talk
- skin that is pale or even dusky
- abdominal pain
- vomiting
A child who is extremely short of breath should be seen by a physician immediately or taken to an emergency room.
Depending on the severity of the symptoms and the patterns of wheezing your child is showing, a variety of tests may be performed. Your child’s doctor may ask you to obtain a peak flow meter, which measures the maximum rate of airflow your child can generate at a given time and can be used as a guide to adjust medications. This simple test can be extremely useful in keeping track of your child’s progress on a day-to-day (or hour-to-hour) basis. A chest X-ray may also be needed to rule out an underlying infection. Allergy testing may be appropriate to determine what is triggering the wheezing episodes.