May is National Asthma and Allergy Awareness Month, and according to the U.S. Centers for Disease Control and Prevention, about 7 million American children have asthma. That’s almost one in 10 kids who suffer the wheezing, chest tightness, shortness of breath and coughing associated with an asthma attack.
“Asthma, by definition, is a chronic disease with respiratory symptoms caused by airway obstruction and inflammation,” explains Dr. John Spivey, a Mercy Clinic pediatric pulmonologist with Mercy Children’s Hospital. Because children have small, narrow airways (bronchi) in their lungs, asthma may be more evident in childhood. “You can imagine that a little bit of airway inflammation or bronchial constriction causes the airways to narrow even further. But there can be adult onset, as well.”
In very young children, diagnosing asthma can be challenging. “If they are younger than 5, they’re generally too young to do standard pulmonary function testing, called spirometry, so we rely on symptoms being in the pattern we typically see with asthma, and we note whether they respond to asthma medication,” says Dr. Bradley Becker, a professor of pediatrics at Saint Louis University. “Asthma typically will trigger with exertion when a kid’s running or exercising; it will trigger at night, especially waking them up from sleep to cough or wheeze; it will trigger when they have a virus or when they’re around tobacco smoke or other irritants.”
Children who are diagnosed with asthma may find that their symptoms improve as they age, although most will experience occasional symptoms into adulthood. The key is controlling symptoms so that they do not negatively affect quality of life.
Two types of medications are commonly prescribed to manage asthma. ‘Rescue meds’ are typically inhaled medications used when an attack occurs in order to quickly dilate the airways and ease breathing. The most common of these shortacting medications is albuterol. ‘Controller meds’ address ongoing inflammation and airway obstruction with the goal of preventing asthma attacks. In many cases, the physician will work with the patient and parents to create an ‘asthma action plan’ for home and school that outlines preventive strategies, including medication and avoidance of common asthma triggers.
“With an asthma action plan, parents should understand what should happen when their child is having an asthma attack,” Spivey says. He often provides parents with a color-coded key to asthma management. “The green zone is good. The child has no coughing, wheezing or shortness of breath, and there’s no exercise limitation or anything else holding him or her back. In those cases, you just take your preventive medicines on a daily basis. The yellow zone means caution—your child is not doing well and needs a quick-acting medicine, usually albuterol. If the child is still struggling and the albuterol is not working, we enter the red zone, which means danger. You need to see a physician or start a systemic steroid, such as prednisone, by mouth.”
Above all, Spivey says that asthma, which is the most common chronic pediatric illness, should not be a source of shame and should be identified and treated. “Most kids do very well. My goal for my patients with asthma is to be symptom-free and have a fantastic quality of life,” he says. “If your child has symptoms, get him or her checked out. The medicines and therapies are so good now—we can get your child’s asthma under control.”