Treatment Key To Controlling Childhood Asthma

By Tanjua Damon

Eight percent of children under 16 in Connecticut are plagued with asthma. Doctors do not know what causes asthma, but they do know what triggers the disease.

The number of children with asthma continues to increase because doctors are better at diagnosing it, according to Dr Gregory Dworkin of the Children Chronic Cough Center at Danbury Hospital, but asthma is also simply rising among children. Even though doctors are not sure what causes the illness, they do believe a combination of environment and heredity are play a significant role in why children get it.

Asthma is the leading serious chronic illness among children, according to the American Lung Association. In March 2002, the ALA estimated that 24.7 million people have been diagnosed with asthma by a health professional and more than a third, at least 7.7 million, are children under the age of 18. According to the National Center for Health Statistics in 2000, 31.3 million Americans had been diagnosed with asthma during their lifetime. Of this group, 9.2 million children were diagnosed.

Lisa Kaplan, a professor and director of biological sciences at Teikyo Post University, describes asthma as a usually a reversible, obstructive, lung disease.

“It is considered to be a chronic [long term] inflammatory disorder of the airways because the parts of the respiratory system that are responsible for transporting air to and from the lungs are swollen and inflamed,” Dr Kaplan said. “Although asthma ‘attacks’ or episodes happen sporadically or intermittently, the inflammation of the airways is almost always present. During an asthma ‘attack,’ uncontrolled inflammation leads to a series of events –– swelling of air passage lining, increased secretion of mucus in the air passage, and tightening of the muscle –– that result in severe constriction or narrowing of the airways. This narrowing of the air passages is what causes the difficulty in breathing and the characteristic wheezing associated with an asthma attack.”

Symptoms of asthma include coughing that continues for more than day tens after a cold, coughing after midnight that wakes you up, shortness of breath, which results in stopping an activity, and wheezing.

There are five key triggers for asthma, according to Dr Dworkin. They are exercise, cigarette smoking including second-hand smoke, allergies, upper respiratory infections, and cold air.

Asthma attacks appear to decrease with age, according to Dr Kaplan. Of the 1.8 million visits to emergency departments in 2000, children had more than 728,000 visits. The 0–4-year-old group had the highest number of visits. There were 214,000 hospitalizations of children in 2000, and again, children 0–4 had the highest rates. Among children asthma deaths are rare; 223 children aged 0–17 died from asthma in 2000.

There are several theories as to why asthma occurs, but doctors are not completely sure why people, including children get the disease, Dr Dworkin said. Some doctors believe asthma occurs because homes are sealed so tightly that the inside air becomes polluted. Other theories point to modern hygiene –– that improved hygiene kills germs needed to help the body’s immune system develop effectively –– and suggest that children should be exposed to pets like dogs and cats at birth rather than be introduced to them later in childhood.

A survey done by the Harvard School of Health approximately 15 years ago showed that asthma already was as high as eight percent in Newtown schools.

“It’s very common,” Dr Dworkin said. “But it is still under diagnosed.”

Dr Dworkin went on to say that people who have colds and a cough that lasts longer than ten days should talk to their doctors about asthma, because a cough can be a sign for mild to severe asthma.

“Coughing causes a degree of inflammation and spasm in the airway,” Dr Dworkin said. “People may need to be treated for underlying asthma.”

Newtown schools still participate in an Open Airways program that began in the mid-1990s. It is a program that helps children learn how to manage their own asthma by learning what their triggers are and what they need to do once an asthma attack begins.

“Once children learn what their triggers are, they can determine if it is possible to stay away from it,” Dr Dworkin said. “But when triggers are identified and avoidance isn’t possible, medicine has to be considered to control the asthma.”

Dee Cupole, supervisor of nurses for the Newtown School District, likes the Open Airways program because it helps children understand their disease.

“It lets the students become more aware of their disease and how they can manage it,” Ms Cupole said. “The students like it a lot. It is hands-on.”

Each of the seven Newtown schools also has nebulizers for children who might have an asthma attack while at school. The Newtown Volunteer Nurses Association donated many of the machines, which enable medicine to reach the children faster. Ms Cupole said that asthma triggers seem to affect Newtown students more in the spring and fall.

Dr Dworkin said asthma medicine is safe and effective. He explained that once the “right balance” is achieved, asthma can be managed effectively and help children live more normal lives. Mild asthma can be when someone coughs while they are exercising. Moderate asthma can be when someone has to take medicine everyday to prevent an attack, not just use rescue medicine when an attack occurs. Severe asthma can be when someone has to go to the hospital because they cannot breathe.

“Most people have nonlife-threatening asthma, but there are no guarantees,” Dr Dworkin said. “You always have to take it seriously. Anyone that is using a lot of rescue medicine needs to be on preventative medicines.”

Dr Kaplan also recommended that children should take medications regularly as directed by their pediatricians. Anti-inflammatory drugs may help prevent swelling and inflammation as well as increase drainage of secretions (mucus) that may fill the air passages. Bronchodilator drugs, which open the air passages and relieve wheezing and tightness in the chest, are sometimes known as “rescue” medicines. In addition, modifying a person’s environment also can help reduce possible allergens, she said, such as getting rid of pets, teddy bears, rugs, curtains, feather pillows, and lampshades in the child’s bedroom; eliminating contact with cigarette smoke and second-hand smoke; modifying behavior; avoiding vigorous exercise; avoiding exposure to very cold air or massive changes in air temperature; avoiding stress and “over” excitement; and having regular conversations with the child to help him or her understand the asthma.

Doctors continue to try to figure out why asthma strikes some people but not others.

“It’s controllable, but not curable,” Dr Dworkin said. “There is still much we don’t know about it.”