Asthma
Asthma
By Dr. Khoo Keh Bin
Consultant Paediatrician,
MD (UKM),MRCPCH (UK)
KB Child Specialist Clinic, Taman Desa, KL
Did you know?
Asthma is one of the most common chronic diseases among children. Its prevalence has increased over the years, affecting an estimated 300 million individuals worldwide. The condition is often underestimated, especially if we only focus on episodes of wheezing, breathlessness and coughing.
Asthma can be treated effectively; most patients are able to achieve good control of the disease. However, AIRIAP 2 (Asthma Insights and Reality in Asia-Pacific 2) clinical study data shows that only two per cent of asthmatics in Malaysia can control their condition.
Some children outgrow asthma by adulthood. In general, the more severe the asthma in childhood, the greater the likelihood of persistence. Some studies suggested if asthma developed in children younger than three years old, it is more likely to progress to adulthood. However if the asthma attack occurs only when a child has viral infection, then the child is more likely to outgrown the asthma.
What is asthma?
Asthma is a long term inflammatory condition of the airways, causing airway hyper-responsiveness. It is not contagious, but can be inherited, i.e., those with a family history of asthma are more susceptible to the disease. Nonetheless, those without a family history of the condition can also get asthma.
The condition can begin at an early age or later in life due to ongoing changes in the airways that make them more likely to react to triggers such as:
1. Viral infection
2. Physical activity
3. Cold air
4. Plants & pollens
5. House dust mites, pests and animal dander
6. Tobacco smoke and strong scents
7. Certain food & medicine
What are the symptoms of asthma?
Recurrent cough especially at night and early in the morning, breathlessness, tightness of chest and wheezing are the most common complaints. The symptoms are attributed to a blockage of the airways caused by:
1. Tiny muscles tightening around the airways.
2. Wall of airways are swollen.
3. Mucous within airways.
As air flow is not always obstructed in the airways, the severity and frequency of the symptoms will vary.
How do we diagnose asthma?
The diagnosis is based on history and physical examination. Diagnosis may be more challenging in patients from a younger age group as they are unable to elaborate on the condition and mainly rely on the caregiver’s observation.
Certain tests like spirometry are used in patients from older age groups (5 – 6 years old). If the child has other allergy symptoms like eczema, cow’s milk protein allergy and allergic rhinitis, then an allergy test (skin prick test/patch test/RAST/ImmunoCap) may be conducted to look for triggers.
How do we manage asthma?
The responsibility of the child falls on everybody. The goal is to achieve and maintain asthma control.
Asthma control means:
1. The use of reliever medication less than twice a week.
2. Sleep is not interrupted by asthma.
3. Daytime asthma symptoms occur less than twice a week.
4. There is no limitation in the child’s normal physical activity.
5. There is no asthma exacerbation
6. The lung function is near normal.
Caregivers can achieve control over asthma by having a better understanding of the disease. Thus, education is important.
What are the medications that treat asthma?
There are two main types of medications:
1. Reliever – to make the airway wider by relaxing the surrounding muscles. The relief is only TEMPORARY.
Examples are Beta 2 Agonists either in liquid, tablet, or metered dose inhaler form.
2. Preventer – to settle the inflammation in the airway. It treats the root cause of asthma. It can provide long-term control for those with persistent asthma symptoms. However, it needs to be taken for at least two weeks to be effective. Thus, compliance and patience are important.
Examples are the Leukotriene receptor inhibitor, inhaled Glucocorticosteroid or a combination of Glucocorticosteroids with long-acting Beta 2 Agonists.
Asthma control may vary from time to time, thus it is important for medication to be adjusted accordingly.
What is an asthma emergency?
Signs of worsening asthma are:
1. Wheezing, coughing, tightness of chest at night or just waking up due to cough.
2. More symptoms with exercise.
3. More frequent need for reliever medication.
An asthma action plan is helpful to guide caregivers in what to do and who to call when symptoms worsen. Caregivers need to take immediate action if:
1. Reliever medication is not effective.
2. Shortness of breath that interferes with the child’s speech.
3. Symptoms get worse quickly.
4. The child has a bluish discoloration around the lips and tongue (cyanosis), i.e., lack of oxygen in the blood (beware: this is a very advanced sign).
How to prevent an asthma attack?
1. Avoid the triggers – identify and avoid triggers that cause the attack. For example, clean your environment frequently, avoid contact with smokers and avoid certain food that the child is allergic to.
2. Exercise regularly and have a balanced diet to improve your general health and reduce viral infection.
3. Those on preventer medications must comply with the prescription faithfully(Please ensure good compliance to the medications for those who are on preventer therapy).
4. Children with asthma are more prone to airway infection due to the disease airway. Vaccination with influenza/flu vaccine and pneumococcal vaccine can help prevent infections that may trigger the asthmatic attack.
Myths and Facts about asthma
Myths: Steroids should be the last resort in treating persistent asthma.
Facts: Inhaled Glucocorticosteroid is now the first choice of treatment.
Myths: Steroids used to treat asthma will stunt growth.
Facts: Inhaled corticosteroids will not stunt growth. Untreated persistent asthma resulting in permanent lung damage will have a significant effect on growth.
Myths: Maintenance inhalers are addictive.
Facts: Maintenance inhalers are not addictive and can help in reducing attacks, thus reducing clinic visits/absence from school while increasing quality of life. They are taken at the lowest required dose to control your child’s asthma symptoms.
Myths: One should avoid exercise and physical activity.
Facts: Adequate asthma control should not interfere with physical activity.
Myths: It is unhealthy to take so much medication in the long term.
Facts: The consequence of not controlling asthma symptoms can be fatal.
