View Full Version : Asthma : Frequently Asked Questions

02-03-2007, 06:11 PM
Q:What is asthma?
Asthma is a chronic lung disease characterized by inflammation and spasm of the airways. This causes breathing problems such as coughing, wheezing and shortness of breath. Asthma can be triggered by environmental factors, infections, allergies, exercise, temperature changes or other airway irritants.
What causes childhood asthma?
Asthma can result from environmental, chemical and infectious factors and may also be partially inherited.
The majority of children with asthma have allergies, such as allergies to mold, pollen, dust, dust mites, pet fur, feathers, rodents and cockroaches. Even exposure to low-grade allergens (allergens that do not cause significant allergic reactions) may increase the severity of the asthma. In addition, allergies may play a role in undiagnosed asthma cases.
Not all children with asthma, however, have allergies. They can have other asthma triggers that may include the following:

* environmental factors, such as cleaning products and strong odors
* exercise
* upper respiratory infections, such as colds
* inhaled irritants, such as secondhand smoke
* temperature changes and certain weather conditions, such as cold air
* physical emotional expressions, such as crying, laughing or yelling

By properly managing asthma, however, such as avoiding being exposed to triggers, taking prescribed medications, looking for warning signs and knowing what to do during an asthma attack, an individual with asthma can have a healthy and active lifestyle.
What are the symptoms of asthma?
Common asthma symptoms include:

* coughing (for some children coughing is the only symptom)
* shortness of breath
* tightness in the chest
* wheezing

Asthma symptoms indicate that an asthma episode is occurring. Action should be taken to treat these symptoms before they worsen. Follow your asthma management plan or call your child's doctor or nurse if you have any questions.
What are the early warning signs of asthma?
Some early clues that asthma may be developing are:

* cough or breathing changes
* feeling tired
* difficulty sleeping
* less energy for exercise
* chin or throat itchiness
* lower peak flow numbers

Every person can have different symptoms, but do not ignore the early warning signs of asthma. Early warning signs are important to learn about and watch for so you know that an asthma episode may be developing.
What are the different levels of asthma?
As determined by the National Institutes of Health (NIH), below is a guideline used by physicians to aid in determining the extent of asthma in your child. The guideline is classified as "steps," because each child may step up or step down to different levels at any time.
The steps are as follows:

* Step 1 or mild intermittent asthma - Have symptoms less than two times a week with no problems in-between flare-ups and only has short flare-ups lasting up to a few hours or a few days. Nighttime symptoms occur less than two times a month.
* Step 2 or mild persistent - Have symptoms more than two times a week, but no more than one time per day; activity levels can be affected by the flare-ups. Nighttime symptoms occur more than two times a month.
* Step 3 or moderate persistent - Have symptoms every day, use rescue medication every day; activity levels may be affected by the flare-ups and have exacerbations greater than or equal to two times a week. Nighttime symptoms occur greater than one time a week.
* Step 4 or severe persistent - Have symptoms constantly, have a decrease in their physical activity and have frequent flare-ups. Nighttime symptoms occur frequently.

When is asthma an emergency?
Severe asthma symptoms require immediate attention and can be a life threatening emergency. You must seek emergency treatment immediately.
Severe symptoms can include:

* tightness in the chest and/or wheezing, severe coughing, shortness of breath
* difficulty talking
* breathing hard and fast
* nasal flaring
* hunched shoulders
* chest and neck muscles pull in when your child breathes
* lips or fingernails turn gray or blue

Who is at risk for developing asthma?
It is important to know that anyone can have asthma. But it most commonly occurs in:

* children by the age of five
* children who have allergies
* children with a family history of asthma
* children who have exposure to secondhand tobacco smoke

What happens during an asthma attack or asthma exacerbation?
When children with asthma have acute episodes, the air passages in their lungs become narrower and it is more difficult for them to breathe. These problems are caused by an over-sensitivity of the lungs and airways.

* The lungs and airways overreact to certain triggers causing:
o airway linings to become inflamed and swollen
o muscles to tighten that surround the airways
o an increased production of mucus
o breathing to become harder and may hurt
* Coughing may occur, as well as wheezing or a whistling sound, which is typical of asthma. A rush of air, moving through the narrowed airways, results in the wheezing sound.
* Without immediate treatment during an asthma attack, respiratory failure may occur in the child.

How is asthma diagnosed?
Physicians use a combination of medical history, physical examination and laboratory tests to diagnose asthma, which may include:

* spirometry - a spirometer assesses lung function. Spirometry, the evaluation of lung function with a spirometer, is one of most common and simplest pulmonary function tests and may be necessary for some or all of the following reasons:
o to evaluate how well the lungs receive, hold and utilize air
o to monitor a treatment's effectiveness
o to determine how severe a lung disease is
o to keep track of a lung disease
o to establish whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)
* peak flow monitoring (PFM) - PFM is a device measuring the amount of air a person can blow out of the lungs. When asthma or other respiratory flare ups occur, the large airways in the lungs narrow slowly. This slows the speed of air leaving the lungs and can be measured by a PFM. Measuring this is essential to determining how well or how poorly the disease is being controlled.
* allergy tests - tests to determine allergies.

What can trigger my child's asthma?
Some triggers can include:

* cigarette smoke
* mold
* rodents and cockroaches
* colds and flu
* dust and dust mites
* strong odors
* cleaning products
* pollen
* pets with fur or feathers
* exercise
* cold air and changes in weather

Do children outgrow childhood asthma?
Every child is different in how they respond to asthma throughout their life. For some children, when they enter their teenage years, symptoms can subside. For others, symptoms can become more severe with time. About one-third of children with asthma will outgrow it, and about one-third of children with asthma will have fewer episodes as they get older.
If my child has asthma, can he or she participate in sports?
Exercise can often trigger an asthma attack in most children and teens with asthma. But with proper management, children with asthma can fully participate in most sports. In fact, aerobic exercise can improve airway function by making breathing muscles stronger.

A few tips for exercising with asthma:

* Have your child stretch before and after exercising, breathing only through the nose to warm and humidify the air before it enters the airways.
* Verify that your child takes all their necessary medication before exercising, as recommended by their physician.
* Have your child wear a scarf over their mouth and nose in cold weather, so air is warmer and easier to inhale.
* Have your child always carry a "reliever" or "reserve" medication, in case of an asthma attack.

How can my child control their asthma at school?
Work with your child, family members, school officials and physician to make sure asthma treatment goals are met at school. Your child may have to take their medications during school hours.

The American Academy of Allergy, Asthma, and Immunology (AAAAI) recommends the following for children with asthma at school:

* Meet with the school nurse, teachers and other relevant school staff to tell them about your child's asthma and medical needs.
* Make sure your child’s school nurse has a copy of his Asthma Action Plan on file. This will explain what steps should be taken if your child has an asthma attack at school.
* Talk to school personnel about your child's asthma medications and how to help during an asthma attack.
* Ask school staff to treat your child normally when asthma is under control.
* Talk to the teacher or coach before your child starts a physical education class.
* Make sure indoor air quality, allergens and irritants in the school are monitored.
* Work to prevent asthma symptoms from starting that could bring your child's energy levels down.
* Make sure you tell your child they are not different from others.

02-03-2007, 06:12 PM
Many things can cause asthma symptoms to start; these are called triggers. Every child's asthma triggers are different. Sometimes it can be difficult to figure out exactly what your child's asthma triggers are. Work with your child's doctor or nurse to identify your child's specific triggers. It is important to try to control your child's exposure to the triggers that make his or her asthma worse.
Irritants and allergies are the two main types of asthma triggers:
Irritants are substances that irritate the nose, throat, or airways. Common irritants include:

* Cigarette smoke
* Strong smells
* Colds or other respiratory illnesses
* Chemicals
* Air pollutants
* Weather conditions

Many children with asthma also have allergies, which can make asthma worse. With allergies, a child's immune system becomes sensitive to allergens, which can include:

* pollen
* pet dander
* dust mites
* mold and mildew
* cockroaches

These allergens can increase inflammation (swelling) in the airways and trigger asthma. With continued inflammation, the airways become even more sensitive to triggers.
Other triggers
Exercise can trigger an asthma attack, often because of the inhaled cool and dry air. Long-term strenuous activities such as long distance running, are most likely to induce asthma. Swimming is the least likely.
Respiratory Infections and Sinusitis
Infections can cause irritation of the airways, nose, throat, lungs, and sinuses, and worsens asthma.
Gastroesophageal Reflux
GERD, characterized by persistent reflux of stomach acids, is also sometimes found in children with asthma. Symptoms may include heartburn, coughing, belching, or infants spitting up.
Sensitivity to Medications
These medications may cause asthmatic attacks due to sensitivities or allergies:

* aspirin
* non-steroidal anti-inflammatory medications, such as ibuprofen, indomethacin, naproxen
* sulfites used as preservatives in food and beverage

Before giving your child any medication, including over-the-counter, talk with your child's physician.
Emotional Anxiety and Nervous Stress
Reactions from stress and anxiety are considered to be more of an effect than a cause. They can cause fatigue, which may affect the immune system and, in turn, increase either asthma symptoms or bring on an attack.
How to limit exposure to irritants:

* Smoke - Do not allow family and friends to smoke anywhere inside the house. Do not allow smoking in the car at any time. Smoke is very irritating in an enclosed area and its odor may be trapped in the car's upholstery for a long period of time and continue to trigger symptoms. When eating out, always sit in non-smoking sections of restaurants. You should also have non-smoking childcare providers.
* Strong perfumes/odors - Your child should avoid things that have a strong smell such as cleaning products, perfumes, hair spray, tar, fresh paint, gasoline, insect sprays, and room deodorizers. Avoid spraying these things and using cleaning solutions when your child is home.
* Germs - Teach your child to wash her hands often, which will decrease her likelihood of catching a cold or the flu. Many children with asthma should get the flu shot each year. Check with your child's doctor to see if this is right for your child.
* Chemicals - Your child should avoid being near things like coal, chalk and talcum powder. Air pollutants Weather conditions -- changes in temperature, barometric pressure, humidity and strong winds
* Air pollutants - Keep your child away from air pollutants such as smog and exhaust from cars or factories as much possible.

How to limit exposure to allergies:
If you think your child may have allergies, talk to your child's pediatrician or nurse about getting a referral to an allergist. An allergist can do skin tests on your child to find out exactly what he is allergic to and what your child should avoid so he can breathe easier.

* Dust
Dust mites, tiny insect-like creatures found in mattresses, carpets and upholstered furniture, thrive in warm, humid conditions and feed on the shed scales of human skin. You can prevent allergy symptoms caused by dust mites by limiting your child's exposure to them. Pay attention to the room(s) where your child spends most of her time.
o beds - Beds should have wooden or metal frames. Don't have your child sleep on a couch or hide-a-bed sofa. If your child sleeps in a bunk bed, he should sleep in the top bunk.
o mattress/box spring - Cover mattresses and box springs with zippered, dust-proof covers and put electrical or duct tape over the zippers.
o pillows - Put pillows in dust-proof covers. Pillows should be made of Dacron or other synthetic fiber. Never use foam, feather or "down" pillows.
o bedding - Wash bedding (sheets, pillowcases, blankets and comforters) in very hot water, which kill the dust mites. Dry the bedding in a dryer instead of hanging outdoors where pollen may stick to them while wet. Do not use wool or down blankets.
o floor coverings - Avoid having wall-to-wall carpeting in your home. If you can't get rid of carpeting, vacuum it often (at least twice a week) and change the vacuum filter or bag periodically. Vacuum when your child with asthma is away and will not return to the room for several hours because of the dust that can be stirred up. Use multi-layered vacuum bags instead of regular single layer bags. Wood, tile, or vinyl flooring should be mopped at least weekly, and avoid using rugs on these floors.
o closets - Closets should store only clothing and should also be dusted and cleaned as often as the rooms. Keep clothes in closets, and not lying around the room.
o furnace (heating) - Electric or gas heat is better than wood stoves or kerosene heaters. Change air filters on the furnace every month and cover furnace outlets with filters. This will catch dust from the furnace before it can get into the air.
o air purifier - HEPA filter units can help to remove airborne allergens.
o air conditioners - Change or clean filters in either window units or central air-conditioning systems each month. Keep windows closed, especially in the summer.
o walls - Try not to put up pennants, pictures, wreaths, flower arrangements or other dust catchers on the walls.
o window coverings -Put up window shades instead of heavy curtains or Venetian/mini blinds. If you have curtains, wash them each month in hot water.
o humidifier - Humidifiers can make dust mites grow because of the high humidity. Instead, use a dehumidifier and keep humidity at less than 50 percent in your home.
o furniture -Instead of upholstered (stuffed) furniture, furnish your home with trendy wooden or plastic furniture. Avoid open shelving that will constantly need to be dusted.
o playing - Keep your child from jumping on beds or playing on carpeted floors, and avoid fabric toys or stuffed animals. If your child has stuffed animals, wash them in hot water often, or place them in the freezer overnight at least once a week to kill the dust mites and then shake them out. Store other toys in a toy chest with the lid closed to keep them from collecting dust.
o sleeping and napping - Your child should nap or sleep in her own dust-free bed only. When traveling, make sure she takes a non-allergic pillow with her. Do not have stuffed animals in the bed. If necessary, limit them to one or two favorites and clean them as above.
* Pollens
Pollens can be high between February and November in many areas. If your child is allergic to pollen, keep the windows in your car and in your house closed and use air conditioning to keep cool instead.
* Animal dander
Pets with fur or feathers can cause trigger allergies. Avoid having pets with fur or feathers if your child is allergic to pet dander, and avoid visiting other homes where there are certain pets.
* Mold/Mildew
Mold and mildew grow in dark, humid areas with poor ventilation. Make sure no place in your home allows mold or mildew to grow.
o outdoors - Avoid damp, shady areas where mold or mildew can grow. Clean up fallen leaves and avoid cutting the grass when your child is around. If your child is allergic to grass, trees or pollens, have him shower or bathe, shampoo, and change his clothes when he comes inside.
o bathrooms and kitchens - Use exhaust fans when cooking or using the shower to help keep mold or mildew from growing. Clean the area with cleansers that contain bleach.
o in the house - Use the air conditioner, and avoid using humidifiers, where mold/mildew can grow in the water tank. If you use one, clean it daily with bleach. It's better to keep indoor humidity to less than 50 percent. Use a dehumidifier instead, and clean it daily also.
* Cockroaches
The substance that cockroaches leave behind can cause allergies in some people. Cockroaches are often found in warm climates and in homes in cities, but they also can be found in cooler climates because of the use of central heat. Use roach traps or a professional exterminator to get rid of cockroaches.

How exercise can help:
Even though exercise can trigger asthma symptoms, your child should not limit his participation in sports and exercise, unless told to by his pediatrician. Exercise is good for the heart, lungs and a child's overall health.
Some sports such as running long distances and playing basketball may be harder for your child to do, but there are many activities which are great for children with asthma such as swimming, golf and karate.
Always make sure your child has a warm-up and cool-down period before and after exercising, and alert coaches or instructors that your child has asthma. Have your child use her reliever medication 15 to 20 minutes before starting exercise, or as directed by her physician. If your child needs her quick reliever more than twice weekly, talk to your child's health care provider about a daily controller medicine.