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Tuesday, May 3, 2016
At least 25 million Americans, including 7 million children, experience shortness of breath, wheezing recurring cough caused by asthma. This condition, most commonly triggered by exposure to viral illnesses, exercise, allergies or weather changes is a result of tightening of a person’s airways. This May, the MGH marks Asthma and Allergy Awareness Month to educate parents about how to better manage their child’s asthma and allergies. Ben A. Nelson, MD, the director of pediatric bronchoscopy, answers some commonly asked questions.
Q. What is asthma?
A. Asthma is an intermittent airway obstruction, most commonly triggered by exposure to viral illnesses, exercise, allergies or weather changes, characterized by tightening of the airway smooth muscle and inflammation or swelling of the tissues in the lungs.
Q. What are the most common symptoms of asthma?
A. Recurrent cough, wheezing and shortness of breath are the most common symptoms. If your child is limited in daily activities due to these symptoms, it is recommended that you see your doctor for further details and diagnosis.
Your doctor may diagnose your child with asthma based on medical history and a physical examination. Beginning at 7 years of age, your child may be able to undergo pulmonary function testing, which is a non-invasive test to assist in the diagnosis of asthma.
Signs of an exacerbation requiring urgent medical attention: If your child has labored breathing, is unable to speak in full sentences or needs to use the rescue inhaler more than every 4 hours.
Q. What are commonly prescribed medications?
A. There are 3 main classes of medications used to treat asthma.
Rescue: Most people are familiar with short acting bronchodilators that counter the tightening of the airways. On average, using this medication less than twice a week demonstrates good control of asthma symptoms.
Controller: Long-term preventative treatments address the underlying causes of asthma by decreasing the inflammation in the lungs. This group, which helps to prevent asthma attacks from occurring, includes inhaled corticosteroids that deliver medication directly to the airways, thus minimizing potential side effects. Controllers need to be used on a daily basis, even when your child is feeling well. However, most children are able to stop controller medications over the summer months.
Emergency: During an asthma exacerbation, patients may need a short 5-day course of an oral steroid to quickly decrease the inflammation and swelling in the lungs. Maintaining optimal daily control of your asthma will decrease the need for oral steroids.
Q. Can asthma prevent children from participating in sports?
A. It’s a natural reaction to hold children back if exercise triggers asthmatic episodes. However, there are effective preventative treatments that are safe for children to use. Therefore, asthma should never prevent children from participating in sports. The goal is to use the least amount of medication possible, but enough to control symptoms and allow full participation. In order to reach this goal, your doctor should create and review an asthma action plan with you and your child.
Q. When should parents consider changing their child’s medication? How should these medications be delivered?
A. Signs that your asthma is not well controlled: If your child has symptoms requiring the use of rescue medication on average more than two times per week, or if symptoms interfere with daily activities such as sleep, exercise or school.
Delivery of medications: Most asthma medications are delivered via nebulizer machine or an inhaler with spacer device. The goal is to use the delivery method that is most effective and easiest for the family.
For example, it can be extremely challenging to get an 18-month old to sit still for an entire nebulizer treatment. When possible, I prefer an inhaler with a spacer as it is quicker, portable and delivers twice as much medication into the airways. As long as the family can demonstrate proper technique, it is acceptable to use an inhaler with spacer regardless of the child’s age.
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