Asthma

What is asthma?

Asthma is an inflammatory condition of the lungs which causes intermittent cough and/or wheeze, and it responds to bronchodilators and anti-inflammatories.

How can I tell if my baby has asthma?

Under the age of two or three years, asthma tends to occur in a child who has had eczema at some point, and whose mom or dad has a history of wheezing, eczema, or allergies. The asthmatic baby or toddler coughs and may wheeze when s/he gets a cold, or when s/he gets excited, or at night. If you give an albuterol treatment as directed, it reduces cough, wheeze, or labored breathing. A chest xray may show typical findings, or may be called normal.

In general, if a baby wheezes but doesn’t have eczema or a family history of allergic conditions, then doctors say the child has “reactive airways disease”. After age two or three, that child may not have recurrent cough or wheeze anymore.

Why do you say my child has asthma, s/he only coughs when s/he gets a cold/runs a lot/sometimes at night?

Asthma is usually only an intermittent problem. Most people who have asthma seem fine most of the time. But when an asthmatic is exposed to a “trigger”, s/he gets a tight feeling in the chest, and coughs or wheezes. Typical triggers include colds, running (especially in cold air), respiratory allergies (for example, to animal dander, or pollen), and sinus infections. Chronic exposure to an irritant like cigarette smoke, or something to which the child has an unrecognised allergy, like house dust, or a pet, can make the child at risk for symptoms when exposed to another trigger.

Why do you want me to give my child an anti-inflammatory inhaler every day, even when s/he isn’t having an attack?

Daily medication is indicated for many asthmatics, according to guidelines written by the US government National Heart, Lung and Blood Institute of the National Institutes of Health. Review of symptoms you and your child report, and her peak flow diary, may show that she falls into a group for whom daily, preventative medication is needed.

For a table that categorizes asthma by severity, please see Long-term Management of Asthma by Classification in Children.

Please see also Medical Topics, Peak Flow Monitoring.

But everyone coughs a little bit!

It is common for parents and kids to consider chronic symptoms, such as nighttime cough, or mild chest tightness with daily activities, to be normal. But cough and chest tightness are not normal, and they indicate the asthmatic has ongoing lung irritation. This irritation makes an asthma attack more likely, if s/he is exposed to a trigger like playing soccer, or a cold. It means your child may avoid physical activity, even unconsciously, because of poor exercise tolerance.

It also may lead to unrecognised scarring inside the lungs, which can ultimately reduce athletic performance (permanently). (The effects of this scarring are not detectable to the individual patient, but scarring is known to occur due to studies of asthmatics.)

How come you won't just give my child an antibiotic for bronchitis, or pneumonia, like the last doctor did?

There are several issues: one is, What is the diagnosis? If the diagnosis in a child really is “bronchitis”, then medical experts agree that an antibiotic is not routinely indicated, because bronchitis is usually viral and won’t respond to an antibiotic.

Unfortunately a lot of doctors will say that a child has “bronchitis”, and give a prescription for an antibiotic to treat it, even though it won’t make any difference. They may think it’s easier to do that than to explain why an antibiotic isn’t needed.

It is easier and quicker to say, “Here is an antibiotic for your child’s cough”, than to say, “I think your child has asthma, this is an inhaler and spacer, your insurance won’t pay for the spacer but you really need to buy it anyway, and I want to teach you how to use it and see you back for asthma education in a week or two”!!

A final point on antibiotics and asthma is that if a chest xray is taken, for example during an ER visit, and the picture is read by the ER doctor (who is not a radiologist, and just doing his or her best), s/he may overinterpret common asthma findings. The ER doctor may see “mucous plugging”, and say the child has “pneumonia”, because the findings are similar on xray.

Some asthma experts made up an ironic term, “asthmonia”. But, the child didn't have a lung infection, s/he had lung inflammation, which needs bronchodilators and maybe anti-inflammatories to get better.