How many times do I hear a parent say that the doctor ha
s told them that their child has asthma, when in fact the
child has been suffering from a one off bronchial infection?
If your child has been diagnosed with asthma after one such
episode, be sure to seek a second opinion before long term
asthma medication and therapy are commenced. True asthma maybe
suspected if:
1. The child develops a wheeze
(squeaky sound when they breathe).
2. Prolonged cough and chest
congestion.
3. Exercise intolerance.
4. Recurrent chest infections.
Asthma in childhood is a common condition and it can be serious.
You need to work out a plan for treating your child’s
asthma once the correct diagnosis has been made. You should
talk to your doctor if you have any concerns or questions
about asthma symptoms or what you need to do to help a child
with asthma.
WHAT IS ASTHMA?
Children with asthma have sensitive airways which sometimes
become narrowed and this makes breathing difficult.
Symptoms of an asthma attack include cough, wheeze, chest
tightness and shortness of breath.
TRIGGER FACTORS FOR ASTHMA
- Viral infections (e.g. colds) are the most common
triggers of asthma attacks in young children.
- Exercise.
- Smoking or passive smoking, (smoke irritates the airways).
Children who live with smokers are more at risk of developing
asthma at a younger age.
- Chemical fumes e.g. household paint, sprays,
and perfumes.
- Changes in air temperature - e.g. going
out into cold night air.
- Breathing in allergens is a trigger for
some people with asthma e.g. pollens, moulds, house dust mites,
animal hair.
Note: There is increasing awareness that mould growth inside
damp buildings is an important factor in childhood asthma,
and if the exposure is very high it can cause severe breathing
problems. This mould grows where there is dampness e.g. on
damp walls or floors, or on paper or cardboard that is wet
for a long time. This black mould is slimy when it is wet
and dusty when it is dry. If you have young children, make
sure that they are not around damp and moldy environments.
Alang-alang roofing can also be a strong allergen for asthma
sufferers. If you have an asthmatic member in your family,
try to choose accommodation without this type of roofing.
ASTHMA AND YOUNG CHILDREN
- It is often difficult to tell whether young
children have asthma as small children have narrower airways
anyway and generally get alot of colds.
- For young children most asthma attacks are triggered
by a cold, however, cough and wheezing is common in colds
and chest infections in young children and may not mean the
child has asthma.
- Some young children with asthma may not wheeze,
and a cough, especially at night, may be the only symptom
of asthma.
- Young children with mild asthma may grow
out of it as they get older and their airways get larger -
but this does not always happen.
- Allergy to food/milk/drinks can be a cause of
wheezing and asthma but this is unusual.
FAMILY HISTORY
- Asthma tends to run in families. A child’s
chances of getting asthma are increased if one parent or a
brother or sister has asthma, and greatly increased if both
parents have had asthma.
- Asthma in families is often associated
with eczema and hay fever. In these children, episodes of
asthma may happen more often with allergy.
- In families with a history of allergy and
/or asthma, children with colds and coughs should be checked
for asthma as they may get help from bronchodilator (reliever)
medicine or preventive medicine when they have colds or chest
infections.
ASTHMA AND EXERCISE
- Breathing harder with exercise or sport
may cause an asthma attack - in fact this may be the only
time some children have asthma attacks.
- Children who cough, wheeze or become breathless
with exercise should be seen by a doctor to check whether
they have asthma.
- Children with asthma need to be encouraged
to exercise or take part in sport, in order to strengthen
their chest muscles. Swimming laps is a particularly good
exercise for opening up the lungs.
- Using inhaled bronchodilator (reliever
puffer) before exercise will reduce symptoms for children
who have asthma when they exercise.
- It is important to teach children how they
can prevent their exercise related asthma attacks by using
their puffer.
ASTHMA MANAGEMENT
- The most important parts of asthma management
are:
Learning as much about your child’s asthma as you can.
Teaching your child how to manage her asthma.
Getting the right preventive medicine, and reliever medicine
to use if the child has an attack.
Working out what triggers the asthma and avoiding triggers
as much as possible.
Recognizing asthma symptoms and treating them early.
Using asthma medications correctly.
- An asthma management plan needs to be worked
out specially for each child - the medications used and the
way they are used depends on the age of the child, how bad
the asthma is and how often the child gets an attack.
- Preventive medicines need to be taken as
the doctor advises even when the child is symptom-free.
- Treatment (reliever) medications (bronchodilator
puffers or medicines taken by mouth) are used to treat attacks
as well as being useful to prevent symptoms, for example with
exercise induced asthma.
- Most children need to use a spacer
with puffers, or a nebuliser for very young children.
CLEANING ASTHMA INHALERS
The new CFC-free beta agonist inhalers should be cleaned at
least once a week. If the inhalers are not washed on a regular
basis they could block, or the dose of medication that the
person receives may not be adequate. This is because the new
inhalers have a narrower nozzle and use a stickier propellant
that can cause blockage, or cause the inhaler not to work
as well as it should. These problems are not likely to occur
if the inhaler is cleaned properly.
To clean the inhaler, remove the canister and then wash the
plastic body of the inhaler by running it under warm water
for 30 seconds at least once a week. (There are instructions
on how to clean the inhalers on the leaflets that come with
them).
WHAT CAN PARENTS LOOK OUT FOR?
- Find out and control or reduce trigger
factors - for example, for many children reducing exposure
to household dust is helpful.
- Keep your home and car smoke free.
- Watch for signs of asthma when your
child has a cold and be ready to start the asthma management
plan as soon as symptoms appear.
- Check with the doctor if management
needs to be improved or changed if your child is unwell, tired,
or lacks energy.
- Depending on your child’s age,
help your child to take as much responsibility as possible
for understanding and managing his own asthma.
Children with asthma can become seriously ill quickly. Asthma
needs to be taken seriously. A child with a serious asthma
attack may not sound wheezy. He may be pale, quiet and breathing
quickly with shallow gasps. Act quickly when your child has
signs of “out of control” asthma such as:
- Difficulty in breathing.
- Usual daily activities or talking
in long sentences becomes a problem.
- Rapid breathing or restlessness.
- Patient uses a accessory muscles
to assist in breathing - shoulders become raised and
hunched, abdominal muscles may be used to try to draw air,
and nostrils may flare.
- In severe cases the patient
may be flushed and sweaty with blue lips and fingernails.
Emergency care
- Assess severity of symptoms (mild
- short of breath, wheeze; moderate - loud wheeze, difficulty
breathing, can speak only in short sentences; severe - distressed,
gasping for breath, single words only possible)
- Sit the child down, reassure/comfort
- Treat with the usual bronchodilator
(reliever puffer)
- Help - if severe symptoms are not
responding in 5 minutes, call an ambulance. Continue with
puffer every few minutes.
- Monitor, and continue with puffer
- 2 puffs every few minutes - if symptoms don’t get
better get medical assistance
- All OK - go back to the child’s
usual treatment plan.
Remember that giving mouth to mouth breathing assistance to
someone suffering from a severe asthma attack or who has stopped
breathing because of an asthma attack is of little assistance.
The airways have become very narrow or closed and the patient
needs specific medication to re-open the airway passages.
Kim Patra is a qualified Registered Nurse / Midwife, and mother
of three, who has been living and working in Bali for past
15 years. She has assisted many traveller (...
and others) either as a flying medical escort
or just a voice on the end of the phone! Kim is happy
to discuss any health concerns that your may have. Her
e-mail contact is info@chcbali.com
