Allergies and Asthma
> Learn About Asthma
Learn About Asthma
Asthma is an inherited disease because it runs in families. It is a common disease that affects 1 out of every 10 people. There is no "cure" for asthma. It may be lifelong, but some people may go for years without symptoms. It is important to understand and avoid your triggers. Triggers are things that are irritating to the lungs and cause asthma symptoms.
Many parents question when to call it asthma, versus other causes of wheezing. Other causes of wheezing include gastroesophageal reflux, vocal cord dysplasia, and bronchiolitis. Recurrence of wheezing with colds or allergies is often asthma. Association with heartburn, dental decay, or poor weight gain can signify acid reflux disease. Bronchiolitis is wheezing in infants triggered by a virus. It often does not respond to the same medications as asthma, but it is difficult to tell if it is simply the first asthma attack. Vocal cord dysplasia involves the vocal cords closing inappropriately during breathing, leading to a wheeze. A careful history and exam, and often time to evaluate progression of symptoms, help to discover the true diagnosis. It matters more that children are appropriately treated than what we call it.
Asthma is divided into four categories:
- Mild intermittent - symptoms less than or equal to 2 days/week or nighttime cough less than twice/month
- Mild persistent - symptoms more than twice/week but not every day or more than twice/month nighttime cough
- Moderate persistent - daily symptoms or cough more than one night/week
- Severe persistent - continual daytime symptoms and frequent nighttime symptoms
Common asthma triggers
- Allergies (pollen, mold, animal dander, etc.)
- Environmental products (cleaning solutions, deodorants, perfumes, etc.)
- Air pollution (ozone, smog, gasoline fumes, etc.)
- Weather (cold air, temperature change, etc.)
- Cold drinks
- Exercise Infections (colds, viral illnesses)
- Nighttime (we make more inflammation cells at night!)
- Smoke (including smoke dust on furniture, clothing, hair, and carpet)
Treatment of an asthma attack
Quick relief medications are called bronchodilators. They can be used in a nebulizer or inhaler. Examples include albuterol and levalbuterol (Xopenex). They are used every 4-6 hours for most wheezing and sometimes can be used before exercise as a preventative medication.
If wheezing is severe, one can give the bronchodilator every 20 minutes for up to 3 treatments (2 puffs every 20 minutes, or 6 puffs in 1 hour). After those treatments, return to every 4 hours. This sometimes breaks the cycle of wheeze, but if a child is this severe, he also needs oral steroids and should be seen in the office within 2 days or should be seen immediately if not improved after those treatments.
Those who have one of the persistent classifications should be on a preventative medication and have an evaluation for underlying causes. This evaluation might simply be a thorough history, but can include allergy testing, evaluation for acid reflux, or lung function testing in children old enough to do this.
The goal of treatment would be to have minimal symptoms requiring use of quick relief medications (though if there are symptoms, using the quick relief medicine is needed). When asthma is under good control activities are not limited by wheezing. Peak flows (for children old enough to do peak flows) should be greater than 80% of personal best (green zone).
Prevention medications include inhaled corticosteroids (preferred first line treatment) and leukotriene inhibitors (add on treatment). They should be given daily, regardless of whether or not your child is having symptoms.
- Inhaled corticosteroids may be used in a nebulizer or inhaler. Examples (in no particular order) are Pulmicort, Flovent, QVAR, and Asmanex. Advair is a corticosteroid and a long-acting bronchodilator, used for some children. It is important to rinse the mouth after treatment with inhaled corticosteroid because the medication might cause thrush in the mouth (white plaques, much like newborns often get). Inhaled corticosteroids decrease the inflammation in the lung tissue caused by reactive airways. They are considered safe and have not been shown to have any serious side effects. The dose daily of inhaled corticosteroid is less than one oral course of steroid for asthma attacks.
- Leukotriene inhibitors (i.e. Singulair) come in chewable and pill forms. They are best taken in the evening.
How often should my child be seen to monitor asthma?
We believe children should be evaluated every 3-6 months in our office for routine asthma treatment (in addition to when they flare up). With each season change, the triggers for asthma change. Frequent monitoring can ensure that they are on enough medication and may allow backing down on controller medications. If they only come in when they are having an attack, we cannot see what their lungs do between attacks. If your child will be doing lung function testing and you are concerned about exercise induced asthma, have your child wear tennis shoes in case we have her work out during testing.
What is evaluated and done at the routine asthma checks?
- How well controlled is the asthma? How many times do you have to use the rescue medicine? Does it work when you use it?
- Any side effects to any of the medications?
- Is the controller (prevention) medication still needed or is the child outgrowing symptoms?
- Are there any other triggers (like acid reflux, new allergies, or exercise) that might contribute to symptoms and need separate management?
- Bring a log of how often rescue medications are used to document needs. Also bring your medications to show that you know how to properly use them.
- Peak flow numbers are also very helpful for those old enough to do peak flows at home.
- Children over 5-7 years old may be asked to do lung function testing at the asthma checks. This test, called spirometry, measures how much air the lungs hold and how fast your child can blow it out. Asthma narrows the airways, which makes it harder to push air out (picture breathing through a coffee straw). Some children without apparent symptoms have signs of airway narrowing on testing. This helps us optimize amount of daily controller medications given.
The above information is used to develop a new Asthma Action Plan, which can be used to manage the symptoms at home.