The leading cause of chronic illness among children is asthma. Among the nearly 6 million children affected by this disease in the United States, more than 80 percent experience initial symptoms beginning before age 5. Yet often the symptoms may be overlooked or misdiagnosed.
A chronic condition of the lungs, asthma results from inflammation in the airways, which produces episodic narrowing of these airways because of a tightening of the airway muscles.
Asthmatics commonly experience cough or breathing difficulty during an attack. This may be accompanied by a high-pitched noise during exhalation known as wheezing. Wheezing results from attempts to force air out of the lungs through narrowed airways.
Symptoms of asthma may follow a seasonal pattern among some asthma sufferers because of the strong association between allergies and asthma and the fact that allergens may trigger asthma symptoms.
Other patterns may be typical of asthma. These may include occasional asthma symptoms among people who otherwise are asymptomatic, gradually progressive symptoms or chronic symptoms that occasionally get worse. For some asthmatics, symptoms may be worse in the morning and then gradually improve.
Among those asthmatics with occasional symptoms, exercise sometimes can trigger the tightening of airway muscles that produce cough, wheezing, breathing difficulty and/or chest pain.
While aerobic conditioning actually can reduce the frequency of exercise-related symptoms, children with asthma triggered by exercise may avoid physical exertion. This is not necessary once asthma is identified because proper treatment can improve tolerance of physical activity.
Other triggers for asthma include viral infections such as colds, as well as secondhand tobacco smoke exposure. Asthmatic children whose parents smoke have higher rates of asthma attacks and may suffer more illness related to asthma. Elimination of secondhand tobacco smoke exposure is considered essential to proper management of childhood asthma.
Asthma most commonly is diagnosed based upon the presence of recurrent symptoms suggestive of asthma. It is important to realize that other illnesses may mimic asthma, especially certain viral respiratory infections among small children.
Lung testing for asthma aids the diagnosis among older children and adults but is not practical in infants, toddlers and preschool-aged children because the testing requires coordinated breathing into a machine. Response to a trial of asthma medication often is helpful in aiding the diagnosis of asthma, however.
Management strategies begin with confirmation of the diagnosis, identification of triggers and recognition of the frequency of asthma symptoms including daytime wheezing and nighttime coughing. This facilitates education of the asthmatic child and his or her family about avoidance of environmental triggers, recognition of impending flares, and also the use of prescription medications which may be indicated.
The management of asthma is geared toward reducing airway inflammation and the frequency of asthma symptoms. One goal in children with asthma is the avoidance of physical limitations. With proper control, children should be able to participate fully in age-appropriate activities, including athletics.
Dr. Matthew A. Clark
is a board-certified physician in internal medicine and pediatrics practicing at the Southern Ute Health Center in Ignacio.