Childhood Asthma

Childhood Asthma: Dying to Breathe

Rashonda Davis's three children were continually diagnosed with bronchitis. Years later, she learned that bronchitis was only a symptom of the real problem: Asthma. This is her story...


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4 Major Myths About Asthma

Many times parents get mixed messages about asthma from family members, friends, teachers, the web and even their doctors. Unfortunately, it is often hard to get real answers. Not knowing the truth can lead to unnecessary worry, sleepless nights (for parent and child), inability to participate in school/sports/work, hospitalization and even death from uncontrolled symptoms. Clearing up these misconceptions and replacing them with facts can help a parent keep his/her child with asthma healthy and active.

#1: “Every time my child gets sick it goes straight to his chest. This is not asthma, it’s just ‘chronic bronchitis.’ By the time he’s in school he’ll be fine.”

While it is true that most children who cough or wheeze with colds in the first three years of life do not go on to have asthma later in life, it is important to recognize when asthma is a possibility. Children with persistent coughing or wheezing episodes four or more times in a year, especially those with an asthmatic parent or with a history of food/ environmental allergy, are at risk for developing persistent asthma. For these children, asthma is a condition that can only be controlled—not cured. In order to make a diagnosis of asthma, a doctor needs to take a detailed history of symptoms and things that trigger symptoms, and closely follow response to medication. It is important to remember that making an accurate diagnosis of asthma is the first step to gaining control. The great majority of children with asthma can live very active, normal lives with proper care and management. By accepting a diagnosis of asthma, a family can learn the steps necessary to take control of this condition and greatly minimize symptoms and limitations caused by the disease.

#2: “My child is doing great as long as he has albuterol everyday.”

While having bronchodilator medicine everyday may prevent constant coughing or wheezing, you may actually place your child at increased risk for more severe complications from asthma, including hospitalization or death. Albuterol just treats the squeezing of the muscles around the airway; it does NOT heal the inflammation and swelling that actually causes asthma. By using albuterol regularly, symptoms may be masked and allow the swelling of the airway to continue, or possibly get worse. This may lead to even more difficulty and problems, including pneumonia and hospitalization. For a certain group of people, chronic use of albuterol also makes the body become more accustomed to the medication—in other words, the more you use it, the less effective it becomes. This is very important because in an emergency, albuterol is the medication that is most available and useful for keeping a child alive. For this reason, daily use of albuterol is listed as a risk factor for death from asthma. Fortunately, a person’s body typically adjusts back to normal relatively quickly when this overuse has been stopped and appropriate preventative medication has been started.

#3: “I have my child’s asthma under control and only need to see my pediatrician once a year for routine check-ups and when my child is sick.”

National guidelines have been written that discuss how asthma affects a person’s body and the most effective way to treat this condition. (These can be found at http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/asthma-info/asthma-guidelines.htm). In these guidelines, experts have recommended that a patient with asthma be seen by their physician every 3-4 months, whether they are well or sick. The goal in asthma management should always be to PREVENT becoming sick, and not just react to an exacerbation. Simply treating exacerbations leads to a roller coaster ride of healthy and sick periods, with healthy periods becoming rarer. This approach places your child at risk for a severe episode or illness. Preventative visits allow a physician time to recognize that your child’s asthma control is slipping and you must act on this early. If your child is requiring oral steroid use more than once a year, having persistent cough in sleep more than two times a month, having difficulty with activity, or using albuterol more than two times a week, he/she is NOT in control and some change to his/her asthma action plan should be made or discussed. For many families, the hectic nature of life makes it easy to lose sight of why it is necessary to take medication. Or, parents don’t realize a child is having symptoms or difficulty with activity due to time spent in school. In between visits, it becomes easy to forget the significance of minor symptoms or what to do in an emergency. All of these things should be discussed regularly with your physician. Every three to four months is also an important time between visits because asthma is an episodic condition that often varies with change of seasons. Therefore, each new season may bring with it a different treatment regimen, action plan or signs of concern. Finally, a regular check-up often has so many other issues to review that asthma-related questions are forgotten or glossed over. At every asthma-related visit, you should expect your pediatrician to answer any questions you may have about asthma; review symptoms and assess asthma control; discuss asthma medication use; check for possible signs of difficulty with medication; review and revise a written asthma action plan; review asthma triggers and ways to eliminate exposure to them; and review any possible contributors to persistent asthma symptoms. If your child is over 5 years old, many experts also recommend a simple lung function test, spirometry, to assess degree of airway narrowing and response to medication. That’s quite a lot to discuss, which is why it is important to have a visit dedicated only to asthma.

#4: “My child’s pediatrician is my only resource for talking about asthma.”

Your pediatrician should definitely be your first stop to finding answers to any question you have about asthma; however, some pediatricians may not have answers that satisfy you or time to discuss your concerns. While care must be taken to read information on the web, there are some valuable and accurate websites that are easy to navigate:

These sites are important for obtaining information about asthma, medications used to treat asthma and possible risks, how to recognize asthma triggers and steps to avoid them and tools for recognizing if your child’s asthma is well-controlled.

If your child continues to exhibit asthma symptoms despite medication and/or your child has ever been hospitalized or has had more than three emergency room visits for asthma in one year, then an asthma specialist may be another important resource. An asthma specialist (usually an allergist or pulmonologist) is specially trained to perform and interpret lung function testing, educate a family in ways to reduce asthma triggers and symptoms, and to recognize when there may be another medical condition that is making your child’s asthma worse. Seeing an asthma specialist often requires a primary care physician’s referral so this may be another topic to discuss with your child’s doctor.

It is very important to remember that with proper care, asthma should NOT limit your child in any way. “Live well and breath easy” is our goal for all children!

Ann-Marie Brooks, MD, is a pediatric pulmonologist and director of the Children's Asthma Center at Children's Healthcare of Atlanta at Hughes Spalding.

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