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Pediatrics - Asthma 

Introduction

Asthma is a lung disease.  Asthma causes the breathing tubes in the lungs to temporarily narrow.  People with asthma have difficulty breathing air in and out of their lungs.  An allergen or irritant in the environment usually triggers an asthma flare-up. 

There is no cure for asthma.  Some asthma flare-ups can be prevented.  Asthma can be treated with lifestyle changes and medication.  Untreated asthma can become severe and life threatening.  Asthma can be controlled with self-management and medical treatment.  Most children with asthma can lead normal lives.

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Anatomy
Your child's lungs are located inside of the ribcage in his or her chest.  The diaphragm is beneath your child's lungs.  The diaphragm is a dome-shaped muscle that works with the lungs when your child breathes. 
 
From the nose and mouth, air travels towards the lungs through a series of tubes.  The trachea or windpipe is located in your child's throat.  The bottom of the trachea separates into two large tubes called the main stem bronchi.  The left main stem bronchus goes into the left lung, and the right main stem bronchus goes into the right lung. 
 
Once in the lung, the bronchi branch off throughout the lung and become smaller.  These smaller air tubes are called bronchioles.  There are approximately 30,000 bronchioles in each lung.  The end of each bronchiole has tiny air sacs called alveoli.  There are about 600 million alveoli in the lungs.  Each alveolus is covered in small blood vessels called capillaries.  The capillaries move oxygen and carbon dioxide in and out of your child's blood.
 
When your child breathes air in or inhales, your child's diaphragm flattens and the ribs move outward to allow your child's lungs to expand.  The inhales air travels through your child's nose or mouth and down the trachea.  Tiny hair-like structures in the trachea, called cilia, filter the air to help keep mucus and dirt out of the lungs.  The air travels through the bronchi and the bronchioles and into the alveoli.  Oxygen in the air passes through the alveoli into the capillaries.  The oxygen attaches to red blood cells and travels to the heart.  The heart sends the oxygenated blood to the cells in your child's body. 
 
When your child breathes air out or exhales, the process is the opposite of when he or she inhales.  Once the body has used the oxygen in the blood, the deoxygenated blood returns to the capillaries.  The blood now contains carbon dioxide and waste products that must be removed from the body.  The capillaries transfer the carbon dioxide and wastes from the blood and into the alveoli.  The air travels through the bronchioles, the bronchi, and the trachea. As your child exhales, the diaphragm rises and the ribs move inward.  As your child's lungs compress, the air is released out of his or her mouth or nose. 

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Causes

Asthma causes the bronchial tubes in the lungs to swell and become narrower.  The muscles in the airways contract causing even further narrowing.  The bronchioles may also produce extra sticky secretions or mucus.  Asthma makes it harder for a child to inhale or exhale.

Doctors do not know exactly what causes asthma.  They do know that the airways in some people are sensitive to triggers that cause an asthma flare-up or “asthma attack.”  Allergens are a type of trigger that causes allergic reactions in the airways.  Common allergens include pollen, pet dander, dust mites, mold, cigarette smoke, polluted air, perfume, and cleaning products.  Triggers may also include cold dry air, physical exercise, stress, nonsteroidal anti-inflammatory drugs, and sulfites, a type of additive found in food or wine.  Some people experience asthma when they have a cold, the flu, or bronchitis.  Laughing or crying can even trigger asthma.

There are different types of asthma.  Adult-onset asthma begins after the age of 20.  Exercise induced asthma occurs during exercise that requires breathing through the mouth, continuous activity, or cold weather.  Occupational asthma involves exposure to irritants at the workplace.  Such irritants may include chemicals, plastics, rubber, paint, and metal products.  Nocturnal asthma occurs between midnight and 8 AM.  It is triggered by allergens in the home or sinus conditions.

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Symptoms
Most people with asthma have periodic flare-ups and symptom free periods.  Some people have difficulty breathing all of the time and periods of very difficult breathing.  Asthma flare-ups can last from minutes to days.  They can be very dangerous if the airway is severely restricted.
 
Asthma makes it difficult to breathe.  Your child may have to work extra hard to breathe under normal conditions.  Your child may experience shortness of breath that is made worse by exercise.
 
You may hear a wheezing sound when your child breathes.  Wheezing sounds like a whistle or high pitched musical noise.  It is caused by air being forced through the narrow airways.  Wheezing usually begins suddenly.  It may come and go.  It may occur more often in the night or early morning hours.  Cold air or exercise may cause wheezing to increase.  Wheezing may be accompanied by a cough.  It is important to note that not all people with asthma wheeze, and not all people who wheeze have asthma.
 
Your child may also experience nasal flaring, chest pain, or chest tightness.  It may take your child longer to breathe out than it does to breathe in.  Your child may have an uneven breathing pattern with temporary stops.  It may be difficult for your child to speak.
 
Symptoms of severe asthma are signs of a medical emergency and may lead to death without treatment.  You should call emergency medical services, or take your child to a hospital emergency room if your child experiences an extremely difficult breathing.  Other emergency symptoms include sweating, a rapid pulse, and anxiety associated with shortness of breath.  Additionally, your child's lips and face may appear blue.

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Diagnosis
Your doctor can diagnose asthma by reviewing your child's medical history and conducting a physical examination and tests.  You should tell your doctor about your child's symptoms, risk factors, and what appears to trigger your child's asthma flare-ups.  Your doctor will listen to your child's chest while your child breathes.  If your child is experiencing an asthma episode, your doctor may hear wheezing.  However, wheezing is not present between asthma flare-ups.  There are several tests that your doctor may conduct to find out the cause of your child's symptoms and the degree of airway obstruction.  Your child's doctor may also order a chest X-ray to rule out other conditions that have similar symptoms.
 
Your doctor will have your child breathe into a hand-held device called a spirometer.  A spirometer measures how much air your child breathes out and how forcefully your child breathes the air out.  Your doctor will also have your child breathe into a peak flow meter.  A peak flow meter is a hand-held device used to manage asthma by monitoring the airflow through the bronchi.  The peak flow meter measures your child's ability to expel air from his or her lungs under the best or peak conditions.  Your child's rates will be higher when your child is feeling well and lower when your child has an asthma flare-up.  By monitoring the changes in your child's breathing patterns the doctor can identify how well your child's lungs are functioning, the severity of your child's symptoms, and appropriate treatment.
 
Your doctor may use a pulse oximeter to determine the amount of oxygen in your child's blood.  For this test, a probe will simply be placed on your child's fingertip.  A medical device attached to the probe displays the percentage of oxygen in your child's blood.
 
The doctor may take a sample of your child's blood to determine the amount of carbon dioxide and oxygen in his or her blood.  A blood test may also be used to identify infections or other causes of your child's symptoms.  Additionally, a blood test or skin test may be used to determine the type of allergies that your child may have.
 
Asthma is classified as Mild, Moderate, or Severe according to its severity.  People with Mild Asthma have symptoms that occur twice per week or less.  The symptoms are quickly relieved with medication and there are no symptoms in between episodes.  People with Moderate Asthma experience symptoms everyday.  They require inhaler medication almost every time for symptom relief.  Severe Asthma causes symptoms for the majority of every day.  People with Severe Asthma may need to restrict their activities.  They may need a hospital stay for treatment.

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Treatment
The goals of asthma treatment are to establish normal lung function, relieve symptoms, and prevent asthma flare-ups.  There is no cure for asthma, although symptoms may decrease over time.  It is important to identify and avoid the allergens that trigger your child's asthma.  Your doctor may prescribe medications based on your child's condition. 
 
The type of medication that your child receives depends on the severity of the asthma, the cause of the symptoms, and your child's lung functioning.  Your child may receive long-term medications or quick relief “rescue” medications.  Long-term medications are used on a regular basis to prevent asthma.  People with persistent asthma flare-ups use long-term medications to prevent symptoms.  Quick relief medications are used during an asthma flare-up to relieve symptoms.  People with Mild Asthma or infrequent flare-ups may use quick relief medications as needed.
 
Your doctor will instruct you how to use a peak flow meter at home.  By measuring your child's lung volume, you may be able to detect an upcoming asthma flare-up and take action according to your doctor’s instructions.  Using a peak flow monitor can prevent an asthma flare-up from taking your child by surprise. 

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Prevention
Your child should wear a MedicAlert bracelet and carry a MedicAlert card in his or her wallet.  In the case of an emergency, the MedicAlert information will be helpful to the healthcare professionals treating your child.  Because the medical complications associated with asthma can be very serious, people with asthma need to diligently manage their condition to remain healthy.
 
You should formulate a plan with your doctor as to what you should do in the case of an emergency or serious situation.  Your child should know how to use medication properly and when to use it.  You should also know what to do if your child's medication does not work right away and when to go to the emergency room.
 
Your child may be able to prevent or reduce asthma flare-ups by avoiding the triggers that cause it.  Talk to your doctor to find out if allergy treatments are an option for your child.  You may also make lifestyle changes to protect your child from allergens.  This may include staying indoors when pollen levels are high or removing carpets from your home.  Ask your doctor for recommendations that are appropriate for your family.
 
Learn how to use a peak flow meter at home.  Check your child's peak flow regularly.  Keep a record of the results and bring them to your doctor appointments.  The record will help your doctor to monitor your child's medications.  Additionally, make sure that your child attends all of his or her doctor appointments.

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Am I at Risk

Is My Child at Risk?

About half of all asthma cases occur in children under the age of ten.  Boys are more likely than girls to develop asthma.  Conversely, women are more likely than men to develop adult-onset asthma.  Asthma affects people of all races.  It is more common in people who are Afro-American or Hispanic. 

Risk factors for asthma:

_____ Smoking or living with a smoker can increase your child's risk because smoke is unhealthy for the lungs and can be an asthma trigger.
_____ A family history of asthma.  If parents, brothers, or sisters have asthma, a child has an increased risk of developing it as well.
_____ If your child has allergies or eczema, a skin condition, your child has an increased risk of developing asthma. 
_____ If your child had allergies or a severe viral infection before he or she three years old, your child is at risk for developing asthma.
_____ Living in the inner city or being exposed to mice and cockroach waste products increases your child's chance of developing asthma.
_____ If your child is frequently exposed to triggers, your child is at risk for asthma.

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Complications
Complications from asthma can lead to hospitalization and even death.  Your child may be hospitalized if his or her asthma is very severe or does not respond to treatment.  Your child may be hospitalized if your child develops a serious lung illness or a pneumothorax, a collapsed lung.  Other conditions that warrant hospitalization include poor lung function and elevated carbon dioxide or low oxygen levels in the blood.  The hospital staff will monitor and treat your child's condition.  Some children may have to be placed on a ventilator, which is a machine that can breathe for them. 

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.