Understanding Asthma

By Alan L. Nager, M.D., M.H.A.

asthma in childrenFlu season generally brings a spike in asthma cases – although asthma can occur year-round – and parents are often confused about this number-one chronic illness of childhood. Educating yourself about asthma is important, because asthma does kill.

Your child is more likely to have asthma if others in your family have it, or if they have allergies or eczema. And you have to know asthma well to manage it. When parents don’t recognize that their child’s symptoms are worsening, they fail to take action and their child ends up in the emergency department.

Start by knowing what triggers asthma episodes in your child. This might include colds, viruses, allergies (to foods, pollen, dust mites or animal dander, for which your child should be tested), irritants like cigarette smoke, and even emotions.

Asthma episodes are generally treated with an inhaler containing a medication called albuterol, along with oral steroids when symptoms start to worsen. You should understand how and when to give these medications – and make sure your child has access to them at school. Often a child will come in to the emergency department with severe symptoms, and the parent will tell us they last gave the medication 12 or 16 hours ago, when they should have been giving it every three to four hours.

Death is most common in people with severe asthma, African Americans and in people with mild asthma who don’t recognize that their symptoms are escalating.

Asthma is defined as a chronic, recurrent, reversible inflammatory disease of the lungs. Symptoms include:

  • Wheezing or signs of inflammation
  • Cough
  • Chest pain
  • Gagging
  • Choking
  • Runny nose
  • Congestion

Another important sign is “retractions,” whereby the notch below the sternum (breastbone and throat), the spaces between the ribs or the abdomen look as if they are caving in when your child tries to breathe. If that’s the case, take them directly to the emergency department.

Kids who have wheezing two or more times per week should also be on controller medications such as inhaled steroids or oral medications that help manage allergic reactions that trigger asthma. Using these medications correctly can help prevent a severe episode.

To learn about this disease, visit the American Academy of Allergy Asthma & Immunology (www.aaaai.org) and the American Lung Association (www.lung.org).

Alan L. Nager, M.D., M.H.A., has been Director of Emergency and Transport Medicine at Children’s Hospital Los Angeles for the past 18 years, and is a professor of Pediatrics at the Keck School of Medicine of the University of Southern California.

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