Asthma in Children
Bronchial asthma is one of the most common health issues affecting children, with sometimes life threatening consequences. It is caused by inflammation of the bronchial tubes in which the bronchial lining tries to protect the body from allergens by increasing mucous, swelling of the mucosal tissues and contraction of the muscles. According to the American Lung Association, this inflammation is produced by allergies, viral respiratory infections, and airborne irritants among other causes. This airway inflammation can cause scarring if it goes on for a long period of time. (1)
Symptoms of asthma usually include difficulty in breathing, frequent coughing, wheezing or shortness of breath after physical activities, and a tendency for allergies. Accordingly, children who have increased symptoms from allergies are diagnosed as having “allergic asthma”. (2)
Frequently, children may say that they feel as if someone is sitting on their chest so that they cannot breathe. Infants who have trouble feeding or who grunt during suckling may have asthma. (3) Even intermittent coughing, which usually increases during the evening, may suggest the possibility of asthma. Loud coughing which sounds like a dog barking is symptomatic of Croup which is usually due to a viral infection and can be treated at home with steam inhalations.
Asthmatic attacks are usually characterized by complaints of wheezing, cough, shortness of breath or tightness in the chest. (4) It is usually more difficult to breathe which can interfere with the child’s ability to speak in full sentences. When the ability to intake enough oxygen is disrupted, the color of the skin may lose its pink tone, signifying an urgent need for medical attention.
Asthma and allergies such as hay fever tend to run in families according to a study printed in the European Journal of Epidemiology. The results of the study showed a high positive correlation for getting asthma if the parents also suffered from it. (5) This study therefore suggests that asthma may be inherited in the Saudi population.
Because asthma is frequently induced by allergies, occurrence is a very individual experience and as a result causes of asthma differ from one child to another. Some of the most common triggers of asthmatic attacks include: pets such as dogs, cats and birds, cigarette smoke, dust, pollen, molds and dust mites found in pillows, mattresses/couches or stuffed animals. Secondhand cigarette smoke is possibly one of the worst offenders where asthma is concerned. According to the New England Journal of Medicine there is a clear association between exposure to environmental tobacco smoke and pulmonary morbidity in children with asthma. The data from their research emphasizes the need for systematic, persistent efforts to stop the exposure of children with asthma to environmental tobacco smoke. (6)
Additional factors which can affect children who have asthma are changes in weather (breathing in cold air), outdoor pollen, air pollution, physical activity and sometimes even emotions. Other items include household cleaners and air fresheners which can also cause distress and should be used with discretion. If the asthma is severe, parents may want to search out alternative natural cleaners such as vinegar and baking soda.
Air fresheners work by putting micro molecules of fragrance into the air. These can irritate the lining of the bronchial tubes and lead to asthma attacks. Many such fresheners contain substantial quantities of terpenes, which when exposed to ozone form small particles with properties like those found in smog and haze. (7) Outdoor pollutants known to trigger asthma attacks include ozone, particulate matter, nitrogen dioxide, and sulfur dioxide. (8)
Methods of treatment will also depend upon each child’s particular case and therefore should be monitored by a doctor. Among the types of treatment, doctors usually choose between bronchodilators and anti-inflammatory medications.
Bronchodilators open up narrow passageways. They help relieve the feeling of tightness in the chest, wheezing and breathlessness.
Anti-inflammatory drugs help prevent the swelling and inflammation in the airways and may increase drainage of secretions from the airways. These drugs can be given by mouth, by injection or inhaled in an aerosol (mist) form. (9)
Another method used is in support to boost the child’s own immune system with multivitamins especially vitamin C and zinc which should be given in amounts suitable for the child’s age.
However, possibly the best treatment is prevention by monitoring the child’s surroundings and activities. Within the Kingdom of Saudi Arabia there are specific needs that parents should familiarize themselves with. Frequent vacuuming of all hard surfaces and upholstered furniture reduces fine dust and sand particles which normal cleaning may not catch. Keeping curtains and bedspreads laundered reduces the dust particles which spread into the air within the home. Furthermore, use of a humidifier is a very useful tool to add moisture to a dry area, and dehumidifiers can be helpful for those in humid coastal regions. Wet damp homes may allow the growth of molds behind cabinets or other wooden decor. For those patients who suffer severe asthma, it may be advisable to have medical quality facial masks available at all times. Reducing or eliminating allergens and other lung irritants will go a long way in decreasing the number and severity of attacks that a child may experience.
Additionally, it is vital that all health information is available to school personnel in order to alert them to any possible risks which may occur in the school setting. Highlighting awareness about asthma and its risks is necessary in schools especially for younger children in order to establish healthy environments as well as providing necessary medical equipment such as nebulizers and masks if possible. By raising awareness and education about asthma and its implications, we can create safer and more comfortable environments for children and their families.
Asthma and Allergy: Childhood Asthma Overview, American Lung Association. April 2008
American Academy of Allergy Asthma & Immunology. Patients & Consumers; What Is Asthma?: How Can You Tell if Your Child May Have It? March 2000
Recognizing an Asthma Attack American Academy of Pediatrics, 1999
A. Bener. Heredity of asthma in Saudi population, European Journal of Epidemiology; vol. 8, Number 5/ September, 1992.
Chilmonczyk, Barbara A. Association between Exposure to Environmental Tobacco Smoke and Exacerbations of Asthma in Children, The New England Journal of Medicine. Volume 328:1665-1669. June 10, 1993
Greensfelder, Liese. Study warns of cleaning product risks, UC Berkeley News. May 25, 2006
Brunekeef B, Holgate ST. Air Pollution and Health. Lancet. 2002; 360:1233-42.
Recognizing an Asthma Attack American Academy of Pediatrics, 1999