


                            ASTHMA


1. What is asthma?

Asthma is a disorder of the bronchial tubes (the smaller airways in  the 
lungs)   characterized by over sensitivity of these airways.  During  an 
asthma  attack,  the  muscles that wrap  around  these  bronchial  tubes 
tighten,  and there is more sticky mucous secreted.  This narrowing  and 
mucous  plugging of the bronchi make it more difficult for air  to  move 
into  and out of the lungs, and cause the wheezing sound and cough  that 
is  characteristic  of an asthma attack.  There are  about  two  million 
children in the U.S. that have asthma.

 
2. What causes asthma?

No  one  really understands why certain children have  overly  sensitive 
airways.   Sometimes,  the  tendency toward  asthma  is  inherited,  and 
occasionally  it  may be secondary to lung damage early in  life  as  in 
certain  premature babies that are born with severe breathing  problems.  
It is not contagious.  Often, no real cause for the asthma can be found.
However,  we do know that certain conditions can set off an  episode  of 
asthma in children that have the predisposition:

     a.  Allergy - Most asthmatic children older than 5 years  may  have 
symptoms caused by allergy.  Usually this is due to something inhaled in 
the air (e.g. pollen, dust, mold, animal dander).  In infants,  wheezing 
can occaisionally be caused by food allergy.  Children with asthma often 
have other allergic problems, such as hayfever or eczema.  

     b.  Infection - Viral upper respiratory infections (colds) are  the 
most  common  cause of episodes of asthma in children  younger  than  5.  
Some children actually seem to be "allergic" to the virus.  Some doctors 
call  this type of asthma "bronchitis", "wheezy bronchitis",  "asthmatic 
bronchitis",  or  "reactive  airways  disease".   Unlike  the  type   of 
bronchitis found in adults that smoke, antibiotics will not usually help 
children with wheezing because the cause is not a bacteria, but a virus, 
allergy, or both.

There  is  reason to be optimistic: 75% of children  with  viral-related 
wheezing will "outgrow" it as their bronchial tubes become larger.

     c.  Exercise - Many children with allergic asthma can also  develop 
"exercise-induced  asthma".  This usually starts 5 minutes or  so  after 
exercise  starts and manifests as cough, chest tightness, and  wheezing.  
It is more likely to happen in cold, dry air or if there are  pollutants 
or allergens (e.g. pollens) in the air.

     d.  Irritants-  Though not a true allergy by  medical  definitions, 
some children wheeze when they breathe cigarette smoke, smog, hairspray, 
insect repellant, paint, etc.

     e.  Drugs-  25%  of  children with chronic  asthma  may  have  more 
wheezing  if  they  take aspirin.  Acetaminophen  (Tylenol)  is  usually 
tolerated well. 

     f.  Other - Some children may develop asthma if they have  a  sinus 
infection,  pneumonia,  or emotional upset.  Asthma is  often  worse  at 
night.  Occasionally,  nothing in particular can be  pinpointed  as  the 
cause of an asthma exacerbation.

3. What is the treatment of asthma?

Unfortunately,  there  is no cure for asthma.  However,  in  almost  all 
children,  the  symptoms  can be controlled, and the child  can  lead  a 
normal life with modern medical therapy.

     a. Environmental control- Allergens and irritants should be avoided 
as much as possible.  There should be no cigarette smoking in the  house 
of an asthmatic child.  The bedroom should be kept dust-free.  Don't use 
a vaporizer, as this can promote mold growth.

     b. Medication- There is now availabile a variety of medications  to 
help  the  asthmatic  child.   You, your  child  and  your  doctor  will 
determine  which medicine or combination of medicines is best  for  your 
child based on his age, severity of symptoms, frequency of attacks, side 
effects, and, often, by trial and error.

      i.   Bronchodilators  - These work by relaxing  the  muscles  that 
surround the bronchial tubes:    

         - Theophylline - This can be given as a liquid or tablet  every 
six hours or in a long acting tablet or capsule that can be sprinkled on 
food every 8 to 12 hours.  

         -  Adrenergics  -  These can be given  as  shots  (adrenaline), 
"breathing   treatments"   (metaproterenol),    pocket-sized    inhalers 
(metaproterenol, albuterol, terbutaline), or orally as liquid or tablets 
(metaproterenol, albuterol).

        -  Anticholinergics  - These have only recently  been  used  for 
asthma. They must be inhaled.

     ii.  Cromolyn - This drug must be inhaled.  It is not used to treat 
wheezing, but is used in certain patients to prevent wheezing.

    iii.   Steroids  -  Prednisone or other steroid  medicines  work  by 
reducing the inflamation in the bronchial tubes.  Occasional short  term 
use of these drugs will not have significant side effects and can be  of 
great  help in stopping severe attacks and preventing  hospitalizations.  
However,  if used frequently or over a long period of time there can  be 
severe  side  effects,  so doctors are careful to use  these  only  when 
necessary.   Recently,  pocket  nebulizers for  inhaling  steroids  have 
become  available  that  are free of the side  effects  seen  with  oral 
steroids, so these are sometimes used in patients with chronic asthma.

     c. Immunotherapy ("Allergy shots")- If your doctor feels that  your 
child's  symptoms  can't be adequately  controlled with  medication,  he 
will  refer  him to an allergist for skin tests and  possibly  shots  to 
"desensitize"  the  child.   Allergy  shots  may  be  of  help  to  some 
asthmatics  whose symptoms are due to allergies, but will not be  useful 
when symptoms are caused by viral infection, exercise, etc.

     d.  General  Health - Good nutrition and physical  fitness  are  as 
important  for children with asthma as they are for everyone.   Children 
should  also  drink plenty of fluids to keep  the  bronchial  secretions 
loose.  With appropriate medication, nearly all children with asthma can 
take physical education class and can participate in competitive sports. 
As  a  matter  of fact, 75 members of the 1984  U.S.  Olympic  Team  had 
exercised-induced asthma.
As  much  as possible, avoid exposure to cold and flu  viruses  and  pay 
attention   to  careful  handwashing  to  help  lessen  the  number   of 
respiratory infections that might trigger an asthmatic episode.  If your 
child has severe asthma, your doctor may recommend a yearly "flu" shot.

4. When should I call the doctor's office?
 
Asthma severity can range from the patient who has only a nagging  cough 
without wheezes, to a life threatening emergency.  Fortunately, in  most 
children,  asthma  is  mild  and  easily  controlled  with   medication.  
However, if your child has mild symptoms that do not clear in a few days 
with his usual medication, please call us.  Likewise, if he seems to  be 
having difficulty breathing and is not relieved after his medication  is 
started, call us right away. It's always better to start asthma  therapy 
"too  early" rather than too late.  If you are unsure about  whether  to 
give  a  particular medicine, how much to give, or  whether  your  child 
needs  to see the doctor, please call us.  When you bring your child  to 
see the doctor for asthma, either bring his medicines with you, or write 
down the names and dosages.


For additional information, you may write to:

Asthma and Allergy Foundation of America
1302 18th St., NW, Suite 103
Washington, D.C. 20032

American Lung Association
909 12th Street
Sacramento, CA 95814
