Asthma is a common condition caused by narrowing of the small air passages (breathing tubes – bronchi) in the lungs. The narrowing happens because the air passages become swollen and inflammed. This makes it harder for air to get through and to breathe, and it causes wheezing, coughing and other associated breathing problems.
In most cases, we don’t know what causes the asthma attack, and there is no permanent cure. We do know that if someone in the family has asthma, one is more likely to have it. But, a very reassuring fact is that with regular and appropriate therapy, one can definitely reduce the frequency and the severity of these episodes.
How will you know if your child has asthma?
It can be hard to tell if someone has asthma, especially in children under the age of five. Having a doctor check how well your lungs work and checking for allergies can help you find out if your child has asthma. He or she will have either of the following symptoms:
- Coughing which usually happens at night, during the early hours of the morning, and during exercise.
- Wheezing when breathing sounds like whistling.
- Breathing problems such as fast breathing, laboured breathing etc.
Asthma attacks can be mild, moderate, severe and very severe. In some asthma attacks, the airways are blocked such that oxygen fails to enter the lungs. This also prevents oxygen from entering the blood stream and travelling to the body’s vital organs. Asthma attacks of this type can be fatal, and the patient may require urgent hospitalisation.
Symptoms of asthma will often go on for two to three days, or sometimes more. Once the initial attack has improved, your child will need bronchodilators three to four times a day until the cough and wheeze are gone.
What is an asthma attack?
An asthma attack may include coughing, chest tightness, wheezing, and trouble in breathing. The attack happens in airways, which are the paths that carry air to lungs. As air moves through lungs, airways become smaller, like branches of a tree are smaller than the tree trunk. During an asthma attack, the sides of airways in the lungs swell and the airways shrink. Less air gets in and out of lungs, and mucous that the body makes clogs up the airways even more. The musical wheezing sound is caused by the passage of air through these narrow passages.
What causes an asthma attack?
An asthma attack can happen when you are exposed to ‘asthma triggers.’ Triggers can vary from person to person. Know your child’s triggers and learn how to avoid them. Watch out for an attack when you can’t avoid the triggers. Some of the most common triggers are:
- Tobacco smoke
Tobacco smoke is unhealthy for everyone, especially people with asthma. ‘Secondhand smoke’ is smoke created by a smoker and breathed in by a second person. Secondhand smoke can trigger an asthma attack. If your child has asthma, people should never smoke near your child or wherever your child spends a lot of time. Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair – this can also trigger asthma symptoms.
- Dust mites
Dust mites are tiny bugs that are in almost every home. Dust mites can trigger an asthma attack. To prevent attacks, use mattress covers and pillow covers to make a barrier between dust mites and your child. Don’t use down-filled pillows, quilts, or comforters. Remove stuffed animals and clutter from your child’s bedroom. Wash bedding on the hottest water setting.
- Outdoor air pollution
Outdoor air pollution can trigger an asthma attack. This pollution comes from factories, automobiles, and other sources.
- Cockroach allergen
Cockroaches and their droppings can trigger an asthma attack. Get rid of cockroaches in your home by removing food residues. Cockroaches are often found where food is eaten and crumbs are left behind. Keep the house clean and keep food in tight containers and out of bedrooms. At least every two to three days, vacuum or sweep areas that might attract cockroaches. Use roach traps or gels to cut down on the number of cockroaches in your home.
Furry pets can trigger an asthma attack. Keep them away from your child’s bedroom. Bathe pets every week and keep them outside as much as you can. People with asthma are not allergic to their pet’s fur, so trimming the pet’s fur will not help. If you have a furry pet, vacuum often. If your floors have a hard surface, such as wood or tile, damp mop them every week.
Breathing in mould (a fungus) can trigger an asthma attack. Get rid of mould in your home to help control your attacks. Humidity, the amount of moisture in air, can make mould grow. An air conditioner or dehumidifier will help you keep humidity levels low. Fix water leaks, which let mould grow behind walls and under floors.
Smoke from burning wood is made up of small particles. Breathing in too much of smoke can cause an asthma attack. If you can, avoid burning wood in your home.
- Other triggers
Infections linked to influenza (flu) and colds caused by other viruses – all can trigger an asthma attack. Sinus infections, allergies, breathing in some chemicals, and acid reflux can precipitate an attack. Physical exercise, some medicines, bad weather, high humidity; cold, dry air, certain foods and additives, and fragrances can also trigger an asthma attack. Ensure the filter of your air conditioner is cleaned regularly and well. Wash curtains regularly, clean fans; in other words, ensure a dust free environment. Remove carpets from bedrooms and vacuum sofas regularly. Strong emotions and psychological stress too can trigger an asthma attack. It would be helpful for you to know what may trigger asthma in your child, so you can help avoid it.
Asthma can be well controlled with the right medicine in nearly all children. The two types of medication used by children are:
- Relievers: Relievers help during an attack and act quickly.
- Bronchodilators (e.g. Salbutamol) are most effective if they are inhaled. They relax the narrowing of the breathing tubes making it easier for air to get through. For acute/sudden attacks, your child will need a bronchodilator every two to four hours. If your child needs it more often, you should speak with your doctor or rush to a hospital.
- Steroids (e.g. Prednisolone) help by making the breathing tubes react more to bronchodilators. It also reduces swelling of the lining of air passages. Prednisolone is given as a syrup or tablet. Your child will usually need it for two to four days. When hospitalised, it may be given as an intravenous preparation, especially if your child is not able to take anything orally or is too sick.
- Steroids are NOT BAD – On the contrary, they are a must in an asthmatic attack. You may have read about their side effects and are understandably wary of administering them to your child. But these side effects occur only when the medicine is given for months at a time. These side effects will NOT happen when steroids are given only for a few days.
- Preventers: Preventers help prevent attacks from happening and are usually inhaled. Preventative medicines have to be taken every day. Not all children need preventer medicines. Your child will need to see the doctor regularly if he/she is on preventative medicines. The doctor will make sure the preventative medicines are working and will adjust the dose of medicine to suit your child’s needs. When preventers alone cannot control symptoms of asthma, a group of medicines called symptom controllers may also be used. They help in a similar way as bronchodilators, but last or work for longer. These are used in addition to preventers and as a result are often combined into one inhaler. Symptom controllers must never be used by themselves; they must always be used with a preventer.
Treatment between attacks
- Most children with asthma, who only wheeze when they have a viral infection, do not need any treatment between the attacks.
- Some children cough or wheeze at night, or when they run around. If these symptoms happen more than once a week, then your doctor might suggest you take medicine to help prevent asthma.
- Inhalation is the best way to take most asthma medicines. Spacer devices and MDI puffs are much cheaper than nebuliser pumps. If used properly, they work just as well if not better, in most instances.
- If attacks are too frequent or severe, search for the cause. It could also mean suboptimal treatment in between attacks.
Care at home
You should learn how to manage most attacks of asthma at home. With good treatment, nearly all children with asthma will be able to join in sports and leisure activities and lead active lives.
Asthma action plans
If your child has asthma, ask your doctor to write down an asthma action plan. The plan will tell you how to prevent asthma attacks and how to manage asthma attacks when they happen. The plan should be kept in a place where you can find it easily.
Four-step action plan
- Sit your child down and remain calm.
- Immediately shake a reliever (bronchodilator) puffer and give four separate puffs through a spacer. Give one puff at a time and ask your child to take four breaths from the spacer after each puff.
- Wait for four minutes. If there is no improvement in your child’s asthma, repeat step 2.
- If still no improvement after four minutes, call an ambulance immediately or rush to a hospital. Continuously repeat steps 2 and 3 while waiting for the ambulance.
If one is aggressive enough in the early stages of an asthmatic episode, there is a better chance of the attack aborting earlier and your child getting better soon.
Message to all parents and caregivers: Please recognise early signs of asthma and do not delay treatment!