Sunday, November 16, 2008


Asthma Asthma in children
Asthma is a common condition that causes coughing, wheezing, tightness of the chest and breathlessness in about 1 in 10 children. The symptoms are caused by irritation and narrowing of the airways and are often set off by an allergy or a virus.
About half of all children who develop asthma will grow out of it, but left untreated asthma can cause permanent scarring of the airways. Very rarely, a severe asthma attack can be fatal.
Understanding asthma
When we breathe, air travels into the lungs through a series of bronchial tubes, which branch out like a tree, gradually getting smaller, until they turn into millions of tiny air bags called alveoli. From here, the oxygen in the air can be absorbed into the bloodstream and taken to the rest of the body.
In children who develop asthma, the airways become irritated and inflamed. As a result, they become narrower and produce extra mucus, making it more difficult for air to flow into and out of the lungs and causing the symptoms of asthma.
How well the lungs are working (lung function) can be measured by blowing into a device called a peak flow meter. If the airways are narrower than normal, air is exhaled at a slower rate, giving a lower reading.Peak flow readings can help diagnose asthma, and regular readings can help monitor the condition.
Urgent treatment is required if a child has severe symptoms that do not improve with the use of a reliever inhaler, or is so short of breath that he or she has difficulty talking.
It´s not as easy to tell how much difficulty babies and toddlers are having with breathing - they need urgent medical attention sooner.
Why do some children get asthma?
In children, boys are more likely to get asthma than girls and black children are more likely to get it than white children. In addition, asthma often runs in families - children can inherit the tendency to get inflamed bronchial tubes. They can also inherit the tendency to have allergies (doctors call this atopy) and this increases the risk of developing asthma. Many children who have eczema also have asthma.
Risk factors
Other factors thought to affect a child´s risk of developing asthma include: l Cigarette smoking in pregnancy - babies are more likely to be born with reduced lung function and a tendency to wheeze. l Passive smoking - children who are exposed to tobacco smoke are at greater risk of developing asthma, and of the symptoms being more severe. l Having been breastfed may reduce a child´s risk of developing asthma.
Children in developed countries are no longer exposed to the kinds of infections they would have had to deal with in the past. There is a theory (called the hygiene hypothesis) that children´s immune systems over-react to harmless substances instead.
Asthma symptoms
The symptoms of asthma may be mild, moderate or severe. They may include: l coughing l wheezing l breathlessness l tightness in the chest l difficulty breathing l disturbed sleep l tiring quickly during exercise
Sometimes, the symptoms flare up for no obvious reason, but specific triggers that set off an asthma attack or make the symptoms worse can often be identified. These triggers can include: l infections such as coughs, colds and flu l allergies - to pollen, medicines, animals, housedust mite, or certain foods l irritants such as dust, tobacco smoke and fumes l exercise - some children only ever have symptoms brought on by exercise, especially in cold, dry air l emotions - laughing or crying very hard can trigger symptoms, as can stress l sleeping - for many children, symptoms are worse at night
Any parent who thinks their child may have asthma should consult a doctor, particularly if they are waking up in the night with shortness of breath.
Diagnosing asthma in children
A GP will listen to the symptoms and carry out a physical examination. Depending on the age of the child, a peak flow meter or a machine called a spirometer may be used to check lung function (in babies and very small children this isn´t possible). Less commonly other tests, such as a chest X-rays, may be done to make sure no other breathing problems are present. An allergy skin test - to find out whether the child is allergic to certain substances - may sometimes be suggested.
Although asthma cannot be cured, with good treatment and management, most children will not need to miss out on school or an active lifestyle.Treatments aim to reduce the frequency, severity and length of asthma attacks. Because a lot of different factors are involved in asthma, each treatment plan will be individual, combining medicines and asthma management in the way that works best for each child.
These devices (sometimes called "puffers") contain a gas that propels the correct dose of medication when the top is pressed. This is inhaled into the airways. There are two basic categories of inhaler medicines:
l Relievers are used when asthma symptoms occur. They contain medicines known as bronchodilators that work to widen the airways and quickly ease the symptoms. Relievers can be short-acting or long-acting. If asthma is not well controlled using a regular steroid and occasional use of a short acting reliever, a long-acting reliever can be added to the treatment. Some doctors consider long-acting relievers to be a separate category of inhaled medicines. Reliever inhalers are usually a blue or grey colour. l Preventers are used every day - even when the child does not have symptoms - to help keep symptoms from occurring. These usually contain a steroid medicine that works to reduce the inflammation of the airways. Steroids are the most effective way of reducing inflammation in the airways and side-effects are unusual at normal doses (although they can sometimes cause a sore mouth or throat). It can take up to six weeks for the full effect of preventer medicines to build up, but once they do, the reliever inhaler may not be needed at all. Other medicines, such as sodium cromoglicate, may also be used as a preventer. Preventer inhalers are usually a brown, orange or red colour.
Inhaler techniqueTo work properly, inhalers need to be used correctly. Pressing the top and inhaling at the right time takes some co-ordination, which can be tricky. A device called a "spacer" can help. It is easier to use because it enables the child to activate the inhaler then inhale in two separate steps. Children as young as three years old can learn to use an inhaler with a spacer. And for babies and very young children, a face mask can be attached to the spacer. Using a spacer also reduces the risk of getting a sore throat from using a steroid inhaler.
Other medicines
Severe attacks of asthma are sometimes treated with a course of steroid tablets, such as prednisolone. In this case steroids are being used as relievers. Taken for about a week there are few side-effects (side-effects of steroids are usually associated with taking them for several months or at high doses).
Several other medicines are available as tablets and inhalers if the standard treatments are not suitable for an individual child (perhaps because of side-effects) or if asthma is still not adequately controlled.
A nebuliser is a device that turns a medicine into an vapour, and is used with a face mask or mouthpiece. It is used for giving large doses of inhaled medicine, usually in hospital, but may also be used at home instead of an inhaler to treat children under the age of two years.
Asthma management
Medicines are only part of the treatment for asthma. Asthma also needs to be managed by dealing with the things that make it worse. Identifying and avoiding the things that trigger a child´s asthma is an essential part of the overall treatment plan.Keeping a diary to record anything that triggers a child´s asthma can help to discover a pattern. Using a peak flow meter to monitor the child´s lung function can also help. Repeatedly low readings in a certain situation may indicate the trigger.The older the child, the more they will be able to understand and participate in their own asthma management. With good management and appropriate treatment, most children with asthma lead completely normal lives.
Asthma in adults
Asthma is a relatively common condition and one in ten people suffer an asthma attack at some time in their lives. Children are more vulnerable.
What is asthma?
The symptoms of asthma are caused when airways (the tubes which carry air to and from the lungs) narrow and become inflamed.
This may happen if there’s too much mucus being produced by the airways, or there is swelling or spasm in the lining of your airways. You feel breathless, wheezy, and may develop a dry cough. Symptoms tend to be worse at night or in the early morning.
The symptoms can be severe and distressing, and may require hospital treatment. Severe asthma attacks can be fatal.
What triggers it?
The symptoms of asthma can be set off by a variety of different triggers.
These include: l exposure to allergens (substances that trigger a reaction) l physical exertion l breathing in cold air l an infection l a reaction to certain medicines
For many people with asthma, especially children, an allergy to house dust mites and animal hair or fur is common. If you have allergic asthma, you or other family members may well also suffer from eczema or hay fever.
Other possible allergens include: l chemicals found in the workplace (it might be helpful to note if your symptoms come on only when you’re at work), l other environmental pollutants, such as cigarette smoke. All these triggers can irritate the airways in your lungs, making an asthma attack more likely. But the reasons why symptoms come on at particular times, and why some people are affected and not others, are not yet fully understood.
The doctor or asthma specialist will use a device called a peak flow meter to help diagnose asthma, and to monitor the progress of treatment. A peak flow meter measures how much, and how fast, air can be expelled from the lungs. This type of test of lung function is known as spirometry.
Spirometry gives a measure of how severely breathing is affected. If measured regularly, over time, these readings can also help reveal how well or badly the asthma is being controlled.
Asthma isn’t always easy to diagnose. Anything that causes congestion of the lungs or airways can lead to problems that are similar to the symptoms of asthma. For example, a young child may have all the symptoms of asthma, but in fact he or she may have inhaled something which is blocking the airways (a coin or a button, for example).
In some adults, the symptoms of asthma may be a sign of heart disease, especially if wheeziness occurs when there has never been an asthma attack in the past. Heart failure can cause congestion (excess fluid) of the lungs, and have symptoms similar to asthma.
Although it’s not always easy, it’s important to try to avoid anything that might make asthma worse, or bring on an attack. There’s also a range of treatments which may help keep symptoms in check. Measuring peak flow regularly, especially first thing in the morning, is a useful way of monitoring the condition and checking whether any treatments are helping.
The most common way of taking treatment is with an inhaler – or "puffer" which delivers a precisely measured dose of a medicine in aerosol or fine powder form. Learning how to use the inhaler properly, including how to co-ordinate "firing" the device and breathing in, is essential.
The two main types of medicine used in inhalers are relievers and preventers.
A reliever medicine helps to open up the airways and works rapidly. It is used at the beginning of an asthma attack. Inhalers containing these medicines are coloured blue.
Preventer drugs, which can be used together with relievers, are for preventing the symptoms. Most preventers are inhaled corticosteroids, usually referred to simply as steroids. They act to reduce the inflammation in the airways. People who regularly have to use a reliever twice a day or more, will probably be prescribed a preventer as well. Unlike relievers, preventers aren’t meant to have an immediate effect and should be used as prescribed, whether or not there are symptoms.
In the inhaled form, steroids have far fewer side-effects than steroids in tablet form. Preventer medicines usually come in red or brown packaging.
If asthma is quite severe or unpredictable, it may be necessary to take a course of steroids in tablet form. These work in the same way as inhaled preventers, by reducing inflammation.
Nebulisers make a mist of water and asthma medicine that is breathed in. They can deliver more of the drug to exactly where it’s needed than conventional inhalers can. This is particularly critical in the event of a serious asthma attack. Nebulisers are mostly used at hospital, but some people may have them at home. They’re also sometimes used to treat young children, who may have problems using an inhaler or taking tablets.
Spacers offer an alternative for people who find an inhaler awkward to use. They’re also good for getting more of the medicine into the lungs.
A spacer is a long tube which clips on to the inhaler. At the other end of the tube is a mouthpiece or mask which you breathe in and out of.
Managing your asthma
If you have asthma – or you have a child who does – it’s worth remembering that it is something you can control yourself to a large degree.
It’s important to plan ahead. Always have your reliever available to help yourself when you feel the symptoms coming on. This should help cut down the risk of more serious attacks, and avoid the need to go to hospital.
Talk to your doctor and find other information to help you understand what might be causing the asthma, and how to avoid the triggers. With the right advice and medications, and an awareness of your symptoms, you can build a personally tailored self-management plan. Click here if you want more information about asthma or other health issues.
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