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Asthma is an inflammation of the breathing tubes of the lungs, a bronchitis, caused by a variety of triggering agents. It is very common in childhood, afflicting perhaps 10% or more of kids at some point in their childhoods. In recent years much more has become known about the way in which asthma develops and how it affects the lungs; this has led to new and much better understanding of how to effectively treat asthma.
An asthma attack begins in the body when something stimulates certain trigger cells in the lining of the lungs to release various inflammatory substances. These substances cause direct inflammation of the bronchial tubes and also attract more inflammatory cells that release even more inflammatory chemicals. The cough reflex is greatly stimulated by the inflammation and the prescence of the sticky mucus clogging the air tubes. The lining of the bronchial tubes swells and starts to block air flow. Thick, sticky mucus is secreted in large amounts, and it clogs the tubes, increasing the blockage of airflow. The inflammation stimulates the muscle that is wrapped around the bronchial tubes to contract, narrowing the diameter and increasing the resistance to air flow even more. All these factors tend to decrease the diameter of the bronchial tubes and produce shortness of breath and usually audible wheezing.
From the perspective of the child, an asthma attack usually begins with cough. At first, it may be just a dry, nagging little cough, especially at night. If recognition of what is going on and proper treatment are delayed, the cough may become more severe, and the child may start coughing up or even vomiting mucus (phlegm). The child starts to experience wheezing, shortness of breath, can't sleep, and is restless. As the attack worsens further, the child begins to experience increasing air hunger, and is using all the muscles in the chest just to get air in and out of the lungs. Hopefully, by this time the parents have recognised the need for prompt medical attention.
A variety of triggers can set off the asthmatic reaction in the lungs, for example:
The tools we use to effectively treat asthma:
The medications that are used include:
Asthma should no longer be an almost crippling disease for children. With advances in therapy and continuing education in treatments, many primary care pediatricians now do an excellent job managing even the more difficult asthmatics. Additionally, there are in most cities of any size allergists, even pediatric allergists, and pulmonologists (specialists in lung disease) who manage pediatric asthma patients. I think it is very important that a child with asthma have a physician who is interested in and comfortable with the modern management of this condition.
These are the goals of therapy for your child from One Minute Asthma, by Thomas F. Plaut, M.D.:
I think that says it all.
A helpful book for parents: Children with Asthma - by Thomas F. Plaut, M.D.; bookstores or available directly from Pedipress Fulfillment Center, 200 State Road, South Deerfield, MA 01002; 1-800-611-6081. Also available on the Web at the Pedipress web site. The Pedipress web site includes current edition information and descriptions, pages on using asthma diaries, and will soon include excerpts from Children with Asthma. If your child has asthma you should visit their site.