What is asthma?

Asthma is one of the most common chronic diseases of childhood. A recent survey in San Diego indicates that 10% of children have a diagnosis of asthma. In inner city areas as many as 20% of school age children have asthma. Over the last quarter century the prevalence of asthma in developed countries has increased dramatically. The reason for this increase is unknown. Asthma is a complex disorder in which the muscle tissues surrounding the small airways of the lung are hyper-reactive. When triggered to contract, these muscles can cause airway narrowing and wheezing.
 
What triggers asthma?

There are a variety of triggers that cause these muscles to react and the child to wheeze. A common trigger is infection especially viruses and mycoplasma (the cause of walking pneumonia). A majority of asthma attacks that cause hospitalization are a result of an infectious trigger. Another common trigger is allergies. Allergic reactions in the lung lead to chronic inflammation and chronic asthma. This inflammation can lead to scarring, known to physicians as remodeling and permanent damage to the lungs. Common allergens in San Diego are house dust mites, animal hair (cat and dog), grass pollens and molds. Tobacco smoke is another important trigger of asthma attacks. Tobacco smoke causes inflammation in the same small airways affected in asthma. In similar fashion air pollution, especially particulate matter such as ash from fires also triggers asthma.

How do you diagnose asthma?

There are several ways to diagnose asthma. In older children we can do pulmonary function testing in which we measure rates of airflow and volumes of airflow. In younger we rely on response of wheezing to asthma medicines which cause the airway muscles to relax and wheezing to stop. In diagnosing asthma physicians must consider other causes of wheezing and if indicated perform tests to exclude these other causes.

How do you treat asthma?

Once a diagnosis of asthma is made, treatment of asthma involves avoiding or eliminating triggers, use of agents that relax the hyper-active muscles of the small airways (reliever medications) and, the use of anti-inflammatory medications in children with persistent asthma (controller medications). To determine if a child needs a daily controller medication, physicians divide asthma into intermittent and persistent asthma. As a rule of thumb, any child who wheezes or uses reliever medication twice a week or awakens more than twice per month with asthma has persistent asthma and should be on a daily controller medication. This rule is called the rule of twos.

What is asthma management?

The goal of asthma management is to allow the child to have normal quality of life. For a child quality of life is attending school everyday, participating in vigorous play and sports with friends and getting a good night’s sleep. To obtain this goal there must be a plan individualized for each child and agreed upon by the physician, parent, and if old enough, the child. The plan should include avoidance of triggers, appropriate medications, and, if the child is old, enough use of a peak flow meter to measure lung function at home. The parent and child must have clear instruction on when to call the physician and when they can treat the asthma themselves. Although rare deaths do occur from asthma and almost always occur at home.
 
What should I do if my child’s asthma is not controlled?

If your child’s life is limited by their asthma ask your physician to develop an asthma control plan for your child as soon as possible. In developing the plan your physician may refer you to an allergist. The allergist will do allergy testing to help determine what triggers the asthma and provide instruction on avoidance of triggers. The allergist will also do lung testing to help determine the severity of your child’s asthma and then recommend appropriate medications. With the help of the allergist and primary physician your child can lead a full and active life.

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