Asthma
Demographics
      It affects approximately 1 in 20 kids. There are many children out there in the community who have symptoms of asthma who are undiagnosed. Awareness of the problem is the key factor in diagnosis of the condition.  It causes repeated illness causing school absenteeism and also parents have to loose work. Annually it is said parents almost loose a total of a billion dollars because they had to stay at home because of their child’s asthma related sicknesses. When the asthma is severe, kids have to be admitted to the hospital. Kids do die from asthma every year. One of the research studies showed that equal number of people die from each group of mild, moderate and severe asthma. So even though your child has mild asthma don’t take it lightly.

Symptoms
      They have recurrent coughing problems. It is a myth that all asthmatics have wheezing. Wheezing is a whistling sound which is heard primarily when the child is breathing out. Often parents say “it seems like my child cannot shake the colds easily. It takes for ever to get over the illness. Each time he gets a cold he has so severe cough that I have take him to doctors and get him medicines.” Early morning and night time cough is significant. Some kids have past history of RSV infection. Some of them have past history of pneumonias. If there are 2 kids one with one without. If they get a cold the child with asthma develops lot of cough, sometimes wheezing and significantly reduced exercise tolerance. Reason is the virus causes swelling (inflammation) of the airways by chemical reaction. The smooth muscles of the airways get narrow accompanied by thick secretions. The child without asthma develops some runny nose, some cough and fever. They can fight the infection easily in a 4 -5 days. However the cough can last for about 10 days or so. In both the cases occasionally the bacteria can infect the already infected airways by the virus.

Triggers
      Asthma flares up when exposed to many triggers. The triggers are of two kinds – Allergic and Nonallergic (irritants).

      Allergic: Mold, Cat, Dog other pets, Dust mite, Ragweed, tree and stuffed animals etc.

      Nonallergic: Cigarette smoke, smoke from industries and burning wood, perfumes, cold air and stress.

Some triggers are worse than others for every individual. Hence the precautions needed vary from one individual to another. Foods are generally not strong triggers for asthma unless they have an anaphylactic reaction to a particular food. Ex: There are some individuals when they take peanuts they develop swelling in the throat, coughing, wheezing. This is a life threatening event needs to be treated with emergency epipen injection and rush to ER or call 911.

How do you diagnose?
      Answering specific questionnaires will give you an idea whether you suspect asthma. Questionnaires will definitely help you what things to watch for in a child. This will not rule in or rule out asthma. Talk to the doctor about the symptoms. The physician can examine the child and may run some tests and can make a diagnosis. Sometimes it can be tricky in a small child. For older kids there are good tests available to check for asthma like spirometry. Different spirometry tests are available. A particular one is chosen depending on individual circumstance. Recently some centers have used impulse oscillometry (IOS) has been used with some success for kids older than 3 years. It does not need too much of patient cooperation. If this is used below 3 years of age adaptations need to be made with the equipment. This is not available in most places. It is promising but not popular yet.

Tests
      Not necessarily everybody needs tests. The common tests done are blood counts, Chest X ray, Barium swallow test (to rule out a vascular ring), sweat chloride test (to rule out cystic fibrosis), blood or skin allergy test and spirometry. The health care provider would be one who decides on what testing is needed for your child. Among these, spirometry is the only test by which you can tell somebody has asthma or not with exceptions. However spirometry is a little harder to do in a child younger than 6 to 8 years of age. Individual variations are seen. An health care provider can usually tell whether your child has asthma even without a test.

Treatment:
    There are multiple options in the treatment of asthma. There are different delivery systems in treating asthma. The key in getting the medications in is by using proper technique. You might have the best medicine in hand but if not administered properly it is not going to work effectively. Hence mastering the technique is the key in getting an optimal outcome. Inhaled steroids are the cornerstone in the treatment of asthma. When you hear the word “steroid” the eyebrows go up for all parents. Steroids when administered by mouth or by injection for prolonged period have lot of side effects. They are used in the treatment generally only on a short term basis to tide over the crisis.  If the steroid medicine is given by mouth it gets absorbed in the stomach gets into the blood and then reaches the lungs where they act.  When we say inhaled steroid we are delivering a tiny dose which is inhaled into the lower airways where they are supposed to act. They have lot lesser side effects. Research studies have shown that inhaled steroids are very potent and relieves the symptoms and help to keep children symptom free (cough and wheeze free) by and large. We use inhaled steroid because the benefits far outweigh the risks. NIH (National institute of health) has given guidelines for using inhaled steroids in children. Your physician can help you to decide whether your child needs the inhaled steroids? There are some nonsteroid medicines available. These are different ways of administering inhalation medicine which includes – inhalers, turbuhaler, diskus, nebulizers, aerolizer, handihaler. If used appropriately inhaled, the medication will reach the lower airways where they act and alleviate the symptoms. Luckily there are lots of medications to treat asthma. However for a child a particular combination of medication is better than others. Many of the asthma medicines are expensive.

1) Medications
      a. Quick relief agents: They start acting in 15 - 20 minutes and last for 4 -6 hours or so. These are not effective for long term prevention. These are good when your child gets sick and for using it before exercise.
      b. Long term medicines: These needs to taken on a daily basis to see a good response. These are extremely important to prevent a future attack. Before stopping  these medicines see your doctor to discuss whether your child is ready to come off these medicines.
              
2) Avoiding contact with allergens and irritants
  Take precautions to avoid contact with allergens. Many of them needs to be considered. Quitting smoking would help a lot. Definitely smoking outside the house is better than inside. If a teenage child has asthma and smokes then he or she needs to strongly consider quitting it. It can be hard to quit. There is help out there. You have to reach for it.

3) Allergy testing and allergy shots
      Allergy tests are of two types – skin and blood testing. Skin testing is superior to blood testing. Allergy testing can be done for environmental allergens or foods. Food allergy testing is not so important as I discussed earlier under triggers.
      Skin allergy testing is generally recommended for kids above 5 -6 years of age. It is little painful. Once the allergy test is done you can do two things.
      a) To avoid contact with the trigger. Precautions for dust and mold. Family has to decide about their pets if a child is strongly allergic and has significant symptoms. This can be hard on the family. One of the options is to get allergy shots.
      b) To get allergy shots. Generally they are given weekly and gradually spaced out.
      Blood allergy testing(RAST) is done by using a blood sample. It is not accurate. If the test is negative it does not rule out allergies.

4) Patient Education:
      This is the most important according to me. You may have the world’s best medicine in your hand but don’t how to use it, don’t know how it works or don’t know why you are using it. This is a perfect setup for failure. This is the whole point why we are putting all these online.