This article first appeared in Smart Parenting magazine's July-August 2003 issue
Imagine that your lungs are a leather bag,” says Amor. “Now picture a giant pair of hands bunching them at one end, slowly working toward the other end. You struggle to breathe. That’s how an attack feels.” Amor, 24, has been an asthma sufferer since she was two. Her whole childhood was affected by this potentially life-threatening, yet exceedingly common disease. She couldn’t play sports, couldn’t stand excitement, and found it more comfortable to stay indoors.
Some 130 million people in the world* have asthma. And over the last two decades, morbidity and mortality associated with asthma have increased because of growing urbanization. In Metro Manila, asthma is a threat especially to children.
Asthma is a chronic condition characterized by inflammation in the air passages of the patient’s lungs. Its symptoms are shortness of breath, tightness in the chest, coughing and wheezing. What causes asthma? Stuart H. Young, M.D., in The Asthma Handbook blames the condition on dysfunction of the automatic nervous system. This results in an imbalance in several of the biochemical systems involved in proper lung functioning.
The asthmatic individual appears to be genetically programmed to react abnormally to certain stimuli or “triggers.” Common triggers are: allergies, exertion, infection of the upper respiratory tract, airborne irritants and even emotions.
Among Filipino children, triggers in the environment include kapok stuffing in pillows and mattresses, air pollution, parents and elders who smoke, pet hair and dander (dead skin cells), pollen from grass or trees, blackboard chalk and dusty schoolyards and classrooms.
Detecting asthma Since respiratory problems are dangerous to the young child, it’s important that they be recognized, properly diagnosed and treated. According to The Asthma Handbook, the signs of respiratory problems are:
- refusal of an infant to suck (or in an older child to eat) - fretting - rapid or labored breathing - continuous coughing - tendency of the child’s nostrils to flare while breathing - “retractions” (sucking in of the skin under the rib cage, between the ribs, or above the breastbone) - tendency for head to bob from the effort of breathing
These symptoms indicate that the child is suffering from something worse than a cold. Your pediatrician will be able to recommend an asthma specialist. Provide a detailed description of your child’s symptoms and medical history, aside from being alert to possible factors in the child’s environment that can trigger the onset of symptoms.
However, breathing problems may also be symptomatic of other ailments such as bronchiolitis and croup. Other diseases with symptoms that mimic asthma’s include epiglottitis, pneumonia, cystic fibrosis and heart disease. The presence of a foreign body in the lungs, which the child has swallowed and apparently recovered from, may also produce intermittent wheezing that mimics asthma.
When to go to the emergency room Girish Sharma, M.D., a pediatrician and pulmonologist, identifies in an article for emedicine.com the ways in which parents can tell if a child’s asthma episode is mild or requires emergency medical attention.
During a mild episode… Patients may be breathless after physical activity, such as walking. They can talk in sentences and lie down, and they may be agitated.
During a moderate episode… Patients are breathless while talking. Infants have a softer, shorter cry and feeding difficulties.
During a severe episode… Patients are breathless during rest, are not interested in feeding, sit upright, talk in words (not sentences), and usually are agitated.
When respiratory arrest is imminent, in addition to the above symptoms, the child is drowsy and confused. However, adolescents may not have these symptoms until they are in frank respiratory failure.
Managing asthma Avoid asthma triggers and attacks on young children with the following tips:
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1. Avoid smoking and secondhand smoke.
2. Avoid exposure to dust and irritants like hairspray, pollen, paint, or exhaust fumes.
3. Avoid exposure to persons with colds and respiratory infections.
4. Air conditioning in a bedroom or car is helpful, but ensure that the filters are clean and free of spore-producing mold.
5. Keep carpets away, as these may have allergens stuck to them.
6. If the child is allergic to animal dander, don’t keep house pets.
7. Have skin tests done to determine if the child is allergic to certain foods.
8. Avoid participating in strenuous sports activities.
9. Monitor the condition with regular doctor check-ups and describe symptoms accurately. Use a peak-flow meter to monitor lung efficiency every morning or as doctor requires.
10. Devise an action plan with the doctor that includes what medicines to take in case of emergency, what numbers to call and when to go to the hospital.
11. Take medication in the doses and frequency ordered by the doctor. Do not ignore symptoms, self-medicate, over-dose or under-dose.
12. Be educated about asthma. Ask your doctor questions and read responsible literature.
Remedies available Medical care includes treatment during acute asthma episodes, and control of chronic symptoms.
Control agents, says Sharma, include “Inhaled corticosteroids, inhaled cromolyn or nedocromil, long-acting broncho-dilators, theophylline, and leukotriene antagonists.” Relief medications include “Short-acting bronchodilators, systemic corticosteroids, and ipratropium.” None of these should be taken without a doctor’s prescription.
In the Philippines, asthma medication like Ventolin, a bronchodilator; “Lagundi” pills, a Department of Health-recommended asthma remedy, are manufactured here and exported.
Some asthma remedies are based on tradition and have not been proven to be medically effective. Yoga is supposed to help sufferers because it teaches relaxation and breath control. A tea made out of dried rosemary leaves is supposed to clear the bronchial tubes. Restrictions on particular foods are effective if the child is allergic to these foods.
Does asthma have to rule your child’s life? Not with proper treatment, sensitivity to your child’s needs, and understanding of the disease. Asthmatic children don’t have to be imprisoned at home. They can be fit, extroverted and active people, with help on your part.
*Statistics cited are at the time the article was written