Asthma and Children: Symptoms, signs, treatment, diagnosis and statistics
Most children with asthma develop symptoms before the age of six, and many begin wheezing before one year. It is important to diagnose infant asthma because if left untreated, inflammation can cause permanent damage to the lungs, says Dr. Samya Helmi, a pediatrician at a private clinic.
Asthma affects an estimated 300 million individuals worldwide. The prevalence of asthma is increasing, especially in children. Annually, the World Health Organization (WHO) has estimated that 15 million disability-adjusted life-years are lost and 250,000 asthma deaths are reported worldwide. Approximately 500,000 annual hospitalizations (34.6 percent in individuals aged 18 years or younger) are due to asthma. In the United States, asthma prevalence, which has increased from 1980 to 1996, showed a plateau at 9.1 percent of children (6.7 million) in 2007.
Helmi defines asthma as a chronic disease of the lungs that causes the airways to swell, tighten and generate a huge amount of mucus. According to her, children are more likely to develop asthma if there’s a family history of allergies and asthma. “Researchers are sure of this fact, especially if a child’s parents have asthma and certain allergies,” she said.
Helmi said that if a baby has a cold and is wheezing, the mother might wonder if the problem is asthma, although it’s not always clear. More important than getting a firm diagnosis is making sure the child gets treated for any breathing problems. “Asthma can be difficult to diagnose in children under the age of five, especially in infants, because other conditions have related symptoms,” she said.
Pregnant mothers who use hairdryers, hair dye, microwaves, vacuum cleaners or who are near any kind of smoke could be putting their babies at risk of asthma, claims Helmi. “Pregnant women should stay away from any kind of threat that can harm the child like X-rays, smoke produced by cigarettes or cooking, hairdryers, microwave fans, coffee grinders and chemical cleaning products,” she says. “Researchers have already shown that this type of magnetic energy and chemicals can increase the risk of miscarriage and some types of cancer.”
Just as in adults, infant asthma symptoms can vary from child to child. In infant asthma, babies may have all the classic adult asthma symptoms from wheezing, chest tightness, and cough to shortness of breath. Additionally, poor feeding, sweating or appearing uncomfortable may be symptoms of infant asthma, says Helmi.
She says one of the most important abilities as a parent of a child with asthma-like symptoms is to know when it is needed to call a doctor or head to the emergency department. “If a mother suspects wheezing and the child has never wheezed before, it is important to promptly see a health care provider to figure out what is causing the wheezing,” she added.
Helmi states that asthma symptoms can be recognized from the following:
Unexplained diarrhea or constipation
Extreme likes and dislikes for certain foods
Extreme nighttime cough
Wheezing after exposure to allergens
Wheezing after crying or laughing
Child breathes so fast that they have difficulty finishing a bottle
Persistent loss of weight
Excessive vomiting
Sudden pain in the chest or heaviness in the chest
When asked if a mother can stop her baby from getting asthma, Helmi said that asthma seems to be connected between the child’s genes and the child’s environment, both before and after birth, and especially in the first year.
“I highly recommend mothers to breast-feed their babies for it may reduce the risk of asthma in early childhood. However, as yet, there is no evidence that breast-feeding protects against asthma for longer than this,” she said. “In addition, mothers should avoid potential allergens in their daily diet such as cheese, nuts, shellfish and eggs during pregnancy and breast-feeding. They should also keep their babies away from smoke, pets, dust and chemicals.”
Infant asthma is treated with many of the same medications as adult asthma. “A doctor can explain how to give the medication to the baby, and he/she might prescribe a reliever inhaler with or without medicine. For babies and young children, the doctor might prescribe an reliever inhaler that is attached to a small spacer chamber, which is attached to a face mask. The inhaler is pressed by the parent or doctor to dispense the medicine into the holding chamber, and the baby’s own breathing then draws in the medicine from the spacer via the face mask,” she explained.
If the baby has been treated with asthma medication and got better on this treatment, then the doctor may ask the mother to continue with this method. The mother will need to have the child checked regularly by the doctor, as changes in treatment are likely as the baby grows.
“If the baby continues to cough or wheeze despite a trial of asthma medicine, this may mean that the baby needs to be reassessed as another condition may be causing his/her symptoms,” said Helmi.
Better asthma treatment for mums-to-be
Australian researchers have devised an improved way of managing asthma which they say could lead to a 50 per cent reduction in attacks in pregnant women.
One in 10 women in Australia have asthma and pregnant women are particularly prone to attacks, says Peter Gibson, a staff specialist at John Hunter Hospital and professor at Newcastle University.
“It’s not only a problem for the mother, it’s also a problem for the baby,” Professor Gibson told AAP on Friday.
“Asthma in pregnancy is associated with low birth weight babies, pre-term labour and an increased rate of the baby having to be hospitalised after birth.”
Currently, asthma medication is delivered according to clinical symptoms, which can result in the condition being under- or over-treated.
But Prof Gibson has developed a system that allows doctors to match the amount and frequency of steroid-based treatments to airway inflammation.
His research, involving asthmatic pregnant Australian women and published in the Lancet on Friday, found that adjusting treatment to match levels of inflammation led to a 50 per cent reduction in asthma attacks.
The research was based on 220 pregnant non-smoking women with asthma in John Hunter and Maitland hospital antenatal clinics.
Prof Gibson and his team measured airway inflammation and adjusted the treatment using a particular chemical marker.
“It’s a much more precise way of adjusting treatment for someone with asthma,” he said.
The results were “fantastic”, he said.
“We want the obstetricians and midwives to get excited about this and think about how they can implement it in their clinics. We want to help them do that,” Prof Gibson said.
The same technique could also work for non-pregnant people with asthma, Prof Gibson said, adding he planned further study in that area.
“There’s no reason why you couldn’t use the same algorithm in anyone with asthma (although) we obviously need to prove that before we go out there saying that’s what we should do,” he said.
Tools to manage Asthma exist
The Global Asthma Report 2011 shows the tools to manage asthma exist but are not reaching many of the 235 million people affected. Asthma is the most common chronic disease among children and also affects adults. “The tools to treat asthma are already available – there is no reason to delay”, says Dr Nils E Billo, Executive Director of The International Union Against Tuberculosis and Lung Disease (The Union). “Moreover, when asthma is not diagnosed, not treated or poorly managed, and when people can not access or afford treatment, they regularly end up having to miss school or work, they are unable to contribute fully to their families, communities and societies, they may require expensive emergency care, and everyone loses. The obstacles to well-managed asthma can be overcome. Asthma is a public health problem that can – and should be addressed now” added Dr Billo.
Worldwide, 235 million people have asthma. For these people, asthma can mean struggling for breath when they have an asthma attack, a diminished quality of life, disability and even death. Although effective treatment is available, many people with asthma, especially in low- and middle-income countries, are unable to access or afford it.
To highlight the issues surrounding this major non-communicable disease, the International Union Against Tuberculosis and Lung Disease (The Union) and the International Study of Asthma and Allergies in Childhood (ISAAC) have collaborated to produce the Global Asthma Report 2011, which will be launched at an event sponsored by the Non-Communicable Disease Alliance on Saturday, 17 September 2011, at the New York Academy of Medicine. Release of the report coincides with the UN High-Level Meeting on NCDs taking place on 19–20 September.
Designed for stakeholders from government ministers and policy-makers to health workers and people with asthma, the Global Asthma Report 2011 is a richly illustrated “atlas” that provides an overview of what is known about the causes and triggers of the disease, the global prevalence, the progress being made and the significant challenges today and for the future.
Key findings in the Global Asthma Report 2011:
- ISAAC data show that asthma in children is increasing in low- and middle-income countries, where it is more severe than in high-income countries.
- The World Health Survey found an 8.2% prevalence of diagnosed asthma among adults in low-income countries and 9.4% in the richest countries. Middle-income countries had the lowest prevalence at 5.2%.
- Smoking and secondhand smoke are two of the strongest risk factors – and triggers – for asthma.
- Although asthma is frequently thought of as an allergic disease, this does not apply to all cases, and the non-allergic mechanisms need to be the focus of more research.
- Surveys around the world found asthma treatment falling short, with few patients consistently using the inhaled corticosteroids that effectively manage the disease. For example, the Asthma in America survey found only 26.2% of patients with persistent asthma used these medicines.
- While many countries now have asthma management guidelines, many health workers do not know how to diagnose or treat asthma and health systems are not organised to handle this type of long-term, chronic disease.
- A 2011 Union survey of the pricing, affordability and availability of essential asthma medicines in 50 countries found dramatic variations. For example, one generic Beclometasone 100μg inhaler in a private pharmacy cost the equivalent of nearly 14 days’ wages – and a patient with severe asthma
requires about 16 of these inhalers per year.
- The Asthma Drug Facility established by The Union has been able to bring down the cost of treating a patient with severe asthma to approximately US$ 40 per year.
- When people do not have access to ongoing care, they often end up in emergency rooms and hospitals — a costly and unnecessarily disruptive process for all involved.
- Although economic data are unavailable for almost all low-income countries, a 2009 systematic review found annual national costs (in 2008 US dollars) ranging from $8,256 million in the United States to $4,430 million in Germany.
- Success stories from five high- and low-income countries that have implemented asthma management activities show that well-managed asthma saves money – and enables people to get on with their active lives. For example, in Finland, the mortality, number of hospital days and disability due to asthma fell 70–90% between 1994 and 2010 and a conservative estimate of the savings was $300 million in 2007 alone.
