What is Asthma?

If your child has asthma, he or she is not alone. Asthma affects 14 to 15 million people living in the United States. It is the most common chronic disease of childhood. Today, 4.8 million children have asthma. Asthma, also known as reactive airway disease, is defined as a chronic lung condition with:

Inflammation (swelling) of the airways

Increased sensitivity of the airways to a variety of things that make asthma worse

Obstruction of airflow

The cause of asthma is unknown. However, we know that children are more likely to develop asthma if one or both of their parents have asthma or allergies. Children with eczema also appear to be at increased risk for developing asthma. Symptoms can develop at any age. The amount of difficulty a child has with asthma often changes with age. The airways of an infant/toddler can become obstructed more easily because of their smaller size. This age group can be prone to more noticeable symptoms. As the child’s airways grow larger, these symptoms may decrease.

There has been alot of recent attention to studies showing that pet exposure as a child and exposure to frequent childhood infections may protect children from developing asthma. These studies are preliminary and somewhat controversial at the present time. Further research needs to be done before any recommendations can be made.

Most children do not experience long-term physical effects of asthma. However, chronic and poorly-controlled asthma may have a slowing effect on growth and may result in reduced lung function as an adult. Adequate asthma control as a child may preserve long term lung function. Treatment with inhaled steroids, while it slows childhood growth initially, does not appear to have any affect on final adult height in children taking these drugs.

As with any chronic illness there may be an emotional impact on children with asthma. Parents should be aware of this and talk to their children about their feelings. In most cases, with use of medication, children with asthma should be able to participate in most, if not all, activities.

What Are the Goals of Treatment?

Your child should be able to:

Participate in activities, including physical activity without asthma symptoms

Sleep through the night without asthma symptoms

Have normal or near normal lung function

Have few, if any, emergency room visits and hospitalizations

Have few, if any, side effects from the medications taken

Feel good about his or her asthma care

How is Asthma Managed?

Asthma management includes:

Learning more about your child’s asthma

Identifying and controlling and/or treating things that make asthma worse

Medication therapy

Monitoring asthma

An action plan

There is no cure for asthma, but you can learn to manage it so that your child has a normal life. With good asthma control, you can often change asthma from a major disrupting factor to a relatively minor annoyance.

Medical Therapy

Asthma management has advanced significantly over the past few years, particularly over the past decade. Research throughout the 1980s and 1990s has allowed doctors to gain a better understanding of the role of inflammation in the airways and the cellular mechanisms involved. This has resulted in more aggressive approaches to management of airway inflammation since it is the source of asthma symptoms.

Depending on the severity of your child's asthma, medications can be taken on an as-needed basis or regularly to prevent or decrease breathing difficulty. Most children with asthma benefit from preventive treatment because this reduces the inflammation in the airways and the possibility of chronic obstruction. It also reduces the frequency of asthma symptoms and asthma attacks. This gives ongoing protection even if there are no apparent symptoms. For many children, a combination of medications are prescribed.

Many of the current medications available are inhaled. When your child uses the correct technique, medication is deposited directly into the airways. This generally produces fewer side effects than tablets or syrups. With some children however, oral administration (tablets or syrup) may also be prescribed.

The important thing to remember is that there is no one "best" drug regimen for everyone. The medication program must be individualized to your child's needs. Monitoring your child's asthma and working with your child's doctor on an on-going basis is the best way to ensure that the medication program is appropriate for your child.

Helpful Hints for Remembering Medications:

Use a daily routine for remembering your child’s medications. Pick something your child does every day such as waking up, brushing teeth, eating meals and going to bed. Plan to give the medications around that activity.

Use a medication checklist or worksheet to record when your child takes medications. Place the checklist someplace visible to use as a reminder.

Pack your child’s medications in pill boxes to help you remember to give them.

The following is a discussion of the medications generally prescribed for children with asthma. Most of the medications fall into two major groups:

Long-Term Control Medications
lLong-term control medications are used daily to maintain control of asthma and prevent asthma symptoms. These usually refer to anti-inflammatory agents, though long-acting bronchodilators also fit into this category. These medications are often increased during an upper respiratory tract infection, and sometimes during allergy season, to prevent occurence of an asthma attack. Children with asthma should NOT be on long acting bronchodilators as their only controller medicine; ie these agents should not be used without anti-inflammatory agents.

Quick-Relief Medications

Quick-relief medications result in bronchodilitation within minutes of use and are used to treat asthma symptoms or an asthma episode. These agents should always be available to the child, including during school hours. Frequent need for quick relief medications is usually a sign than airway inflammation is not being adequately controlled, either long term or as a result of an upper respiratory tract infection.