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Saturday, February 16, 2013

Post #33 Asthma: A Pedi Perspective - Part 1 of 5

It's difficult to diagnose, can attack without warning, and unfortunately we don't know exactly what causes it.

It's said to be the most common chronic medical problem in children, fortunately it's manageable with medication.

Asthma is a lung disease that causes inflammation and narrowing of the airways, making it hard to breathe.

While it affects people of all ages, it most often starts in childhood. According to the American Academy of Pediatrics, between 80 to 90 percent of people with asthma develop symptoms by the age of 4 or 5.

Parents tend to worry at the first sign of a cough or wheeze, but in reality, a one-time episode is not indicative of asthma. That would be like labeling a friend of yours "tardy" just because she showed up late one time.

Further coloring the diagnosis of asthma in shades of grey is that children with asthma can present with different symptoms at different times.

When to wonder

The most common symptoms of asthma are coughing, wheezing, chest tightness, shortness of breath and difficulty breathing.

Coughing is a protective mechanism designed to move mucus through the respiratory track. In a child with or without asthma, coughing can be worse at night because during the day gravity and activity helps mucus drain and clear from the airways; however at night, laying horizontal and the lack of movement allows mucus to pool in the airways thus increasing the coughing bouts.

Coughs caused by a virus can last anywhere from two to six weeks or sometimes even longer, but chronic coughing - coughing for more than eight weeks - should be brought to the attention of a doctor.  Although asthma can present with just coughing, an experienced doctor can help distinguish between a cough caused by a cold virus (or other germs) versus a cough secondary to asthma.  It should be noted however that in a child with asthma, cough is often initiated by a cold virus and exacerbated by the underlying asthma producing a mixed picture, hence it may take a few visits to delineate whether asthma is a true player or not.

Often the easiest way to differentiate the two is a trial run of asthma medications to see if there is a response to the medications or not. If there is a response, the good news is there is something you can do for the cough. The bad news is your child may have asthma. If there is no response to the medicine, the good news is your child is unlikely to have asthma. The bad news is there's not much you can do about the cough.  Keep in mind that in children with asthma, there is usually a mixed picture of a cold virus triggering asthma symptoms; in other words the asthma medications will help control the asthma but not the symptoms brought on by the cold virus itself, so a positive response may not be a complete response.

Although asthma can present with just coughing, a child with true asthma will typically have a chronic cough combined with wheezing.  However, note that what most moms call wheezing and what most doctors call wheezing often differ.  There are many sound-a-likes to wheezing that can be best distinguished by an experienced clinician.

Wheezing occurs when the muscles in the airway tense up or clamp down due to inflammation. The result is decreased diameter in the airways, making it more difficult to move air. Just like you make a whistling sound when you purse your lips and breathe, the airways also make a wheezing sound when the diameter is narrowed.

Just as a chronic cough on its own does not mean your child has asthma, a wheezing episode alone is not necessarily indicative of it either, since both of these things can happen in response to a bad cold. A cold virus may cause just enough inflammation in the lungs to cause a one-time wheezing episode.

That being said, kids with asthma will not only wheeze chronically but their lungs will actually show changes that can be seen under a microscope. This is called "remodeling."

Airway remodeling is a response to long-term airway inflammation that can lead to permanent structural changes.

Asthma is more likely to manifest itself in long-term changes if it shows up before age 3, with the child displaying obvious symptoms of these changes by age 6.  Asthma that starts after age 6 is less likely to become a long-term problem. 

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