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Saturday, February 16, 2013

Post #36 Asthma: A Pedi Perspective - Part 4 of 5

Conundrum of cause

According to a 2010 National Health Interview Survey by the Centers for Disease Control, more than 10 million U.S. children aged 17 years and under have ever been diagnosed with asthma, and 7 million still have it.

The study shows that boys were more likely than girls to become diagnosed with asthma.

Furthermore, asthma cases in children under 4-years-old increased by 160 percent between 1980 and 1994. And there's been a steady increase in the nearly two decades since then.

An analysis by the U.S. Agency for Healthcare Research and Quality states that the percentage of children who use prescription medications for asthma has nearly doubled from 29 percent in 1997 to 58 percent in 2007.

While that could simply mean we're better at diagnosing asthma and have access to better medications, it's still easy to see why asthma is considered the leading chronic illness in kids.

But we don't really know why.

There is definitely a genetic component to asthma.  How big a role genes play isn't clear, nor is it obvious whether or not the environment is a factor – and if so, to what extent.

The "hygiene hypothesis," says that early exposure to the dirtiness of life helps prevent asthma.  If your child isn't exposed to dirt, other kids, and cold viruses early on, it leads to an imbalance in the immune system that in turn increases the risk of developing asthma. 

One real-life example of this is the fact that country boys have less asthma and allergy issues than city boys.  They grow up around animals and are exposed early on to lots of thing, thus the immune system is more balanced and less prone to asthma and allergies later on.  However, keep in mind that even country boys get asthma, just less so than city boys.  It seems that early exposure to “life” reduces the risk of asthma - but doesn't entirely prevent it. 

That's because the overall likelihood of developing asthma is multi-variable:  Environment, genetics, number of early colds, allergies, and other factors all play a part.  Sometimes the genetics are too strong to overcome.  But just because asthma runs in the family does not guarantee your child will develop it, although they do have a higher risk. 

Should asthma actually manifest itself, it's important to avoid the triggers that exacerbate it. Therein is the "Catch 22."  Early on, when there is no asthma, let your kids be exposed to stuff and hopefully they will never develop asthma.  Yet should your child eventually get diagnosed with asthma, from that point on you may need to avoid the things that trigger it. 

Triggers are things that make asthma worse or can cause an asthma attack – defined as any acute change in symptoms that interrupts your child's normal routine or requires medical intervention.

  • Exercise:  The majority of children with asthma will present symptoms when they exercise such as coughing and wheezing.
  • Pollen:  This is a common allergen.  Most children with asthma have allergies, and allergies are a major trigger of asthma symptoms.
  • Animals with fur or hair:  Keep pets out of your child's bedroom, remove carpeting, and install a HEPA filter.
  • Mold:  Control indoor humidity.  Repair water leaks no matter how small.
  • Dust mites:  These critters live in mattresses, pillows, upholstered furniture, and carpets.  Get allergy-proof bedding and pillowcases.  Frequently wash bedding in hot water.  Avoid stuffed toys.  Vacuum and dust often.
  • Weather changes:  When air quality is poor, keep your children indoors and make sure they are compliant with asthma medications.
  • Airborne chemicals or dusts:  Try to avoid things like scented candles and air fresheners.
  • Menstrual cycles:  Monthly hormone fluctuations can trigger symptoms.  Make sure your daughter is compliant with asthma medications.
  • Viral infection:  Symptoms may flare with a cold.
  • Smoke:  Avoid tobacco and wood burning.

While parents do their best to make sure the home environment is asthma friendly, don't forget to check daycares, school and relatives' homes. Some triggers can't be avoided, which is why it's important to make sure your child is compliant with his or her medication regime.

That being said, there is no guarantee that an asthma outbreak or attack can be foiled by regular preventative medicine.

There are many different strengths of preventative medicine, and these are tailored-based on the severity of the asthma.  The hope is that as kids get older, they outgrow their propensity to have asthma flare-ups and can eventually be weaned off medications.

Nearly half of children will have a decrease in asthma symptoms by the time they hit adolescence, but about half of those will develop symptoms again when they're adults.

So even though asthma cannot be cured, both you and your child can breathe easier knowing that it can be controlled – and that even after a diagnosis of asthma, he can get back to the business of being a kid.


Bill Stewart said...

I have a nephew that has this problem. Do you think that looking at pediatric allergy in Orlando, FL would help? I have heard it can but I don't know how accurate that is.

Peter Jung said...

Bill, if your nephew has asthma AND it is not well controlled on preventive medications, it is generally a good idea to have an allergist get involved to see if some allergy therapy can help control the asthma better. If he is doing well on his current regimen, an allergy doctor's involvement is not always necessary.