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Asthma (ER)

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Wednesday, February 18th, 2009 | CWK Producer

“It’s most likely a virus, because in this time of year, that’s the most likely reason for children to begin to wheeze.”

– Dr. Cedric Miller, Emergency Pediatrics, Children’s Healthcare of Atlanta

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Five-year-old Isabella has had breathing problems since she was a toddler … but never this bad.

So she goes to the ER, where her mom explains her symptoms to the doctor. “Just real exhausted and she was still [doing] that heavy breathing where, even at her neck it was sucking as she was breathing, and very rapid breathing.

They give her steroids and put her on a bronchodilator.

“Cough for me right now,” urges the respiratory therapist. Just like that, I need you to cough three times. Good job.”

What triggered this particular episode of wheezing?

“It’s most likely a virus because in this time of the year, that’s the most common reason for children to begin to wheeze,” says Dr. Cedric Miller, emergency pediatrician for Children’s Healthcare of Atlanta.

A cold virus can bring additional congestion. That’s why the doctor says in the winter, parents need to be extra vigilant. When a child starts to cough or wheeze, “That is a signal that if you have asthma,” says Dr. Miller. “You should probably start your asthma medications. And if you’re already on asthma medications, that you should increase the frequency of those asthma medications.”

Isabella’s blood-oxygen level is only at 90-percent. “At 90-percent saturation,” explains Dr. Miller, “you are usually in some distress. People describe it as feeling as if they’re suffocating. They’re just not able to get enough air in. And more importantly, they’re not able to push that air out.”

So she’ll have to stay in the hospital for a few days. “But she’ll do well,” says Dr. Miller. “She’s got a parent who cares, and I’m sure she’ll get to her pediatrician and get taken care of in the way she should, after she’s discharged.”

What We Need To Know

Asthma is the most common serious chronic disease during childhood. The American Academy of Allergy, Asthma & Immunology (AAAAI) cites the following statistics about asthma and children:

  • Asthma affects nearly 5 million U.S. children.
  • It is the cause of almost 3 million doctor visits and 200,000 hospitalizations each year.
  • Up to 80 percent of children with asthma develop symptoms before age 5.

According to the Asthma and Allergy Foundation of America (AAFA), the number of children with asthma in the United States has more than doubled in the past 15 years. Consider these additional facts about asthma from the National Center for Environmental Health:

  • Asthma accounts for 14 million lost days of school missed annually.
  • Asthma is the third-ranking cause of hospitalization among those younger than 15 years of age.
  • The number of children dying from asthma increased almost threefold from 93 in 1979 to 266 in 1996.
  • The estimated cost of treating asthma in those younger than 18 years of age is $3.2 billion per year.

The AAAAI defines asthma as a chronic, inflammatory disease of the airways. The tubes that bring air to the lungs are constantly swollen and inflamed, making it difficult for air to move in and out freely. Those airways are also sensitive to certain triggers, which can vary from person to person. It is difficult to predict who will develop asthma and who won’t, but studies have shown that certain factors are associated with the onset of asthma symptoms in children:

  • Wheezing accompanied by viral upper respiratory infections in infants and young children
  • Allergies (The relationship between asthma and allergies is very strong. If your child has allergies, be on the alert for potential signs of childhood asthma.)
  • A family history of asthma and/or allergy
  • Perinatal exposure to tobacco smoke and allergens

While the cause of asthma remains unknown, certain factors appear to increase a person’s chances of developing the disease. The National Asthma Campaign cites the following factors that might contribute to the prevalence of the disease:

  • Asthma is not an infectious disease, but it often runs in families. If one or both parents have an allergic condition, such as asthma, hay fever or eczema, their child is more likely to develop asthma.
  • Many aspects of modern lifestyles, such as changes in housing and diet and a more hygienic environment, may have contributed to the rise in asthma over the last few decades.
  • Smoking during pregnancy increases the chances of a child developing asthma.
  • Environmental pollution can make asthma symptoms worse but has not been proven to actually cause asthma.

Although asthma is very common among children, it is also a very individualized disease. No two people have exactly the same symptoms or outcomes. The bottom line, according to the AAAAI, is for parents to watch and listen to their children.

The American College of Allergy, Asthma & Immunology offers the following tips for parents of asthmatic children:

  • Learn everything you can about asthma.
  • Learn what triggers your child’s attacks – mold, pet hair, cleaning agents, etc. – and avoid those triggers as best you can.
  • Recognize the signs of an oncoming attack, and learn to judge its severity.
  • Provide preventive care so that your child has the least amount of difficulty with asthma.
  • Teach your child how to care for himself or herself.

A child’s physician must rely heavily on parents’ observations to determine the signs and to make a proper diagnosis. Experts at the Mayo Clinic say that diagnosing asthma can be difficult because symptoms can range from mild to very severe and are often similar to those of other lung conditions. In diagnosing asthma, you can expect the pediatrician to perform a complete medical history and physical exam. In many cases, a lung (pulmonary) function test may be used to determine how much air moves in and out as your child breathes.
If your child is diagnosed with asthma, your doctor will recommend a course of treatment based on your child’s age and the persistence of the symptoms. In general, three types of medical treatments are available for asthmatics:

  • Bronchodilator medications relieve acute symptoms or prevent flare-ups.
  • Corticosteroids and other medications suppress airway inflammation over days, weeks or months.
  • Immunotherapy or allergy desensitization shots can also help relieve symptoms.

While medications and shots may help, the best way to prevent asthma attacks is to identify and avoid indoor and outdoor allergens or triggers. The American Academy of Family Physicians suggests the following tips for minimizing asthma triggers in your home:

  • Cover your child’s mattress, pillows and box spring with an airtight vinyl or nylon case that zips shut.
  • Remove carpets from your home, and use a damp mop to clean linoleum or wood floors. You may use throw rugs that can be machine-washed.
  • Instead of drapes and cloth-covered furniture, use washable curtains or vinyl shades and furniture you can wipe with a damp cloth, especially in your child’s bedroom.
  • Wash sheets, blankets and pillows, throw rugs and stuffed animals often, using hot water to kill dust mites.
  • Use pillows or comforters filled with polyester instead of feathers.
  • Use cotton or acrylic blankets that can be machine-washed. Don’t use wool blankets unless they can be machine-washed.
  • Keep the humidity in your house below 50 percent when possible. Dust mites and mold grow best in damp areas. You may have to use a dehumidifier or an air conditioner to keep the humidity low.
  • Use cleaning agents that will not affect your child’s asthma. Try to keep fresh air flowing into these areas, and use a dehumidifier to keep the air dry.
  • Try not to have pets with fur or feathers, or at least keep them out of your child’s bedroom. If you have cats or dogs, shampoo and brush them often (outside of the house).
  • Keep your child’s bedroom windows closed to minimize contact with pollen.
  • Use a clothes dryer, instead of hanging the laundry outside, to keep pollen from getting on clothes and sheets.
  • Don’t smoke cigarettes, pipes or cigars in your home or allow anyone else to smoke there. Help your child stay away from cigarette smoke in other places. Teach him or her never to smoke.

An additional trigger for those children living in cities or highly populated areas may be air pollution. If you and your family live in an area with a high concentration of air pollution, you should talk to your doctor about adding vitamin C and E supplements to your child’s diet. The National Library of Medicine and Ohio State University cite the following foods that contain vitamins C and E:

  • Vitamin C: Green peppers, citrus fruits, strawberries, tomatoes, broccoli, turnip greens and other greens, sweet and white potatoes and cantaloupe; fish and milk contain small amounts
  • Vitamin E: Fats and oils, meats, poultry, fish, legumes, nuts and soy

In determining the correct amount of vitamin C and E intake for your child, it is important that you consult your child’s health-care provider.

Resources

  • American Academy of Allergy, Asthma & Immunology
  • American Academy of Family Physicians
  • Asthma and Allergy Foundation of America
  • Children’s Healthcare of Atlanta
  • Mayo Clinic
  • National Asthma Campaign
  • National Center for Environmental Health
  • National Library of Medicine
  • Ohio State University

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