Pediatric asthma and wheezing in infants and children, symptoms, treatments, inhalors - basic facts for parents: IMPORTANT

Asthma
by name need not be a disease of adults, but is equally common in children.
Asthma in medical jargon is known as HRAD, meaning hyperreactive airway disease.
by hyper reactive we mean is that the airway or the windpipe (trachea and bronchi)
throws a reaction to various stimuli or triggers
thus getting narrowed and causing a wheezy or
musical sound when breathing air passes through the windpipe.
Its a reversible(with medicines),
obstructive (as windpipe get narrowed),
airway disease (and usually doesnot involve lungs in children)
It can be seen in various variants such as bronchiolitis, early and late wheezers and asthma.

who get affected?
usually children of age group 2 to 7 year old
although unusally can be seen in infants and elderly children.

Reasons:
not known and clear,
strong genetic and family basis for allergy is suspected, although not a must.
Strong family history of asthma in elderly member or sibling.
Allergic tendencies in family or kid viz allergy to food , pollen, dust, clothes etc
They may have atopic tendencies too manifesting as skin changes of allergy.
other allergens / triggers are:
dust mites, fungus, pollution, carpets, smoke, dog-dirt and bird droppings,
smoke of chulha or cigars, cold, winter, crackers, nonuniform wind, milk, egg, fish, shells etc

Associated illnesses:
(may be, but if present can be a good predictor of asthma)
Recurrent colds or recurrent bronchiolitis or recurrent respiratory illnesses,
allergic rhinitis, sinusitis, atopic dermatitis, tonsiloadenoiditis and gastroesophageal reflux disease.

Clinical presentations:
commonest is a wheezing child with or
without previous episodes of wheezing usually without fever
suggetss asthma.
wheezing is a sound similar to the sound produced when
wind is blowed through a pipe 15 cm long and half inch wide.
wheezing may be associated with
increased (tachypnea) and abnormal (respiratory distress) chest movements
especially at root of neck and just below the rib cage.
In serious and sever cases child may not lie down or is restless and panting for breath
with mouth breathing and decreased speech with or without sweating.
frequency of night symptoms ( cough and wheeze ) are key factors in assessing severity and chronicity.

other features:
wheezing is mainly nocturnal although daytime wheeze is also seen, night wheeze
is characteristic of severity of illness.
It is also more early in morning startint at aroun 5-7 am.
It may or maynot be associated with cough, some asthma children maynot wheeze but
mainly cough can be the feature suggesting asthma.

Caution:
All colds are not noisy bretahing or chest movements and also voice versa.
all colds donot wheeze.
all noisy breathing do not wheeze,
All wheezes are not asthma.
All asthma need not wheeze (especially severe asthma with sever air hunger)
Cough variant asthma are known although uncommon and difficult to diagnose and treat.
Severe asthma if untretaed fro significant hours can be fatal.
improper and or inadequate treatment and follow up in cases may result in chronic asthma.

Diagnosis:
Its a clinical diagnosis
investigation are required only to confirm it and / or to rule out similar and/ or associated
illnesses where tretament change may be likely.
the tests required may be:
Allergen tests eg RAST, ELISA on skin or blood.
PEFR and Pulmonary function tests (for those above 5 yr age)
ESR and eosiniphil count and eosinophil basic protein assay as allergic markers
X ray chest and sinuses
A detailed Ear Nose Throat evaluation
Stool test for infesting worms as allergens

Treatment:
Mainstay is prevention of allergen when its known, that will avoid repeat episodes.
simultaneusly the treatment for acute episodes
and prevention of further episodes by reducing duration and severity.

Frequency of symptoms and frequency of night symptoms are a better guide in deciding
the nature of therapy, short term or long term; one drung or many drugs.

More often the symptoms more the night symptoms more is the need for combination regimens
and more may be the need for steroids (safe steroids).

Bronchodilators like salbutamol and albuterol etc are usually are meant for acutely relieving
the symptoms of bronchoconstriction. Steroids do help by reducing the swelling within airway mucosa
and thus easing the breath.

Inhaled therapy is the standard therapy for asthma as it causes almost no side effects and
has the least dose concentration requirent as it acts to the site of the problem.

In children inhalors need to be taken with an accessory called spacer,
as without it inhalors will be ineffective because children can not have the
required breathing coordination.
children above 5 years can be trained to use rotahalors.

Medicines when started for acute or short problem will be only for short phase,
and if any chronic element is suspected then steroid inhalations are added for a long term.
If the patient has been contibuously symptomatic despite therapy, both these medicines may be added
on long term.
periodic reasessment with symptoms and tests, usually helps us to taper the medicines
with stp up when required and or gradually omitting the medicines ones
significant phase without symptoms is observed.

Pediatric asthma links:
National library of medicine: http://www.nlm.nih.gov/medlineplus/asthmainchildren.html
also read: also read this
Important tips and tools for parents: http://www.keepkidshealthy.com/asthma/index.html





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thanks
Dr kondekar Santosh venketraman
pediatrician, lecturer
Pediatric ICU and Asthma clinic
Seth GS Medical college and kEM hospital
Mumbai INDIA
feel free to inetract 919869405747
visit for more child health articles http://drpeds.blogspot.com


Dr Alpana S Kondekar
DNB Pediatrics (ministry ofH & FW)
15/N2 358 Tenaments BMC quarters
Pujari Nagar KAG road
Worli Mumbai 400018

















visit http://drpeds.blogspot.com for more details
Dr Kondekar Santosh Venketraman
Pediatrician
Seth G S Medical college and KEM Hospital Mumbai India
call any time 919869405747