Asthma is the most common chronic disease in children in developed countries, affecting about 12 percent of children who are less than 18 years. It is more common in males than females under the age of 15 years.
Asthma occurs when the small airways (bronchi) in the lungs become inflamed and narrowed, which limits the flow of air out of the lungs . This narrowing is almost always reversible in children with treatment. Many different genetic and environmental factors can increase the risk of developing asthma a few of which include:
- Pollution - Increased exposure to indoor and outdoor pollution may increase the risk of developing asthma.
- Exposure to tobacco smoke - Exposure to tobacco smoke during pregnancy and throughout childhood increase the risk of developing asthma.
- Family history - Children with a personal or family history of certain medical problems, such as asthma, allergies, or eczema, are at increased risk of developing asthma.
However, not all children with asthma have known risk factors. In other words, even children who live in rural areas and whose parents do not smoke or have asthma can develop asthma. It is not clear if there are ways to reduce a child's risk of developing asthma.
- Coughing and wheezing - Symptoms of asthma in children include coughing and wheezing. The cough is usually dry and hacking and is most noticeable while the child sleeps and during early morning hours. It may also be triggered by exercise. Wheezing is a high-pitched musical noise that is usually heard when the child breathes out. It can generally only be heard with a stethoscope.
- Coughing and wheezing tends to come and go during the day or night, depending upon the degree of airway narrowing in the lungs. Breathlessness, chest tightness or pressure, and chest pain may also occur. In addition to coughing or wheezing, a child may report that their chest or stomach hurts.
- Asthma symptoms often develop in children before five years of age, although it is sometimes difficult to diagnose asthma in infants and toddlers.
- Asthma triggers - Wheezing and coughing may occur at any time, but certain triggers are known to worsen asthma in many children.
- Environmental conditions - In children with seasonal allergies, asthma symptoms may worsen during certain pollen seasons; trees pollinate in early spring, grasses in the late spring and summer, and weeds in the summer and fall. Symptoms can also flare as a result of mold growth (eg, during rainy seasons or in damp areas). Cold air, changes in barometric pressure, rain, or wind may cause increased asthma symptoms in certain people.
- Upper respiratory infections - Viral upper respiratory infections (head and chest colds) are a common trigger of asthma in infants and young children. The most common viral infections include rhinovirus (the virus that causes most colds), respiratory syncytial virus, and influenza virus.
- Children with asthma should use their asthma treatments for cough and chest congestion rather than over-the-counter cold remedies.
- Exercise - Narrowing of the airways can be triggered by exercise. This is called exercise-induced asthma (also called exercise-induced bronchoconstriction or EIB). Breathlessness, wheeze, and/or cough usually occur within 5 to 10 minutes of the cool-down period after vigorous exercise. These symptoms tend to disappear after 20 to 45 minutes. Certain types of exercise (eg, swimming) are less likely to cause exercise-induced asthma than others (eg, running, skating), probably because they produce less airway cooling and drying. Short bursts of activity tend to be better tolerated than prolonged exercise.
- Allergens and irritants - Indoor and outdoor allergens are an important trigger of childhood asthma, particularly for children older than three years of age. Indoor pollutants can act as irritants and also trigger asthma symptoms. Irritants and allergens include:
- House dust (ie, dust mites, cockroaches, mice droppings), particularly during vacuuming
- Animal exposures; cats and dogs are especially provocative but other furry animals (gerbils, rabbits, hamsters, etc) may be suspect, particularly if symptoms only occur in settings where these animals reside
- Indoor pollutants (eg, paint, perfume, cleaning products, space heaters, gas stoves, room deodorizers)
- If allergies are a possible cause of symptoms, skin or blood testing may be recommended. This can help to both identify triggers and determine the necessity of avoiding these triggers at home.
Symptom patterns - Children with chronic asthma may have one of several distinct patterns of symptoms:
- Intermittent asthma attacks with no symptoms between attacks
- Chronic symptoms with intermittent worsening
- Attacks that become more severe or frequent over time
- Morning "dipping", when symptoms worsen in the morning and improve as the day progresses
- Symptoms that begin during upper respiratory tract infections (eg, colds) and linger for several weeks after, with resolution during warmer weather.
Most asthma attacks develop slowly over a period of several days. Uncommonly, a severe attack can occur suddenly and with minimal warning.
The diagnosis of asthma in children requires a careful review of a child's current and past medical history, family history, and a physical examination. Specialized testing is sometimes needed to diagnose asthma and to rule out other possible causes of symptoms. Many children with asthma appear and sound completely normal.
Families First Pediatrics is located at 1268 West South Jordan Parkway in South Jordan. (801) 254-9700. For more information, please visit: http://www.ffpeds.com