HEALTHWATCH
Demystifying asthma
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Dr. V. V. VARADARAJAN clears misconceptions about asthmatic attacks in children.
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ASTHMA in children is more commonly seen in the West. The incidence of asthma is increasing in all countries that have adopted a westernised lifestyle. Apart from increasing exposure to airborne indoor and outdoor allergens (more commonly seen with carpets, teddy bears, upholstered furniture and passive smoking), declining exposure to microbes favours lesser production of protective antibodies (IgG) and more of IgE, which predisposes the child to asthma. India is no exception.
Asthma is hereditary.
Asthma is a disease of multi-factorial origin. There are three factors which are to be taken into consideration: the atopic tendency (the ability to produce IgE antibodies, when exposed to an allergen); Bronchial hyper responsiveness (which indicates increased reactivity of the airways to various stimuli); and Sensitisation to environmental allergens.
Though there are no definite Mendelien laws to indicate that Asthma is hereditary there are recent studies which have linked certain genes to the increased propensity to produce IgE antibodies and hyper reactivity. If one of the parents or a sibling is affected by Asthma, the chances of the child getting the disease is doubled. If both parents are affected, the chances are much more.
Children outgrow asthma with time.
This is not true of all children. Some who tend to wheeze in the first few years of life are born with smaller airways. They become less prone to asthma as their airways grow. Another group of children, who have the onset of illness after three years, with raised IgE levels and family history of Asthma or Eczema, become asthmatics as adults.
Steroids are unsafe for children with asthma.
Not true. In fact, inhaled steroids have come to stay in the daily management of childhood asthma. Inhaled corticosteroids are in microgram doses and do not have the side-effects of oral steroids like osteoporosis (weakening of bones), ulcers, diabetic tendency, increased susceptibility to infection or growth suppression.
Use of inhalers leads to dependency/addiction.
Asthma is characterised by inflammation of the airways. Regular use of anti-inflammatory drugs reduce the inflammation and the hyper-reactivity of airways to the inhaled irritants and allergens. Drugs like Beta agonists (eg. Salbutamol) are very effective in relieving the acute symptoms (like breathlessness). For a lay person, inhaled medicines are often linked to smoking or opium inhalation and is, therefore, perceived as addictive. The paediatrician should emphasise that addiction is a pharmacological property of the drug rather than the device or the route. None of the asthma medication is known to cause physical/psychological dependence.
Inhaler therapy is difficult to use in children.
There are several devices like the spacer and mask that make the inhalation therapy easy and simple to administer even in a young infant. There are several easy-to-carry dry powder inhaler devices, for school children.
Inhalation therapy is expensive.
At the beginning yes. But considering the long-term benefits and decrease in the need for repeated visits to the pediatrician's office and emergency room, it woks out cheaper in the long run.
Asthma cannot be cured
Asthma can be kept under control. Some children outgrow asthma as their airways become larger with age and hormonal changes of adolescence. The first step in the management is the acceptance of the diagnosis.
Asthmatic children cannot play games or participate in strenuous exercises.
Exercise should be looked upon as the only trigger that the asthmatic child should learn to conquer rather than avoid. More than 50 Olympic gold medallist swimmers have been asthmatics. Some do get breathless when they exercise. They can prevent such attacks by taking inhaled Beta agonists 20 minutes prior to exercise, or oral Leucotriene modifies everyday at bedtime. Current theories suggest that water and heat loss from the lower respiratory tract are responsible for exercise-induced symptoms. Hence the importance of teaching the child to breath through the nose rather than through the mouth. The child may also be advised to avoid exercise in cold weather and choose sports such as swimming, table tennis, gymnastics, aerobics and dance.
Sweets and cool drinks worsen the child's asthma.
The role of dietary restriction is invariably over-emphasised. In less than three per cent of children, an attack of asthma can be traced to an ingested allergen. In the rest, it is the inhaled allergen that is responsible. A recurrent cause-effect relationship between ingestion of food items and occurrence of symptoms observed by parents and verified by avoidance is more relevant. Issuing a common avoid list of foods is incorrect and impractical. A small subgroup of children may react to food preservatives such as Sulphites found in processed potatoes, shrimps, dry fruits and canned juices. Colouring agents like caramel yellow, tartarazine have also been implicated in precipitating an attack.
Children with asthma are at a risk during surgery.
Every asthmatic child should have his symptoms and medicines reviewed prior to surgery and the pulmonary functions should be improved to their personal best. If the child has received oral corticosteroids in the previous six months, he/she should receive hydrocortisones intravenously every eight hours before surgery, followed by post-operative nebulisation if needed. Afternoon or evening hours may be more ideal for surgical procedures as the airways are wider in the evenings than in the mornings.
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