Dubai: Asthma attacks at any age are unpleasant but to see a child cope with this attack is extremely distressing. Asthma in children is one of the main reasons for school absenteeism.
Dr Tanmay Radhakrishna Amladi, Specialist Paediatrician, Zulekha Hospital, Dubai, with more than 25 years of experience in the field of childcare, helps us understand the finer details of this condition and what caretakers and parents can do to help little ones cope when they have an attack or even otherwise.
What is asthma?
It is a condition of the air tubes within the lungs and the chest cage, whose walls swell up and which become narrow in response to certain factors in the environment and food, and cause cough and breathlessness in the patient.
Is it true that asthma is a disease of adults only?
Not true. Asthma can occur even in young children — in fact asthma-like complaints are seen even in older infants and are treated using the same principles.
How do parents know whether their child has asthma?
Asthma cannot be diagnosed by parents. Any child who has repeated coughing spells, is breathless to the extent that it affects his or her work, activities and play, has coughing episodes in the night or after exercise or at particular times of the year should be checked for asthma. There may also be a family history of childhood or adulthood asthma, but this is not necessary to make the diagnosis.
Are there various grades of severity in childhood asthma?
Yes, doctors grade childhood asthma as intermittent and persistent, and the latter into mild, moderate and severe, based on daytime symptoms, night-time symptoms, frequency of them worsening and then some checks on what is called a ‘peak flow meter’ before and after an inhaler to complete the grading.
Is there a risk of it going from mild to severe?
No, provided the treatment is regular and done the right way.
How does a child develop asthma when nobody in the family has it?
There need not be a family history. The tendency to develop the disease is in a person’s genes and requires exposure to the triggering factors. It is genetic but not necessarily hereditary. (Genetic means in it in the genes of the individual. Hereditary means the genes are passed on from parents to children). In asthma, these genes may not necessarily be passed on.
Is asthma infectious? Can siblings get it?
No. It cannot be transmitted through air or close contact. However, children in the same family may have similar genes as the affected child does and may also, therefore, develop asthma.
What are the triggers and how do they affect children who have asthma?
Triggers are items in the environment or in the food — such as dust, pollen of flowers or grass, animal hair, bird feathers, chemicals in day-to-day use such as air fresheners, paint primer or foods such as eggs, shellfish, chana dal (Bengal gram), which may cause the airways to react with swelling and narrowing when the patient comes in contact with them. Sometimes, exercise can be a trigger too.
It is difficult to control food, play and exposure to pollen with children. What are the preventive measures?
Environmental triggers are more difficult to control. For example, you cannot avoid exposure to dust. But other kinds of exposures can be avoided — like to pet animals, birds, air fresheners, strong perfumes, paint primer, dust from house renovation, moulds on leaky walls and ceilings, flowering plants at home, household pests, strong insecticidal sprays, etc.
Likewise, certain foods — like chana dal, shellfish — can be substituted with safer options like use of other dals, other fish. If exercise is a trigger, this can be controlled using an inhaler before exercise and doing slow warm-ups followed by cool-down, relaxation exercises.
Is childhood asthma a life-long condition?
Most childhood asthmatics improve well after about 1-1/2 to 2 years of continuous inhaler treatment, after which it can be tapered and topped provided the child has been complaint-free during that prescription period. After that too, attacks may occur at any age, but they will be fewer.
What are co-morbidities and what is the relation of these to asthma?
Co-morbidities are illnesses which exist side by side with asthma. For example, mouth-breathing, snoring and excessive sneezing can be symptoms of allergic rhinitis or hay fever; these co-morbidities are important to recognise and treat with the asthma treatment, or else the treatment of asthma can fail.
How to determine the treatment
Sometimes a child can be on a doctor’s prescription of daily inhalers since a few months but still has attacks which need the reliever inhaler and nebulisation. This calls for a rethink on several aspects of the treatment being given. As apparent you may want to get a second opinion or do a follow up visit with the doctor to see if perhaps the initial diagnosis was incorrect – the child may not even be an asthmatic!
It could be that the diagnosis is correct, but...
1) The technique of giving the inhaler is incorrect
2) The medicine in the inhaler spray is exhausted (does not contain any more medicine)
3) The child is not taking the inhaler regularly – has missed doses
4) There is some co-existing condition triggering the attacks – such as allergic rhinitis, sinusitis, adenoids enlarged which needs to be treated
The child has exposed to triggers in the food he is eating which is triggering the attacks, such as cold drinks, ice cream.
When the wheezing child does not improve...
Sometimes a child can be on a doctor’s prescription of daily inhalers since a few months but still has attacks which need the reliever inhaler and nebulisation.
This calls for a rethink on several aspects of the treatment being given. As apparent you may want to get a second opinion or doa follow up visit with the doctor to see if perhaps the initial diagnosis was incorrect – the child may not even be an asthmatic!
It could be that the diagnosis is correct, but...
The technique of giving the inhaler is incorrect.
The medicine in the inhaler spray is exhausted (does not contain any more medicine).
The child is not taking the inhaler regularly – has missed doses.
There is some co-existing condition triggering the attacks – such as allergic rhinitis, sinusitis, adenoids enlarged which needs to be treated
The child has exposed to triggers in the food he / she is eating which is triggering the attacks, such as cold drinks, ice cream.
The child is exposed to triggers in the environment, such as pollen, household dust, insecticidal spray, air fresheners, perfumes, exhaust fumes, pollen, animal fur or feathers, cockroaches, exposure to cigarette smoke, dust from civil repairs.
The child’s asthma is triggered by exercise or physical training or use of the gym by adolescent asthmatics.
Inhalers have a prominently displayed number such as “100” or ‘200” – this may be the strength and not the number of doses which may be mentioned in smaller print elsewhere on the inhaler!
Setting rules and limits
Parents often find it difficult to completely monitor and control their child’s eating and lifestyle habits. There is just too much temptation these days.
Deal with eating habits first
1) Certain foods are obvious triggers – cold drinks, ice cream, cold water, deep-fried foods, spicy foods, can all trigger cough, and subsequently, wheezing. In addition, dairy products, and ready-to-eat foods (potato chips, wafers, sauce, jam, jellies, cakes, pastries, burgers, gums and mouth fresheners, noodles, pasta, tinned food ) contain colouring agents, flavouring agents and preservatives which may trigger an allergic response. Some fruits may also trigger wheezing. When the child has just started daily inhaler treatment (more about that next week), he/ she has not yet stabilised and hence, diet control is especially crucial in the first few months. After that the asthma may be sufficiently controlled for the child to face triggers in the food or environment occasionally without experiencing an attack.
Hence, in the initial few months, observing strict trigger control in food and environment along with daily inhaler treatment as advised, is very important in preventing ‘breakthrough” attacks.
After a few months, under the doctor’s advice and supervision, the restrictions may be relaxed in a phased manner, few foods at a time, to shortlist exactly those which cause the triggers. Likewise, the child may also be able to enjoy play and exercise which is increased in a graded manner.
2) A positive frame of mind can do wonders for a chronic medical condition. Focus on what you can give your child to eat instead on what you cannot. Cannot have egg or shrimp? Make some chicken or beef instead. Not allowed to eat ice cream? Make him a rich semolina pudding with dried fruits and natural flavours like cardamom, saffron and nutmeg instead. No cakes and pastries? A nice eggless steamed or baked cake is delicious. No chocolates? A home-made ‘fudge’ of dried apricots, walnuts, dates and pistachios ground together is yummy.
Innovation is the key here. Invent new recipes, make the food more attractive and also reward your child with little gifts and greeting cards for complying with the treatment. Express your appreciation of his / her cooperation in front of family members and relatives. Avoid negative statements and complaining in front of your asthmatic child.
3) Exercise flexibility with care:
Children are playful and can be boisterous and can they certainly engage in their normal play, while avoiding close contact with pet animals, pollen and dusty areas. A very young wheezer will regulate his/her own activity level and is not of the age to be eligible for formal sport like football, cricket, swimming, karate, jogging, aerobics or workouts so not much active restriction is needed. Still, a hyperactive young wheezer can be kept engaged indoors with clay-modelling, origami, colouring books, finger painting, puzzle books, video games and hordes of other choices, which will not cause too much physical exertion.
In an older child, it may mean giving up activities which the child liked and enjoyed in the company of his/her peers. This can be a big blow to to him or her to be labelled as an asthmatic by his peers.
4) Explain to your child that this restriction on exercise is temporary - and will be relaxed after a while provided he/she complies with the treatment plan and gets well soon.
Provide other avenues for keeping the body fit – yoga, walks, stretch exercises, indoor sports like table tennis, carom, which will keep the young mind stimulated and engaged.
Provide intellectual stimulation – Sudoku, crosswords, bridge, chess.
Encourage other activities of interest – sketching, painting, photography, singing, learning a play a musical instrument, star gazing
Watch and take action
Have your child checked for asthma if she or she has repeated cough attacks, cough for more than 15 days, or breathlessness after playing or exercise, disturbed sleep at night due to breathlessness or cough or a family history of asthma.
Childhood asthma is easy and safe to treat. The doctor will check for the items in the food and environment which may be causing this and also check for other medical conditions side by side which may need to also be treated to control asthma.
Ruqya Khan is a Sharjah-based freelance writer.
