SATURDAY, MAY 18, 2024
Herald Café: Why do some children get asthma.?
Dr Virendra Gaonkar: Asthma is caused by complex interaction of genetic and environmental factors . An asthma exacerbation develops when a genetically predisposed child is exposed to triggering environmental factors.This results in increased contractility of airway muscles and mucus production, causing the airways to become narrow.
HC: Are there any changes I can do to reduce asthma attacks in my child?
Dr VG: Once the causative factors are clear, prevention of the asthma attack is easier.
a) Prevention: To reduce the attacks, one has to keep the child away from the precipitating environmental factors & conditions. Smoking bans are effective in decreasing the exacerbations of asthma. Decreasing exposure to smoke, air pollution , chemical irritants including strong smelling agents ,keeping pets and pests away ,maintaining a hygienic home environment with reduced exposure to indoor allergens, avoiding allergic foods, can all help in prevention. As mentioned earlier , in pre school children wheezing is often precipitated by common respiratory viral infections.Congested poorly ventilated classrooms or nurseries or playschools shoud be avoided. Yearly vaccination against influenza virus is recommened for all children with asthma..
b)Control: use of preventer medicines ( inhalers) if advised, plays a key role in prevention of asthma exacerbations, as they make the airways less likely to react to further triggers. They have to be used in the correct dose in the right technique and helps in preventing damage to the lungs from the asthma attacks.
HC: Which tests need to be done and how frequently to keep asthma in check?
Dr VG: The diagnosis of asthma is clinical in most cases .However lung fuction tests can be used for diagnosis as well as monitoring response to therapy, especially in older children.
a)Spirometry: This test can provide an insight into the extent of airway obstruction and their reversibility with medications. It is desirable to perform spirometry more frequently in the initial period and later ,once a year to see how well the asthma is controlled.
b) Peak Expiratory flow (PEF) is tested by using a Peak Expiratory Flow Meter. It helps in daily self-monitoring of asthma control, especially in those with moderate to severe disease.Any significant deterioration in the flow is useful to anticipate an asthma attack in advance, so that necessary steps can be taken.
HC: What is the immediate treatment in an asthma attack?
Dr VG: In known cases of asthma if the parents know the initial management, then the child can be taken care of at home. Initially ,the child should be given 10- 20puffs with the Salbutamol or levosalbutamol Metered Dose Inhaler (MDI) with spacer with in one hour. Spacer should be used along with a face mask in a child less than 4 years old. If no improvement is seen within one hour, then the child needs to be shifted to the emergency department.
HC: How to use inhalers correctly and which one is the best?
Dr VG: As mentioned above , inhalers have to be used with the spacer in the correct technique. The best ones are the Metered Dose Inhaler (MDI) with spacers (with face mask in child less than 4 years old). If spacer is used, the deposition of the drug into the lungs is better and more effective. Co-ordination is also better. Prior to each use , inhalers should be properly shaken. The MDI with spacer with or without facemask should be properly fitted ensuring a tight seal around the lips or mouth and the drug is delivered by pressing the inhaler. After every dose the mouth has to be rinsed thoroughly with water to prevent deposition of the drug in the mouth and the pharynx which can cause fungal infection. Older children can use inhalers alone without a spacer, if they can co-ordiante well , but the deposition of drug in the lungs will be lesser comparatively. Other devices include Dry Powder Inhalers ( DPI) like rotahalers or Breath Actuated Inhalers which has features of both MDI and DPI.
HC: Are the inhalers with steroids not harmful to my child?
Dr VG: Using the inhalers in the proper technique will help the drug to be delivered directly to the lungs. Hence the dose of steroids in the preventer inhalers is very low in micrograms .Therefore they are least likely to cause any side effects .Use of very high dose steroids for a prolonged period of time, can cause some side effects like growth suppression , infections etc.
HC: How about alternative therapies alongwith medicines?
Dr VG: Though it is not my field of expertise I am not the best person to comment but , I have seen some children who have been benefitted from alternative therapies.
HC: Can child with asthma play active sports?
Dr VG: A child with asthma can participate in active sports . However those children with exercise induced asthma, may have to keep their asthma symptoms in control with appropriate medicines. In addition, they may have to take a rescue dose of inhaled Salbutamol or levosalbutamol before indulging in excessive physical or active competitive sports such as running, football etc.
HC: Does stress worsen asthma?
Dr VG: Stress sometimes does precipitate asthma; but more likely in adolescents.
HC: What to do with pets in the house?
DR VG: Pets dander may act as allergens and may precipitate an asthma attack. Feathered or furred animals as pets are best avoided in the house or at least in the bedrooms or in sleeping areas of children with asthma.
HC: Should antibiotics be given each time there is an asthma attack?
Dr VG: Antibiotics usually do not play a role in the management of asthma as the attacks are triggered by more by viral infections than bacterial infections. They are indicated when there is suspicion or evidence of associated bacterial infection and their use is not directly related to the treatment of the disease.
HC: Is Asthma curable? Will my child ever be asthma free?
Dr VG: The incidence of asthma in pre school children is around 35%. About 2/3rd of the children outgrow their asthma by 7- 10 years of age, while remaining 1/3rd remain asthmatics and require long term controller / preventor medicines.This again depends on the history of strong allergies and severity of asthma. Children with more severe attacks or more frequent attacks with a strong family history of asthma and allergy are more likely to remain asthmatics.
