BY DR. CHAITALI LADDAD (FOUNDER & DIRECTOR, THEPEDIATRIC NETWORK)

Asthma is a respiratory ailment where the airways are hypersensitive / hyperactive to a variety of factors known as triggers resulting in narrowing/spasm and swelling of airways which in turn manifests as wheezing,cough and breathlessness. A trigger is anything that can lead to an asthma attack. When your child is around something that triggers symptoms, keep track of it. This can help you find a pattern in what triggers symptoms. Maintaining a symptom diary /asthma diary would definitely help track.The common triggers are pollens, cigarette smoke, dust mites, pet dander,
cockroaches,viral infections.

A lot of taboo has been associated with asthma and there are quite a few myths and misconceptions in prevalence. Childhood is a period when respiratory ailments are at its peak and asthma is a fairly common ailment. When diagnosed and managed properly asthma does not affect the quality of life, however appropriate followup is essential.
It is however also overdiagnosed/mislabelled . All that wheezes is not asthma: A single episode of wheezing is not asthma. Wheezing particularly in younger children is most commonly associated with viral infections. Almost 30% of children younger than 3 years have atleast one episode of wheezing .Many children outgrow this problem by the time they are 6 years old. Hence the diagnosis is not made in younger children. Asthma is a chronic disease and is associated with recurrent episodes of wheezing or other symptoms. Asthma is not a contagious disease and cannot spread from contact . It does have a genetic predisposition, Children with 1 or more parents with asthma have a greater risk of having asthma. Many children develop asthma even though there is no
family history of the disease. There is nothing that you can do to prevent onset of
asthma.

One can however predict the risk of developing asthma in a child. There are higher chances of developing Asthma if he has 3 or more wheezing episodes per
year and has 1 or more of the following high risk factors –
#Skin allergy –eczema/atopic dermatitis
#Family history of asthma or allergies
#Allergic rhinitis
#Wheezing without associated colds.
Diagnosis is mainly based on a clinical history and examination in addition to response to medicines. however the doctor may prescribe certain tests to support the diagnosis or rule out an alternate diagnosis. CBC ,Xray Chest is generally done at the time of presentation/first episode. bedside Peak flowmetry is helpful in older children. Pulmonary function tests may be done in adolescent children.
It is not necessary to get an allergy test for every child with asthma. Many
paediatricians do not advice to go for allergy tests in children with asthma. There are
many possible allergens in our environment and it is not possible to test for all of
them reliably. Also false positive reactions may occur sometimes. It is not possible to
avoid some common allergens completely like dust, pollens, molds.

Asthma is spasm of airways and inflammation /swelling of the airway lining . Management of asthma is a culmination of avoidance of triggers , medicines: inhaled and oral medications, and Monitoring and followup with home treatment plans. Inhaled medicines act directly at the site of swelling and hence faster action. also lesser side effects as the medicines do not enter the blood.There are two types of medicines for management of asthma: the Relievers and the Controllers. Relievers are used for acute attacks and Controllers for long term suppression of reactivity . In moderate to severe cases controllers need to be used for a prolonged duration …3-6 months on an average.Another misconception is about steroids in asthma ,which belong to the controller category, parents are apprehensive that steroids are STRONG /HARMFUL/ADDICTIVE.
Please do not be scared of steroids used for asthma. These are inhaled steroids
and most kids are started with minimum dose and low potency steroids. Even for children on high dose or high potency steroids, the systemic side effects like hypertension, obesity, growth retardation are extremely rare.
There are other drugs available for asthma prevention but steroids are usually the
preferred drugs and are totally safe.
Serious side effects are rarely seen with inhaled steroids.Chances of local side effects like
thrush can be reduced by using spacers and gargling and rinsing mouth after each use.
It is important that your child is regularly reviewed by your paediatrician to ensure
that he/she are using the lowest dose needed to control asthma and to look for any
possible side effects.

Many children have mild asthma but for some people it can be a severe and lifethreatening
disease. Even people who usually have few symptoms can have severe
asthma attacks and they can start very suddenly. The good news is that asthma
symptoms and control can almost always be improved with the right treatment.
If your child indeed has asthma, then it will not go away. But if he/she is having
recurrent wheezing and is younger than 6 years of age, then you should definitely be
hopeful. Sixty percent of young kids with wheezing outgrow it by the time they are 6
yearsold.There is no permanent cure for asthma at present.

DIET and PLAY

Contrary to popular belief, there are no “cold”foods as such which aggravate cough.
i.e. milk/curd/rice/citrus fruits,etc . Hence no need to avoid them. Many food
colors, additives are known to trigger wheezing, hence try and find out if any specific food item triggers an attack of wheezing. A wholesome diet is essential for growth and development and there is no need for a generalised ban on milk, fruits, nuts etc.

There should be no restrictions on children’s ability to play, take gym class, orcompete in sports just because they have asthma.A well-controlled asthma doesn’t interfere in day to day activities.If your child has been instructed to take medicine before physical activity, however, make sure that she does so everytime even if the child seems fine.If your child has poorly or incompletely controlled asthma or children on long term steroid inhalers should take the influenza vaccine yearly. To conclude, tackling asthma is a team work with the parent and doctor working in tandem to help maintain a symptoms free and unrestricted lifestyle for the child and to achieve his potentia


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