Asthma: the basics

Apr 28, 2023 | General, Healthy Living

Asthma is a common disease in pediatrics. Nobody knows exactly why some children have it and others don’t. It tends to run in families, and is associated with lung immaturity, allergies and eczema. Asthma is a manageable disease. When treated correctly, it will not limit a child’s ability to go to school, participate in sports, or to live a happy and fulfilling childhood. 

During an asthma attack, the airway muscles squeeze down, causing the airways to become narrow. Narrow airways produce cough, difficulty breathing, and wheezing. Air can become trapped in the lungs. If asthma is severe enough, it can cause lung failure and even death. 

Asthma is a chronic disease with periodic flares. A severe flare is often called an “asthma attack”. Even if symptoms are not present, the disease is still present. This is because the airway muscles are still predisposed to squeezing. 

If asthma symptoms have not occurred in several years, your pediatrician may consider declaring the asthma officially gone. Many children do “outgrow” their asthma. Others, unfortunately, will not outgrow it. 

There are many potential asthma triggers. The most common are viral respiratory illnesses (such as “colds”), environmental allergies, exercise, and cold air. 

The goal of asthma treatment is to prevent flares, and to quickly stop them if they occur. Albuterol is a rescue medicine used to treat asthma flares. Think of it like a fire extinguisher. If flares occur frequently, other medicines (such as inhaled steroids) can be used to prevent flares from occurring. 

There are many misconceptions about pediatric asthma 

Pediatricians deal with asthma frequently during their training, and therefore tend to have a very good understanding of asthma. Sometimes, however, they do not fully explain the disease to parents. Plus, it is not the simplest disease to understand without a medical degree. Parents often have misconceptions about asthma. Below, some of the most common asthma misconceptions are addressed. 

  • My daughter doesn’t have asthma. She has reactive airway disease.” 

Asthma is a form of reactive airway disease (RAD). When a child is under 2 years of age, your pediatrician may refer to asthma-like symptoms as RAD, before it is clear that asthma is the cause. There are rare lung conditions other than asthma which can cause RAD. The vast majority of the time, though, RAD and asthma are practically the same. 

  • “My son doesn’t have asthma. He just needs his inhaler when he gets sick.”

If your son needs albuterol when he has cold symptoms, that is the definition of respiratory illness-induced asthma. Therefore, he does, in fact, have asthma. It is important to understand that even if symptoms only emerge periodically, the underlying disease is still present. 

  • “My 6-year-old daughter’s asthma was caused by a cold when she was 9 months old.” 

Parents often believe that the illness which first triggered their child’s asthma symptoms, many years ago, was the “cause” of their present-day asthma. Typically, viral illnesses do not cause asthma. They trigger asthma symptoms in an individual who already has asthma, thereby revealing the underlying problem. 

There is one notable exception. Having RSV (respiratory syncytial virus) bronchiolitis in early childhood may increase a child’s risk of developing asthma. 

  • “Inhalers don’t work for my son’s asthma. Only the nebulizer works.” 

Albuterol is albuterol, regardless of whether it is inhaled via an inhaler with spacer, or via a nebulizer. When used correctly, inhalers and nebulizers are equivalent methods for treating asthma symptoms. If an inhaler is used without a spacer (a plastic tube attached to the inhaler), the medicine will not reach the lungs, and therefore the medicine will not work. 

Mucus congestion can cause wheezing, especially in infants. Sometimes mucus congestion is mistaken for asthma. In this case, the inhaler will not help. The nebulizer may help, not because of the albuterol, but because of the water vapor that comes with it! Water vapor is very effective at treating mucus congestion. 

In other words, if the inhaler doesn’t work, but the nebulizer does, you are either (1) using the inhaler wrong or (2) unknowingly treating mucus congestion rather than asthma. 

  • “I give my daughter albuterol twice per day for asthma maintenance.” 

Albuterol is not a maintenance medicine; it is a rescue medicine. It does not prevent future asthma flares. Think of it like a fire extinguisher. You would never spray a fire extinguisher in your kitchen twice per day to prevent future fires. If your child truly needs albuterol twice per day, every day, that is a problem. That is like having two fires in your kitchen every day. You should contact your pediatrician to discuss using an inhaled steroid to prevent asthma flares. 

  • “The pediatrician prescribed a daily steroid inhaler. But my son has no symptoms, so we stopped giving it.” 

Not having symptoms is the reason that a steroid inhaler is prescribed! Steroid inhalers are designed to prevent asthma attacks. They should be used as prescribed, every day, regardless of symptoms. By withholding a recommended steroid inhaler, you are putting your child at risk for an asthma attack.

It is important to note that, sometimes, steroid inhalers are prescribed for use only when a child is sick. Ask your pediatrician to clarify how the steroid inhaler should be used. Even better, ask your pediatrician for an Asthma Action Plan, which outlines exactly how to treat your child’s asthma when symptoms are present, and when symptoms are absent. 

  • “I don’t want my child to use a steroid inhaler. They have too many side effects.” 

Sure, steroid inhalers may have mild side effects. But nothing as severe as an asthma attack. Plus, if your child has an asthma attack, he or she will need to be put on oral or IV (intravenous) steroids, which come with significant side effects, including irritability, immune suppression, and adrenal insufficiency. For children with persistent asthma symptoms, the benefits of inhaled steroids far outweigh the risks.

If you have questions about asthma and your child, please get in touch with our office.

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