Kids Love Dr. Barton

Asthma Attack!

by Dr. Douglas Barton, M.D., Pediatrician 08/10/2009

Last night, at the end of my day, I had a very perplexing case. Mom had brought her young teenager in for a cough that just never seemed to end. As we got to talking, it became pretty clear that her son has asthma, but that we had never really considered the possibility before. He had never wheezed. He had no allergy problems. No one else in the family has asthma. We really had no reason to consider the possibility before. Yet, there he was in my office clearly having trouble with asthma.

So when should parents be worried about asthma? We don’t have the space here to go into a full explanation, but we’ll cover some basics. Asthma, by definition, is a chronic disease that inflames and narrows the airways, making it harder (or sometimes impossible) for a person to breathe.  The word “chronic” tells you that you will notice at least some of the symptoms over a long period of time.  The most obvious symptom is wheezing, that sort of whistling noise that some people make when they are trying to get the air out of their lungs. Usually, when patients are wheezing, there is some measure of discomfort to their breathing as well. Wheezing can be triggered by cold temperatures, upper respiratory infections, allergies, irritants (cigarette smoke), sinus infections, exercise or even emotions. Shortness of breath and chest pain accompany the wheezing most of the time.  In addition, a cough is almost universal in kids with asthma. It is usually a dry cough, but since sinus infections are a common trigger, we’ll often see a wet junky cough as well. A cough that persists through the middle of the night and wakes other family members frequently is more common with asthma than with other illnesses. Furthermore, since asthma is an allergic disease, you will often see allergy symptoms along with the asthma.

Individuals with asthma are treated in a step-wise manner. Those who only have minor symptoms of wheezing once in a while are often treated only with albuterol, the inhaler that you have probably seen people carrying around. This is considered a “rescue inhaler” and is central to the care of patients with asthma. It is the only medication that will rapidly reverse the shortness of breath. Steroids are the mainstay for any asthma attack. Steroids work by reducing swelling and mucus production in the airways of a person with asthma. The albuterol will only temporarily relieve symptoms; the steroid is what really settles down the respiratory system and allows a patient to return to normal. As patients present with more persistent symptoms, preventative measures are taken which might include a daily inhaled steroid, long-acting inhaled albuterol equivalents, and allergy medications. Often, an allergist is asked to assist in the planning since controlling allergy symptoms may completely eliminate asthma symptoms.

Asthma is a very serious illness. Our society tends to make light of it, because so many people have extremely mild cases.  But it’s that tendency to under-recognize and under-treat the symptoms that will get patients in trouble. So, if your child has a family history of asthma, allergies or eczema, experiences a cough that won’t go away, or has wheezing or shortness of breath with exercise, a trip to your pediatrician is likely in order. A few simple steps might improve his or her quality of life significantly.




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