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Asthma
By Dr. Sally Robinson and Dr. Keith Bly

Asthma is the number one reason that children miss school in the United
States and the most common chronic illness that sends kids to the
emergency room.

Some children have only mild, occasional asthma flare-ups, or only show
signs after exercising, while others have such severe asthma that it affects
how active they are and causes changes in the way their lungs function.
Asthma is a chronic inflammatory lung disease that causes airways to
tighten. Asthma flare-ups often appear to happen without warning, even
after weeks or months without having. All children that suffer from asthma
have airways that are overly sensitive to triggers, such as exercise,
allergies, viral infections, and smoke. When children with asthma are
exposed to triggers such as these, their airway linings become inflamed,
swollen, fill with mucus and the muscles that line the airways tighten and
shrink, which makes it difficult for air to move through them. A child
experiencing an asthma flare may cough, wheeze, have tightness in his or
her chest, have an increased heart rate, sweat, and have shortness of
breath.

There are four main categories of asthma:
.. Mild intermittent asthma – brief flare-ups that occur no more than
twice a week. The child rarely shows symptoms between flare-ups.
.. Mild persistent asthma –flare-ups more than twice a week and
symptoms occur at least twice a month and may affect normal
physical activity.
.. Moderate persistent asthma –daily symptoms and take medicine
daily.
.. Severe persistent asthma – continuous symptoms with frequent
wheezing, coughing or shortness of breath that may require
emergency treatment or hospitalization.

It’s not easy to diagnose asthma because children with asthma have
different patterns of symptoms. Some children may cough all night, but
seem fine during the day, while others seem to get chest colds that don’t
go away easily. Doctors normally rule out all other possible causes of a
child’s symptoms before diagnosing asthma. The doctor may ask the
family for asthma and allergy history, perform a physical exam, and may
order tests, such as chest X-rays, blood tests, and allergy skin tests.
The doctor will also want to know symptoms and how severe they are,
when and how often they occur, how long they last; your child’s allergies;
how often your child gets colds; and things that seem to trigger the flareups.

Each category of asthma is treated differently because no single remedy
works for every child. There are two categories of asthma medications:
quick-relief, or “rescue” medication, and long-term preventative, or
“controller” medications. Prescription asthma medications treat symptoms
and causes, so they control asthma effectively. Over-the-counter
medicines, home remedies and herbal medicines should not be
substituted for prescription asthma medicines because they cannot
quickly and effectively treat the causes or reverse the flare-ups.
Your doctor will provide a written, step-by-step plan detailing what to do
between flare-ups and how to recognize and manage them when they
do occur.

Families that take the time to learn more about asthma are
often the most successful in controlling it. Check out local support groups
or contact organizations, such as the American College of Allergy,
Asthma and Immunology at (800) 842-7777 or the American Lung
Association at (800) LUNGUSA.

Dr. Sally Robinson is Professor of Pediatrics, and Dr. Keith Bly is Assistant Professor of Pediatrics at the University of Texas Medical Branch at Galveston Children's Hospital. For more information, visit: www.utmb.edu

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