By Judy Voynow, MD and Dennis Clements, MD, PhD
is a chronic respiratory disease that can be triggered by viral
infections, allergen exposure, exercise, tobacco smoke, air pollutants,
and even changes in the weather. In patients with asthma, these
triggers activate the bodys immune system; white
blood cells enter the airway and release mediators that cause inflammation.
This inflammatory response causes smooth muscles in the airway to
contract (bronchospasm), increases mucus production, and causes
the airway lining to swell (airway edema). These changes all contribute
to the airway obstruction which we know as asthma.
are the symptoms of asthma?
The most common symptoms associated with asthma in children are
cough, wheezing (a high-pitched noise during exhalation), increased
shortness of breath, and/or the sensation of chest tightness or
pain. Children with these symptoms should be evaluated by their
physician, as the same symptoms may also be caused by other lung
diseases such as cystic fibrosis, viral bronchiolitis, and other
disorders of the lung, heart, or gastrointestinal tract. (It is
important to note that bronchitis in children may be an exacerbation
of asthma and, if it is, it should be treated like asthma.)
severe is the asthma?
Asthma is classified as mild, moderate, or severe depending on the
severity of a childs symptoms. These definitions help determine
what treatment is necessary.
asthma is defined as asthma symptoms that occur less than three
to six times per week. Moderately severe asthma is defined as asthma
symptoms that occur daily or nighttime symptoms more than once per
week. Severe asthma is characterized by continual symptoms and frequent
symptoms can be a useful sign that asthma is acting up, older school-age
children can also monitor their airway obstruction by measuring
peak expiratory flow through a peak flow meter at home. Each child
records their peak flow number at the same time of day and at the
same time in relation to when they take their medications. They
establish their personal best peak flow. If their peak flow is between
their personal best and 80 percent of their personal best, this
is the green zone and they continue their current asthma
regimen. If their peak flow is between 80 percent and 60 percent
of their personal best, they are in the yellow zone
of lung function and will require extra doses of rescue medication
(short acting beta-2 agonists) and doubling of their inhaled glucocorticoids.
Finally, patients with peak flows less than 50 percent of personal
best require evaluation by their doctor.
children with asthma may be symptom-free between asthma attacks.
However, asthma is a chronic disease that does not go away--even
when they have no symptoms, children need maintenance therapy to
Asthma therapy is divided into two categories -- maintenance
(or long-term) therapy and quick relief therapy.
therapy reduces inflammation, which decreases the risk of bronchospasm
and helps to diminish airway swelling and mucus production when
asthma is triggered. Anti-inflammatory maintenance therapy includes
inhaled glucocorticoids (Pulmicort or Flovent), an effective broad
spectrum anti-inflammatory medicine; or an oral leukotriene modifier
(Montelukast or Singulair), a once-a-day medication that blocks
an inflammatory receptor. Other maintenance therapies include a
combination of an inhaled glucocorticoid and a long-acting beta-2
agonist that reduces bronchospasm (such as Advair) or oral theophylline.
children with mild persistent asthma, either a low-dose inhaled
glucocorticoid or leukotriene modifier are used daily to keep symptoms
under control. For moderately severe asthma, the inhaled glucocorticoid
dose may be increased to the medium range, and used along with a
second maintenance medicine such as a leukotriene modifier and/or
a long-acting beta-2 agonist. For severe asthma, inhaled glucocorticoids
are used at the highest end of the dosage range, in combination
with a leukotriene modifier and a long-acting bronchodilator--either
a beta-2 agonist and/or theophylline.
quick relief or rescue medication, which is used during
asthma attacks, the most commonly used drugs are the inhaled short-acting
beta-2 agonists (such as Albuterol). Inhaled medications may be
administered through a nebulizer, through hand-held inhalers with
spacers, or through special devices that dont require spacers.
It is important that a trained professional evaluate whether the
device is working for your child and effectively delivering medication
to the lungs.
severe exacerbations of asthma, the most potent therapy for outpatients
is oral glucocorticoids. Although glucocorticoids are very effective
to resolve asthma symptoms, they should only be used for a limited
time as regular long-term use can cause unwanted side effects. Antibiotics
are not effective therapy for asthma except in the setting of a
bacterial infection such as an ear infection, sinusitis, or pneumonia.
is important that families seek the advice of specialists if asthma
is severe (requiring hospitalizations) or if the child fails to
respond to therapy. Children with difficult-to-control asthma should
also be evaluated for conditions that can exacerbate asthma, including
allergic rhinitis, sinusitis, and gastroesophageal reflux.
asthma is a challenging problem, it can be managed. Our goal is
to help every child with asthma keep their condition well under
control so they can grow, develop, and exercise to their potential.
Voynow, MD, is an associate professor of pediatrics at Duke. Dennis
Clements, MD, PhD, is interim chair of the Department of Pediatrics
at Duke University Medical Center. For more information, visit:
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educational aid, and is neither medical nor healthcare advice for
any individual problem, nor a substitute for medical or other professional
advice and services from a qualified healthcare provider familiar
with your unique circumstances. Always seek the advice of your physician
or other qualified healthcare professional regarding any medical
condition and before starting any new treatment.