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Childhood Asthma
is number one chronic diseases of childhood, and is the most
common cause of emergency room visit and hospitalization for the
children under the age of 18 years.
The cost of asthma related illness accounts to about $ 10
billion worldwide.
Asthma is the most common cause of school absenteeism due to
chronic disease and also causes parents to miss days at work.
Asthma often goes unrecognized in the children. Many children
have more subtle symptoms including a night time cough, a cough
that worsens with exercise or activity, or only a chronic cough
that won't go away. In these children especially for infants and
toddlers asthma can be hard to diagnose. Asthma cannot he cured,
it can almost always be controlled.
A child can live
an active life if asthma is controlled properly.
THE RESPIRATORY SYSTEM
The Respiratory
system is basically concerned with the exchange of gases between
the air we inspire and the blood. Lungs provide surface for
transfer of gases through which blood gets rid of carbon dioxide
and absorb oxygen which is vital for living. Lung is a cone
shaped structure situated in the thorax; it is where the
exchange of gases takes place.
As the air passes through the nose and mouth, it is rapidly
warmed and moistened. The nose and airways trap large particles
(dust, pollen, molds bacteria) and chemicals (smoke. sprays,
odors) which could cause serious injury to the lungs. The air is
then transported through smaller airways. These airways branch
like a tree forming millions of small airways that carry oxygen
to the tiny air sacs called alveoli. The alveoli have network of
capillaries around them. The gas exchange takes place here.
The airways have a delicate cellular lining (mucosa), which is
coated with a thin layer of mucous. Foreign particles are
trapped by the sticky mucus and are removed by the normal
cleansing process present in the airways.
The process is assisted by the movement of millions of tiny
“whip like “structures called cilia. Cilia are present on the
inner lining cells of the airways. Cilia move the mucus and
trapped foreign particles up toward the mouth and nose where
they, are coughed and sneezed out or swallowed.
Bundles of muscles surround the airways and the contraction of
these muscles allows airways to selectively direct the flow of
air.
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WHAT IS ASTHMA?
Asthma is a
chronic inflammatory condition of the bronchial (lung) airways.
This inflammation causes the airways to become over-reactive to
various stimuli, thus producing increased mucus, muscle swelling
and muscle contraction
These changes produce airway obstruction, chest tightness,
coughing and wheezing. If severe this can cause severe shortness
of breath and low oxygen levels in the blood. This obstruction
is partially or completely reversible with or without treatment.
Each child suffers
a different level of severity. All children with asthma enjoy a
reversal of symptoms until something triggers the next episode.
WHAT IS THE CAUSE OF ASTHMA?
Childhood asthma
is a disorder with genetic predisposition and is caused by
complex interaction between genetic and environmental factors.
Approximately 75 to 80 percent of children with asthma have
significant allergic problem. As stated earlier asthma is a
chronic inflammatory disease of the airways. Every asthmatic
patient has some degree of inflammation of airways of the lungs.
This inflammation is produced by many factors mainly allergy,
viral respiratory infections and airborne irritants.
Studies indicate
that allergic reactions produce both immediate and late phase
(delayed) reactions. Research indicates that approximate half of
the immediate allergic reactions to inhaled allergens are
followed by a late phase reaction.
This late phase reaction produces more serious injury and airway
inflammation. This airway inflammation leads to Irritability or
hyper responsiveness of the airways. In addition, prolonged
airways, inflammation can cause scarring.
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WHAT ARE THE SIGNS AND SYMPTOMS?
The common asthma
symptoms are wheezing, coughing, chest tightness, shortness of
breath, faster or noisy breathing.
Wheezing though characteristic of asthma, is not its most common
symptom. Coughing is noted with even "hidden" asthma when
wheezing may not be apparent to child’s family members or the
physician.
Any child who has frequent coughing or respiratory, infections
(pneumonia or bronchitis) should be evaluated for asthma.
The child
who coughs after running or crying may have asthma. Coughing
from asthma is often worse at night or early in the morning,
making it hard to sleep. Infants who have asthma often have a
ratty cough, rapid breathing and an excessive number of
respiratory infections, “episodes of bronchitis” or “chest
colds”. Obvious wheezing episodes might not be noted until
after 18 to 24 months of age.
Chest tightness and shortness of breath are other symptoms of
asthma that may occur alone or in combination with any of the
above symptoms. Since these symptoms call occur for reasons
other than asthma, other respiratory diseases must always be
considered.
In a young child the discomfort or chest tightness may lead to
unexplained irritability.
Note: If your
child has frequent coughing or respiratory infections (pneumonia
or bronchitis) he or she should be evaluated for asthma.
During an acute
episode, symptoms vary according to the severity.
Mild episode:
Child may be breathless after physical activity such as walking.
They can talk in sentences and lie down, and they may be
agitated.
Moderate severe
episode: Child is breathless while talking. Infants have
feeding difficulties and a softer, shorter cry.
Severe episode:
Child is breathless during rest, are not interested in feeding,
sit upright, talk in words (not sentences), and are usually
agitated.
Symptoms with imminent respiratory arrest
(In addition to the above symptoms), the child is drowsy and
confused. However, adolescents may not have these symptoms until
they are in frank respiratory failure. Absence of wheezing in
severe asthma is associated with most severe airway obstruction
and is a serious emergency situation.
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