The Childhood Asthma Battle Zone

For more information on respiratory therapy or cardio-pulmonary services call 859 625-3108. 

By Karen Miller, RRT

For Melissa, it had become a bad day early. It started when she had a yelling match with her little brother because his new puppy had chewed up her winter coat.  She had to grab last year’s coat from the musty closet.  She was running late when she ran out the door.  As she reached the bus her breathing came in short puffs and she recognized the suffocating signs of an asthma attack.  She began to regret forgetting to tell her mom when she ran out of her medication a few days earlier.  As the bus made it’s way to school her breathing grew faster and more difficult.  This was becoming a bad attack and she was getting scared.  Her lips and fingernails were turning a bluish gray and she was making a wheezing sound with each labored breath.  “Can’t breathe”, she gasped to her seatmate. She tried to control the panic as she struggled to take each breath.  As soon as the bus arrived at school, Melissa was rushed to the nurse’s office and given her “rescue inhaler” by the school nurse. Within 10 minutes Melissa began to feel some relief but she was still in trouble.  When her condition failed to improve, the school nurse called an ambulance to take Melissa to the Emergency Department.     

Melissa is one of the more than 8.6 million children who suffer from the disease called asthma.  One-third of the asthma victims in the U.S. are children under the age of 18.  Asthma incidence has increased 86.8 percent since 1982, making it the most common chronic disease among children.  Asthma is the number one cause of hospitalization for children under the age of 15 and the fourth most common reason for emergency room visits.  More than 10 million absences from school occur each year due to this disease.

The exact cause of asthma is unknown but it is agreed that inflammation of the airways leads to the contraction of the airway muscles, increased mucus production and swelling in the airways.  

The symptoms for asthma in children are the same as in adults but they may not be as noticeable or as easy to detect.  Wheezing—a breathing noise caused by constricted air passages—is a common adult symptom in asthma but may not be as noticeable in children.  The most common characteristic of childhood asthma is coughing.  Coughing during exercise, crying, or a persistent cough at night may be signs of asthma.  Frequent respiratory infections, like bronchitis or pneumonia may also indicate asthma as does chest tightness, shortness of breath and unexplained irritability.  Any one or all of these symptoms may be present in the child with asthma and it is important to consult your physician for a diagnosis. 

Once the diagnosis has been made, the next step is education.  Asthmatics should work with a health care professional such as a respiratory therapist to come up with an asthma management plan.  The respiratory therapist will help to identify specific  “triggers” to asthma attacks for the child and will teach them how to monitor the signs and respond appropriately to the symptoms.  Respiratory therapists can educate asthmatics about medications their doctor has prescribed for both everyday use to prevent an attack and for emergency situations like the one Melissa experienced. The better informed a person becomes about their asthma the better it can be controlled.  

There are many different things that can trigger an asthma attack. As in Melissa’s case, allergies are common triggers.  Allergens can include pollen, mold, animal dander, certain foods, dust and dust mites. Cockroaches and their droppings are also allergens.  Inhaled irritants are known to cause attacks and include perfumes, household cleaners, paints, varnishes, chalk dust, and powders.  Smoke is particularly irritable to asthmatics.  More than 200,000 children experience severe asthma attacks due to second hand smoke exposure each year.  Smoke from wood-burning stoves and fireplaces can also release irritating fumes.  Medication sensitivities, as well as infections of the nose, airways, throat or sinuses can lead to asthma attacks.  Exercise, such as running, can also be a trigger.  Even expressions of emotions like laughing, crying or yelling can contribute to an asthma attack.  Melissa’s attack was aggravated by the molds from an old coat, animal dander, yelling at her brother and the sudden exposure to cold air. 

Many triggers are controllable once identified.  Mold can be minimized with ventilation and regular disinfecting with a fungicide.  Second hand smoke can be eliminated by not allowing smoking or wood burning fires around anyone affected by this irritant.  Dust can be controlled in the bedroom by removing stuffed animals, feather pillows, blinds, and other dust collectors along with covering pillows and mattresses with plastic cases.  Keeping windows closed and using air conditioning will avoid bringing in outdoor air, which can have pollen and other outside irritants.  It is also important to change filters on air conditioners and furnaces often.  Respiratory therapists certified in Asthma Management can help in creating an environment low in irritants.

Avoiding the triggers involved in asthma attacks may not be entirely possible for some children, which points to the need for appropriate medications. Bronchodilators, used to help open the narrowed airways, are prescribed for everyday use as a maintenance medication to help control flare-ups. More powerful versions are available as rescue medications for emergency situations such as Melissa’s.  Asthma control is often supplemented with anti-inflammatory medications.  Anti-leukotrienes are a relatively new type of medication which prevent and reduce airway inflammation, making airways less sensitive to triggers. These medications help to decrease the narrowing of the airways and to decrease the chance of fluid in the lungs, and should be thoroughly discussed with one’s physician and respiratory therapist

Melissa spent the rest of the day in the emergency department.  The ER doctor ordered treatment with various medications to stop her attack, open her airways and stabilize her breathing, all of which were administered by the respiratory therapist.  Her prescriptions were refilled and she was instructed to work more closely with her family physician and asthma educator to prevent future emergencies.  Melissa survived this battle but realized the war was far from over.

Karen Miller is a Registered Respiratory Therapist and Certified Asthma Educator at Pattie A. Clay Regional Medical Center in Richmond, Kentucky.

12/03

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