What are the Signs of Asthma in Children?

Children can also be Affected by Asthma, and its Diagnosis can be More Challenging

Chronic diseases like asthma and diabetes are often associated with adults, even though they can also affect children and adolescents. Recognizing asthma in children can be more difficult compared to its diagnosis in adults. There are two reasons for this. One, the symptoms of asthma are also shared by several other respiratory diseases. Second, children may not be able to express their experiences in a manner that would allow an easy diagnosis. In such a scenario, greater awareness on part of parents, guardians and caretakers can help in an early diagnosis and bring relief to the child.

Chronic diseases of the airways are often associated with older adults, whereas the acute respiratory infections like pneumonia are more often associated with children. Though it is true that the chronic diseases are more prevalent in older age and the incidence of acute attacks more common in children, it is also true that chronic diseases like asthma can affect children and acute diseases like pneumonia can affect adults at all ages. This aware is instrumental in ensuring their timely diagnosis and management.

How common is Asthma in Children?

Asthma affects a large number of children in the world. In United States alone, it is estimated to affect around 7 to 9 million children and is one of the three leading causes of school absenteeism. It is more common in households belonging to the lowest socioeconomic strata, probably because of poor hygiene and frequent infections. The most dangerous aspect of childhood asthma is the fact that its incidence is rising unlike most other diseases of childhood that are experiencing a falling incidence.

Why is the incidence of Asthma rising in Children?

There is no single factor that can fully explain the rising incidence of asthma in children. In all probability, it is a combination of several factors. One potential cause of rising asthma could be the rising level of air pollution and secondary smoking that children are subjected to in polluted urban agglomerations. Another reason could be a lack of exposure to infections and allergens early enough in life, which can be a result of more time spent indoor and in isolation. This retards the development of immune processes and desensitization to common allergens in the child. 

What Happens when a Child develops Asthma?

Asthma is a disease of respiration in which breathing becomes difficult and strained and is associated with coughing and discomfort. It happens because of the inflammation and swelling of the walls of smaller wind pipes. 

In the process of breathing, the inhaled wind passes first through the nose or mouth to enter the single wind pipe in neck called 'trachea', which gets divided into two 'bronchi', one on either side, in the chest. Each bronchus then gets divided and subdivided into a branched structure of 'bronchioles', which finally terminate in air spaces called 'alveoli' where exchange of oxygen and carbon dioxide takes place. The walls of these structures are lined by 'mucosal' cells which secrete mucus. When for any reason there is swelling or inflammation of this respiratory mucosa, breathing becomes difficult. In severe cases, the swelling of mucosa can block the air passage leading to a bronchial spasm.

What are the Symptoms of Asthma in children?

The main symptoms of asthma include persistent or intermittent coughing, difficulty in breathing, shortness of breath, wheezing, and chest congestion or a feeling of tightness in the chest. Generally the affected child may have only one or a few of these symptoms. Different children suffering from asthma may present with different symptoms.

Thus it is important to be conscious of the possibility of asthma in all children who are having frequent cough and breathing difficulty. In many children, asthma can also be silent, which means that the symptoms are mild and not apparent enough to suggest asthma till the time some other factor like infection precipitates an acute asthmatic attack. In many children the only symptom may be difficulty in outdoor activities in the form of coughing, wheezing or shortness of breath that is triggered by outdoor exercise or playing. In some children, the primary symptom could be a lack of energy and tiredness. In some cases, one can see tightening of neck and chest muscles while breathing. In many children with asthma there are frequent bouts of pneumonia or chest infection, with no intermittent symptom.

What Causes Asthma in Children?

Asthma is a group of disorders that arise from different causes, and lead to inflammation of bronchiolar mucosa and its resultant symptoms. In that sense it is not a single disease. However, the two most common causes of asthma in children are infection and allergy. Allergy is the most common cause of asthma, and can be to any kind of dust, pollen, moulds, weed or pet dander. In some cases, allergy can also result from sudden temperature changes of air. In many such children, there is evidence of other forms of allergy such as hay fever, eczema or family history of allergies.

Infection can be the main cause of asthma or it can be a precipitating factor in worsening of a relatively silent asthmatic condition. In either case, infection needs to be taken care of in most children in asthma. The infection can be a viral infection or a bacterial one. 

What are Asthma Triggers?

Along with Infections, exposure to allergens that lead to worsening of asthma trigger the acute asthma attack. Hence, being aware of these “ASTHMA TRIGGERS” is very important in effective management of asthma.

How is Asthma Diagnosed in Children?

All children having frequent coughs and respiratory difficulties need to be investigated for the possibility of asthma, but the primary basis of asthma diagnosis is always the meticulous clinical history and physical examination. In a majority of children, especially less than 5 years old, the diagnosis of asthma is exclusively based on it.

Among investigative tests, X ray may suggest hyperinflation, but in most cases it may be normal. In children older than 5 years, pulmonary function tests can be very useful, but a normal function text does not rule out asthma on its own. Other useful tests could be exhaled nitric oxide test, which is a marker of airway inflammation, impulse oscillometry and methacholine or mannitol challenge to find out hyper-responsiveness of airways. The presence of positive allergy tests can also support the diagnosis of asthma.

Asthma Action Plan: A set of instructions for managing asthma

What is the Role of Counselling in Managing Asthma in Children?

Counselling of the child as well as her parents or caretakers can help in several ways. It can reassure them that with a bit of precautions and preparedness, it may be possible for the child to lead a normal life. It can also ensure that they are aware of the precautions as well as the significance of symptoms and are able to take the first measure immediately on recurrence of symptoms. Lastly, placing a label of asthma on a child in a tender age and making her conscious of the fact can have a damaging psychological impact. Hence the diagnosis of asthma should not be allowed to become a psychological burden on a child, even when the necessary precautions like staying away from dust, pollen and smoke and keeping the environment at home and around is emphasized.

How is Asthma Treated in Children?

Asthma cannot be cured, but it can be managed with due precautions and immediate treatment in case of worsening. The treatment consists of two groups of measures, one as a short term therapy to get rid of immediate symptoms, and the other to prevent these episodes and reduce their frequency. The former consists of bronchodilator drugs, while the latter consist of those that reduce the irritability of mucosal lining and improve their strength. All such treatment must be undertaken strictly in accordance with the advice of a medical expert.

What is Asthma Action Plan?

An "Asthma Action Plan" is a set of written instructions meant for the patient as well as all those who may be involved in taking care of the patient at any point of time. It is a practical plan for managing asthma that is developed by the treating physician in close consultation with the caretakers of the asthmatic child. It provides details of daily treatment, as well as the treatment that should be given immediately in case of any worsening of symptoms and the situations when the child must be immediately brought for medical consultation. It also documents the asthma triggers so that their exposure can be avoided. In case of asthmatic children, not only parents, but also all caretakers including those in school, play centreror outdoor instructors should be made aware of the child’s asthma action plan.