What is Asthma in children ?
Asthma is a chronic disease which impacts the airways of the person. The airways are tube like structure which help in carrying air in and out of the lungs. But when one is effected by the asthma the inside walls of these airways become sore and swollen which causes breathing related problems. Thus, Asthma is a condition when there is inflammation of airways in the lungs. This inflammation makes the airways susceptible to episodes of problem in breathing which is known as asthma attacks. General triggers of asthma are cold, pollen grains, dust allergies, cigarette smoke, exercise, common cold infecting etc. In case of small children the management of asthma requires special care as the children are unable to properly communicate their problem in better ways. Moreover children have smaller airways when compared with the adults, which makes asthma especially serious for them. The diagnosing of asthma in children thus is very difficult. In infants and young children, the main symptoms of asthma are, coughing and wheezing chest tightness, and trouble breathing, especially early in the morning or at night.
For these reasons, the management of asthma in children can take steps carefully and relatively while regular monitoring. There is an Action plan made by doctors for the asthma treatment that is very helpful in reducing asthma symptoms by following them in a correct and proper manner. A written asthma action plan can be developed with your child's doctor to monitor symptoms and adjust treatment whenever necessary.
Common symptoms of asthma in children are:
- Trouble breathing or shortness of breath
- Cough and cold
- Wheezing or whistle-like sound when exhaling
- Breathing in so hard such that the abdomen is sucked under the ribs
- Difficulty in gasping for air
- Exposure to cigarette smoke or other airborne causing irritation in breathing
- Facing trouble in speaking due to restricted breathing.
- Strong emotional reactions, such as crying or laughing
- Having gastrointestinal reflux etc.
If any of these symptoms are existing in the children then there is a need of proper treatment to them. The normal diagnostic tests used to calculate how well the patient is breathing are not that easy task for the doctor to under age of 5 or less. Asthma in children is managed by controlling inflammation with drugs, avoiding triggers when possible and using medications to treat asthma attacks.
How is the Asthma treatment done in childrens ?
The biggest challenge in the treatment of the asthma in children is the diagnosis of the asthma in the children especially with kids of age below than 5 years. The basic treatment procedure is as follows:
- Diagnosis: First of the entire doctor recommend some important test to the patient. With the help of these tests and checkups doctor find out the actual condition of the patients health. It is not easier for any doctor to find out the actual condition of the patient especially in children so they make question answering round which is very useful in the treatment of the children diagnose with asthma. Some of these questions are like knowing the medical history of the children, family history of asthma, changes in cold weather, frequency of the symptom, duration of the attack, night pattern, allergy, etc. The pediatrician shall test the child airway functioning through a pulmonary function test which is done through a device called as spirometer. Through this device the amount of the air blown out of the lungs for a period of the time is measured. For diagnosis the pediatrician may also give some medicine for trial asthma control and then perform the pulmonary function test again. Through this test the blockage if any in the air passage is found and is treated. After the above test, for some patients the doctor may recommend a chest radiograph especially with children having wheezing sound. After that some other Laboratory tests are recommended for the patient these tests are blood test, chest x-ray and allergy test.
- Treatment: Once the diagnosis is done the treatment begins. The treatment can be a trail treatment, a short term treatment and a long term treatment based on the children condition.
- Short-acting bronchodilators: If the child has relatively mild and infrequent symptoms, then the child may be given a short-acting drug. This medication is called short-acting bronchodilators which provide in immediate relief to the patient from the asthma symptoms and the medication effects last four to six hours. These short-acting bronchodilators contain albuterol substances like ProAir HFA, Ventolin HFA, others and levalbuterol Xopenex HFA.
- Long –term medication: If the patient is not feeling better with the short- term treatment medication then the doctor will consider another diagnosis and another treatment of the patient . Moreover if the symptoms of asthma in the patient are more regular then the doctor will likely begin a drug for long-term management. Some of these medications are as follows:
Types of long-term control medications include:
- Inhaled corticosteroids. One of the common long-term control medications for asthma in children. These are anti-inflammatory substances include fluticasone, budesonide, beclomethasone, ciclesonide and mometasone.
- Leukotriene modifiers. These are in the form of chewable tablet for the kids. Some notable names are montelukast, zafirlukast (Accolate) and zileuton (Zyflo). These tablets can be used alone or along with the inhaled corticosteroids.
- Combination of inhalers. These are used to reduce the risk of a severe asthma attack.
- These medications are combination of inhaled corticosteroid plus a long-acting beta agonist (LABA). Some of these include the combinations fluticasone-salmeterol, budesonide-formoterol, fluticasone-vilanterol and mometasone-formoterol.
- Oral corticosteroids: these medicines are used only when asthma cannot be controlled with other treatments.
- Theophylline. This is a daily medication that opens the airways (bronchodilator).
Apart from the above mode of treatment there is a need to have Medication delivery devices nearby to treat the asthma in the children. These act as the supportive devices to help the child breath some of them are Nebulizer and Valved holding chamber with mask. These devices help the child to inhale the medication and don’t allow exhaling the medicine back into the device. The mask of the device enables the child to take six normal breaths so as to get the same dosage as inhaling a single large puff of medication.
Who is eligible for the treatment? (When is the treatment done?)
Generally the kids who are suffering from breathing problems or asthma attacks are eligible for the treatment. Kids who are facing difficulty while breathing due to changes in weather, due to dust and pollen allergy and are having blockade in the airways are eligible for the treatment.
Who is not eligible for the treatment?
Kids who are not having any trouble while breathing and are thus not having any airways infection or blockade are not eligible. Sometimes the kids may have short breaths due to cold, sinus and other lung related infection. They require other mode of treatment and thus require proper diagnosis.
Are there any side-effects?
The drugs used for the treatment of the asthma in children may pose following side-effects.
- Dysphonia which is difficulty in speaking
- Sore mouth or throat
- Spasms of the trachea
- Increased pressure in the eye known as glaucoma
- Headache and Dizziness
- Nervousness or tremors
- Increased heart rate palpations
- Weight gain
- Diabetes or Elevated blood sugar
- Anxiety in kids
- Growth suppression in children
- Fluid retention
- Osteoporosis in adults
- High blood pressure
- In rare cases, montelukast and zileuton can lead to psychological reactions such as agitation, aggression, hallucinations, depression and suicidal thinking.
If any of these side effects appear and any other unusual pattern is observed it is advised to seek the medical advice as early as possible so as to take corrective action at the earliest.
What are the post-treatment guidelines?
The post-treatment guidelines for asthma in children are:
- It is essential that the medicines are taken as advised and as per the dose instruction.
- Regular checkup are necessary
- Things which cause allergy and can trigger the asthma attacks are to be avoided.
- In order to get recovery from this disease there is a need to make a proper action plan with the help of your doctor. The action plan shall help in ensuring that the treatment is moving properly in right direction. The action plan contains details like: Child’s name and age, the physician and his contact number, the prescribed medicine and its timing, the dosage instructions, etc. This should be with the kid and at home. This is necessary in case of emergency.
- For the kid make a strict rule at the home which includes
- A record of the child's symptoms and treatment.
- Details period and conditions of an asthma attack
- Medicines responses to asthma attacks
- Side effects of treatment etc.
- The patient should not smoke and not do heavy exercise which may trigger asthma attack.
How long does it take to recover?
The recovery period from asthma in children is dependent upon the seriousness of disease and the condition of the patient. Most kids who have the symptoms like wheezing and shortness of breath may get treated for the asthma and the symptoms go away around adolescence. But in some cases it has been reported that it may reappear in their adult age. Asthma can be life-long persistent if the following conditions are met:
- When there is a parent suffering with asthma
- Eczema and other kind of food allergy
- Sensitivity to airborne allergen
- When there is a high count of a certain type of white blood cells
Short term asthma can be treated properly in few months. But long term treatment requires lifelong support.
What is the price of treatment in India?
The price of the treatment of asthma in children in India may vary from the condition of the kid and the mode of the treatment availed. General consultation is within the range of INR 500 to INR 2500/- Medication, diagnosis and treatment may be in the range of Rs: 20,000/- to INR 3.5 lakhs.
Are the results of the treatment permanent?
The result of the treatment of asthma in children is dependent upon the causes and seriousness of the disease because in some cases the outcome of the treatment may be permanent but in many cases the outcome of the treatment is not permanent and the asthma may be life-long because some children can face more attacks of asthma in their life. Such kids require supportive treatment regularly. These asthma attacks are more possible, if the patient is not following the guidelines of the doctor and sometime can occur if the usage of medicines is not properly done.
What are the alternatives to the treatment?
The alternative treatments that may also be helpful for the treatment of asthma in children include:
- Relaxation techniques.
- Herbal remedies
- Breathing techniques. The breathing techniques may consist of planned breathing programs, like the example of the Buteyko breathing technique, yoga breathing exercises (pranayama) which help the patient to control the breathing patterns and help the airways to function properly.