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Childhood Asthma

Definition


Disease: Childhood Asthma Childhood Asthma
Category: Respiratory diseases
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Disease Definition:

In recent decades, childhood asthma has become more widespread. Causing signs and symptoms that range from minor coughing or wheezing to serious flare-ups that interfere with breathing, the inflammation of the airways, which is the underlying cause for both childhood asthma and adult asthma, makes the airways overly sensitive.

With monitoring, regular doctor visits, a written plan and making treatment changes as needed, the child and his/her parents can keep the symptoms under control, although asthma can't be cured.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Causing bothersome daily symptoms that interfere with sleep, school, sports and play, childhood asthma can be very disruptive. Serious or even life-threatening asthma attacks can be caused when asthma is not managed.

Chest congestion or tightness, coughing, shortness of breath and a whistling or wheezing sound when exhaling are all included in the common symptoms of childhood asthma.

Here are some other signs and symptoms of asthma in children:

  • Fatigue or trouble breathing during active play or exercise, which are signs of exercise-induced asthma
  • Bouts of coughing or wheezing that get worse with a respiratory infection such as a cold or the flu
  • Trouble sleeping caused by wheezing, coughing or shortness of breath
  • Delayed recovery or bronchitis after a respiratory infection.


Over time, the signs and symptoms of asthma, which may vary from one child to another, may get better or worse. Not all children with asthma wheeze, even though wheezing is most commonly associated with asthma. The child may have only one sign or symptom, like chest congestion or lingering cough.
Whether the child's symptoms are caused by asthma or not is sometimes difficult to determine. Infectious bronchitis or another respiratory problem may be the cause of wheezing episodes and other asthma-like symptoms.

Breathing every day may be improved by early treatment which may also control disruptive asthma flare-ups. So when suspecting that a child has asthma, parents should take him/her to see the doctor. The child should also be taken to a doctor when the following are noticed:

 

  • Wheezing or whistling sounds when the child exhales
  • Repeated episodes of suspected bronchitis or pneumonia
  • Shortness of breath or rapid breathing that may or may not be associated with exercise
  • Coughing that's constant, intermittent or associated with physical activity
  • Complaints of chest tightness


Parents should also listen for coughing that wakes the child at night or even coughing during sleep as asthma can be worse at night. Wheezing or coughing may be triggered by yelling, crying, stress and strong emotional reactions or laughing. If an asthma attack does occur, parents should be ready; monitoring symptoms can be done by creating an asthma action plan if the child is diagnosed with asthma.
Seeking emergency treatment:
If the child has any trouble breathing, urgent medical attention should be sought, even if the child hasn’t been diagnosed with asthma. Asthma attacks can start with coughing, which progresses to wheezing and rapid breathing, although episodes of asthma vary in severity.

Parents may notice that the child's chest and sides are pulling inward as he/she struggles to breath in severe cases. The child may also experience sweating, chest pain and increased heartbeat. If the child has the following, urgent care should be sought:

  • Widening the nostrils when breathing in
  • Breathing so hard that the child has to stop in midsentence to catch his/ her breath
  • Trying so hard to breathe that the abdomen is sucked under the ribs when he/she breathes in
  • Using the abdominal muscles to breathe

Causes:

When being exposed to triggers such as allergens or smoke, an overly sensitive immune system makes the airways become inflamed and swollen in children with asthma. Asthma symptoms sometimes occur with no apparent triggers. Asthma symptoms are caused when airway muscles constrict, the lining of the airways swell, and thick mucus fills the bronchial tubes, which happens when asthma flares up.

The triggers of asthma are not the same for all children, they include the following:

  • Allergens such as pollen, pet dander, mold or dust mites
  • Exercise
  • Viral infections such as the common cold
  • Weather changes or cold air
  • Tobacco smoke or other environmental pollutants


Heartburn (gastroesophageal reflux disease), a chronic runny or stuffy nose (rhinitis) and inflamed sinuses (sinusitis), are all conditions that are linked to asthma.

A combination of genetic (inherited) and environmental factors may be the reason why some children get asthma and others don’t. The risk of developing the disease is greater in children with a family history of asthma. A child's chances of developing asthma may increase as well due to other environmental factors such as:

 

  • Low birth weight
  • Obesity
  • Living in a large urban area with increased exposure to air pollution
  • Previous allergic reactions including food allergies, skin reactions or allergic rhinitis (hay fever)
  • A family history of asthma, eczema, hives or allergic rhinitis

Complications

Complications:

Listed below are some of the complications that may result from asthma include:

 

  • Long-term use of inhaled corticosteroids may cause slightly slowed growth in children
  • Long-term use of some medications used to stabilize severe asthma (oral corticosteroids) may cause side effects
  • The bronchial tubes (airway remodeling) may become permanently narrow
  • Emergency room visits or even hospitalization  may be required in severe asthma attacks

Treatments:

Controlling the asthma is the aim of asthma treatment.

When the child has the following, it means that asthma is well-controlled:

  • Minimal use of fast-acting "rescue" inhalers
  • No limitations on physical activities or exercise
  • Few or no side effects from medications
  • Minimal or no symptoms
  • Few or no asthma flare-ups


Both treating an asthma attack in progress and preventing asthma symptoms are included in treating asthma. The inflammation in the airways of the child that can lead to symptoms can be reduced by preventive medications. Swollen airways that are limiting breathing can be quickly opened by quick-relief (rescue) medications.

Quick-relief medications can't keep the child's symptoms from coming back, although these medications work quickly. Taking a long-term control medication will be necessary in case the child has frequent or severe symptoms. Over time, the symptoms and triggers of the child are likely to change. Working with a doctor to adjust medications as required, and monitoring asthma symptoms carefully may be needed.

MEDICATIONS FOR LONG-TERM CONTROL:
To control persistent asthma, these preventive anti-inflammatory medications are taken every day on a long-term basis. If asthma symptoms get worse at certain times of the year, these medications are taken seasonally. Here are some examples:

Leukotriene modifiers:
These include zileuton, montelukast and zafirlukast.

Cromolyn:
This medication is usually taken along with an inhaled corticosteroid and it needs to be taken two to four times a day. Mild to moderate asthma attacks may be prevented with the help of cromolyn.

Inhaled corticosteroids:
The need for other medications and chronic inflammation in the airways can be reduced by these medications, which are used to treat persistent asthma. These medications include flunisolide, mometasone, beclomethasone, budesonide, fluticasone and triamcinolone. The benefits of good asthma control outweigh the risks of possible side effects in most cases. A minor side effect is that slightly slowed growth in children is associated with the continuous use of inhaled corticosteroids.

Theophylline:
To make breathing easier, this medication, which is a daily pill that opens the airways (bronchodilator), relaxes the muscles around the airway.

Combination inhalers:
These consist of inhaled corticosteroids in addition to a long-acting bronchodilator.

MEDICATIONS FOR QUICK RELIEF (RESQUE MEDICATIONS):
Immediate relief of asthma attack signs and symptoms such as shortness of breath, wheezing, chest tightness or coughing is provided by these medications, which are called short-acting bronchodilators. A metered dose inhaler is the name of a small, hand-held device that is used in delivering these inhaled medications. The most commonly used short-acting bronchodilator is albuterol. Levalbuterol and pirbuterol are included in others. Within minutes, these bronchodilators begin working and last from four to six hours.

Allergy-desensitization shots (immunotherapy):
If the child has allergic asthma that can't be controlled by avoiding triggers, immunotherapy may help. The child may need injections once a week for a few months, then once a month for a period of three to five years. Lessening the immune system response that triggers asthma symptoms, the allergic reactions of the child will gradually diminish.

Inhaled medication devices:
Inhaled short- and long-term control medications are used by inhaling a measured dose of medication.
A device called a nebulizer, which is a machine that turns liquid medications into fine droplets, can be used for babies. The nebulizer delivers the correct dose of medication while the baby wears a face mask and breathes normally.
A face mask attached to a metered dose inhaler or a nebulizer to get the correct amount of medication is usually used for infants and toddlers.
A pressurized metered dose inhaler – a small, hand-held device – or an inhaler that releases a fine powder may be used by older children and teens.

HFA inhalers: A recent change:
A propellant called hydrofluoroalkane (HFA) has replaced the chlorofluorocarbon (CFC) propellant in quick-relief asthma inhalers. HFA inhalers don't harm the environment, which makes it unlike CFC inhalers. The child is still getting the full dose of medications, although the spray from an HFA inhaler may not seem as strong. So the taste of the spray from the new inhalers may be different.

Prognosis:

Not Available

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