More than 23 million Americans have asthma and more than one-quarter are children younger than age 18. In recent years, better ways to diagnose and treat asthma, even in young children, have significantly improved daily life for children living with asthma. With proper medication, severe flare-ups can be minimized – even prevented – and children with well-managed asthma care can lead active lives with minimal restrictions. Dr. Michael Schechter, a pediatric pulmonologist with extensive experience working with children with asthma, shares more about asthma care in today’s world, managing care for a full and active life, and a new community program that can help.
What is asthma?
Asthma is a condition that affects a person’s breathing. Inside the lungs are airways called bronchial tubes. In people with asthma, there is chronic irritation or inflammation of the bronchial tubes associated with swelling and increased mucus production. As a result of this inflammation, some people have frequent, even daily, symptoms such as cough, wheezing or difficulties with exercise. Other people with asthma only have these symptoms when exposure to certain triggers causes the muscle around the bronchial tubes to tighten up and narrow (this is called bronchospasm). People with asthma who have only mild, intermittent symptoms (such as with colds or with strenuous exercise) may successfully rely on the occasional use of rescue medications. Those who have more frequent or more severe symptoms are better treated with controller medications. (See below for details about both of these medication options.)
What triggers asthma?
Common causes of asthma flare-ups are known as “triggers.” Infections, colds or flu (i.e., respiratory virus infections) are far and away the most common trigger of asthma flare-ups. Having a cold also makes a person with asthma more sensitive to exposure to other triggers, such as: strenuous exercise; cigarette smoke; anything with a strong smell (good or bad) including perfume, paint or chemicals; and dust, pollen, mold and other allergens (which are the most common cause of the chronic airway inflammation seen in asthma). Intense exposure to something that a person is allergic to may also trigger an asthma flare-up. Generally speaking, the overall goal of managing asthma is to reduce daily symptoms while maintaining normal activity levels and minimizing exposure to triggers helps with this.
Rescue medications (also called quick-relief or fast-acting medicines) work immediately to relieve asthma symptoms when they occur. The most commonly prescribed rescue medication is albuterol, which has a number of brand names such as Proventil, Ventolin and ProAir. When a rescue medication is inhaled into the lungs, it works within minutes to relax bronchospasm, open up the airways, and relieve wheezing, coughing, shortness of breath and other symptoms. However, relief is temporary, typically lasting only 4 to 6 hours. Although they are an important part of asthma treatment and are needed when flare-ups occur, rescue medications are a temporary “fix”; they don’t provide adequate long-term control and their frequent use may lead to worsening problems over time. Talk with your child’s doctor about how often your child uses rescue medication. If it’s too often, the doctor also might prescribe controller medication to reduce symptoms and help prevent asthma flare-ups from happening.
Controller medications (also called long-term control or maintenance medicines) ease airway inflammation, so there is less bronchial swelling and mucus, and therefore help prevent asthma symptoms and flare-ups. These are slower-acting medicines that typically can take days to we
eks to start working. Research shows that controller medications improve asthma control with minimal risk of side effects. Inhaled steroids (QVar, Flovent and others) are the most common form of controller medication and these have been identified by the American Academy of Pediatrics as the preferred long-term treatment for children who have frequent asthma symptoms. With proper use of controller medications, children with asthma should rarely need to seek emergency care/hospitalization and rarely have symptoms, except maybe with colds. They should be able to run, play hard, exercise and do anything anyone else can do (except smoke). Ask your child’s doctor to refer you to a lung doctor (pulmonologist) if your child has symptoms between colds, is unable to run around with friends, or needs to visit the emergency department ER or hospital for asthma.
Do inhalers or nebulizers work best?
Rescue and controller medications are both inhaled into the lungs. Inhaled medication may be given through a metered dose inhaler or a nebulizer, and research has shown that as long as the inhalers are used with valved holding chambers (a plastic tube that holds the medicine in place to allow it to be breathed in more completely), they work as well as or better than nebulizers for children of all ages including infants. The key to success in using either type of system is to be taught the right way to use it…then the choice is yours! Most parents and children prefer the inhalers (once they are taught the correct method for use) because they are easier and more convenient, but some children seem to prefer the sound and the mist of the nebulizer. It usually takes about 10 to 15 minutes to give medication by nebulizer, and the child must keep a facemask on for the medication to penetrate into the lungs; inhalers dispense the medication in much less time. Both inhalers and nebulizers are much less effective if a child is crying during use, since less medicine will be inhaled.
New community asthma program offers treatment, education and support
Although asthma can be easy to manage, for some families a variety of barriers can make asthma treatment difficult and CHoR has recently started a new community asthma program to help. This new program, YoU CAN Control Asthma Now (UCAN), is funded by Children’s Hospital Foundation. UCAN emphasizes intervention to promote successful asthma management while providing education and treatment for eligible children and their families.