What are the other Names for this Condition? (Also known as/Synonyms)

• Asthma in Children

What is Pediatric Asthma? (Definition/Background Information)

• Asthma is a disorder of the lungs, which causes the airways of the lungs to be affected. It occurs as a result of excessive sensitivity of the lung airways, to various stimuli.
• Swelling and narrowing of the airways occur, which results in a variety of symptoms, such as wheezing, difficulty in breathing, persistent cough, and painful chest tightness
• Asthma in Children is called Pediatric Asthma. It is a chronic disorder and commonly affects school-going children

Who gets Pediatric Asthma? (Age and Sex Distribution)

• Pediatric Asthma affects young children; infants, pre-school, and school-going children
• It is more common in boys than girls (in a 3:1 ratio), before puberty. But, both genders are equally affected, at adolescence
• Children in developed countries are much more affected by Asthma, than those living in the developing nations

What are the Risk Factors for Pediatric Asthma? (Predisposing Factors)

The risk factors of Pediatric Asthma could include:

• A family history of Asthma
• Previous allergic history
• Living in urban areas; more exposure to air pollution
• Exposure to tobacco smoke
• Low birth weight, children with a poor health status
• Obesity
• Rhinitis- stuffy nose
• Sinusitis, leading to inflamed sinuses
• Gastro esophageal reflux disease (GERD)
• Frequent respiratory infections

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Pediatric Asthma? (Etiology)

Asthma is a disorder of the respiratory system, affecting the lungs.It causes the airways to:

• Swell,especially in the airway lining
• Produce large amount of mucus that is thicker than normal
• Become narrower, due to muscle contractions

Asthma is caused by airways inflammation, when the airway muscles tighten. The lining of the air passage swells, thereby reducing the amount of air that can pass by.

Asthma in Children is triggered by breathing in, allergy-causing substances called allergens, or by triggers that include:

• Animal dander (pet hair, skin particles)
• Cold weather
• Dust
• Chemicals in the air
• Exercise
• Mold
• Pollen
• Respiratory infections
• Strong emotions
• Stress
• Tobacco smoke
• Aspirin, other non-steroidal and anti-inflammatory drugs
• Gastro esophageal reflux disease (GERD)

What are the Signs and Symptoms of Pediatric Asthma?

The signs and symptoms exhibited by children suffering from Asthma may be mild, moderate, or severe. These include:

• Frequent coughing
• Shortness of breath, breathing trouble
• Chest congestion
• Chest pain,tightness in the chest
• A whistling sound while exhaling
• Disturbed sleep
• Bronchitis (inflammation of the airways)
• Fatigue

How is Pediatric Asthma Diagnosed?

The diagnostic procedure for Asthma in Children depends on the age of the child. These include:

• 6 years and older children: Lung function test is performed (spirometry) to measure the speed and quantity of air that a child can exhale. Lung function test is performed while children are at rest, after exercising, and after taking Asthma-medication, to closely observe the child
• Younger children: Lung function test does not give accurate results for young children. Hence, the doctor will rely on a set of detailed information provided, by the symptoms
• In children younger than 3 years: The doctor will follow a ‘wait and watch’ approach

Other diagnostic procedures include:

• Chest x-ray: Is performed to visually see the structures inside your chest, including the heart, lungs, and bones
• Arterial blood gas test to measure the amount of oxygen and carbon dioxide in blood. It also determines the acidity in blood
• Blood tests to measure eosinophil and IgE- immune system protein, called immunoglobulin
• Allergy skin testing, in which the skin is tested for any reaction, to a variety of allergens

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Pediatric Asthma?

The complications associated with Pediatric Asthma are:

• An attack of Asthma can disrupt the everyday life, at home, school, play, etc. There is an impact on the quality of life, and it affects those living around us too
• The child may require emergency treatment and hospital care
• Permanent narrowing of the airways or bronchial tubes
• The attendance at school is affected causing additional stress of trying to keep-up with the class schedule
• Disturbed and poor sleep pattern, resulting in the child getting easily fatigued

How is Pediatric Asthma Treated?

Two kinds of medications used for treatment of Pediatric Asthma are:

• Long-term control medications
• Quick-relief medications

Long-term control medications: These need to be taken on a daily basis to prevent episodes of Asthma. They may be administered, even if there are no symptoms. These include:

• Inhaled corticosteroids
• Leukotriene modifiers: These oral medications help prevent Asthma symptoms for up to 24 hours
• Combination inhalers: These contain an inhaled corticosteroid plus a long-acting beta agonist (LABA). LABA medications are always taken using an inhaler, which also contains a corticosteroid
• Theophyline: A daily pill that helps keeps the airways open. It is used to relax the muscles around the airways and make breathing easier

Quick-relief medications: Also called as rescue medications, these are used for rapid, short-term symptom relief. They include:

• Short-acting beta agonists: These bronchodilators are inhaled and can rapidly ease the symptoms, acting within minutes. The effects may last for several hours. They include albuterol, levalbuterol, and pirbuterol
• Ipratropium: This inhaled medication is used for getting an immediate relief. It relaxes the airway muscles and makes for easier breathing
• Oral and intravenous corticosteroids (like prednisone and methylprednisolone), are used only for severe Asthma symptoms and on a short-term basis

Treatment for Allergy-Induced Asthma in Children includes:

• Omalizumab – This reduces the immune system’s reaction to allergy-causing substances, such as pollen, dust mites, and pet dander. It is given to the patients through injections, every 2-4 weeks
• Allergy medications: This includes oral and nasal spray antihistamines, decongestants, as well as corticosteroids, and nasal sprays
• Allergy shots (immunotherapy): These injections are given once a week, for a few months, for 3-5 years
• Inhaled medication devices:
  • For older children and teens: They can use an inhaler that releases a fine powder, or a small hand-held device (which is a pressurized metered dose inhaler)
  • For infants and toddlers: Use of a face mask, which is attached to a metered dose inhaler (or a nebulizer)
  • For babies: Use of device called a nebulizer, which turns liquid medication to fine droplets
• Asthma action plan: Discussion should be held with the child’s doctor to create an Asthma action plan and follow them strictly, to help the child, especially during severe Asthma attacks
• Depending on the age, the child can use a peak flow meter to measure how well he/she can breathe

The action plans are correlated with the observations of the peak flow meter and the symptoms, to categorize the level of an Asthma attack into green, yellow, and red zone. These correspond to well-controlled system, somewhat-controlled system and poorly-controlled system, and helps in tracking the Asthma in Children.

How can Pediatric Asthma be Prevented?

Asthma may only be controlled, but not cured. The following general guidelines may be followed to minimize, or prevent an attack of Asthma:

• Avoiding Asthma-inducing triggers, is the first step in preventing Asthma
• Avoid exposure to plant pollens; control molds, both inside and outside your living areas
• Reduce exposure to dust and dust mites
• Pets should be kept outside homes (if possible) and in any case, should not be allowed inside the bedroom
• Smoking should be avoided near a child, affected by Asthma
• Avoid indoor fireplaces, wood-burning stoves
• Keep your homes clean and dust-free
• Food should be kept in containers and away from the bedrooms. This reduces the presence of cockroaches, which can trigger Asthma
• Use unscented detergents and cleaning products at home

As advance precautionary measures, the following factors may be considered:

• All allergies and sinusitis should be treated, as and when they occur
• Avoid the inhalation of smoke or chemicals
• Discuss with the medical practitioner the routine the child should follow, to keep Asthma in check; and follow that established routine
• Reduce exposure to house dust, mites, cockroaches, pets, and mold

What is the Prognosis of Pediatric Asthma? (Outcomes/Resolutions)

• Pediatric Asthma is not a life-threatening condition, but it can be a serious and chronic disorder. With appropriate care, the child can lead a normal life
• When Asthma is properly managed, the symptoms usually disappear, as the child gets older. But, if it is not properly controlled, it may cause permanent changes in the lung function
• A lack of proper attention may cause the child to miss school and miss participation, in other activities. The child may also be a frequent visitor to the hospital
• An Asthma action plan, developed in coordination with the family caregivers and the medical practitioners (or healthcare providers), is essential to care for the child and help prevent severe Asthma attacks

Additional and Relevant Useful Information for Pediatric Asthma:

When Asthma is diagnosed in people older than 20 years, it is called Adult-Onset Asthma.