Childhood Wheezing and Asthma

Updated: Apr 30, 2019


All those who wheeze are not Asthmatic.

However, all those who wheeze have bronchospasm (narrowing of the airways)!

Airway hyper-responsiveness causes smooth muscle spasm and airflow obstruction thereby manifests as wheeze.

This could be due to a viral infection, with or without an allergic background or it could be due to Asthma.


How to Decide on taking Medical help?


If your child coughs on and off; while playing, during sleep; in early morning etc it gives you an idea that he has bronchospasm. Child may not complain of it at all but may seem irritable. In severe cases, he/she develops breathing difficulty, which will be obvious.


What is the Difficulty in Bronchospasm?


Child develops hypoxia meaning lack of oxygen. Oxygen is the much needed lifeline for our body. Normal air contains an Oxygen concentration of 21%. How we deliver the oxygen is dependent upon the severity. In mild cases, normal air is sufficient along with medications aimed at relieving bronchospasm. In severe cases, oxygen supplementation along with other treatments will be necessary.


What should be done during an Episode of Bronchospasm?


Get medical help! If cough is mild and not associated with breathing difficulty, clinic management will be sufficient. Although, if it is severe with severe breathing difficulty, he/she may need hospital admission and supervised treatment.


What Happens to Air tubes in Wheezing?


First of all, the air tubes become narrow due to muscle spasm. Further narrowing happens when the inner lining of the air tubes get thickened by edema. And finally the thick secretions clog the air tubes causing almost > 70 - 80% reduction in the size of air passages.



What is the Treatment of Bronchospasm?


Doctors will give medications that help to relax the bronchi; the big air tubes to the lungs.

A bunch of things have to be done to achieve this.

  1. There are medicines which simply enlarge the air ways by relaxing the muscles.

  2. There are medicines which will reduce the edema of the airway wall.

  3. There are medicines to thin out the secretions so that it can be easily coughed out.

  4. Hydrate the child by giving plenty of fluids to help thinning of the secretions also.

  5. And if the condition is worse, Oxygen should be given.



What is the Acute Treatment of Asthma?


Acute treatment of asthma includes Bronchodilators of more than one kind like salbutamol, ipratropium bromide, and Anti Inflammatory medications like short course of Steroids, Leukotriene Antagonists like Monteulokast, Oxygen in severe cases, and Supportive measures with good hydration.

In many cases, if resulting from a Viral infection or an acute insult like Allergy, this treatment will be sufficient. Antibiotics are not needed in such cases. Nevertheless, it may be supplemented in case of Mycoplasma infection, or any other infection, which is an unusual association



What is Prophylactic treatment?


If the child is breathless at night and/or in the day, more than twice a week, he will deter in overall health and this leads to school absence etc. This gives a clue to the need for prophylaxis. Prophylaxis includes Steroid inhalersLeukotrine Antagonists, and long-acting bronchodilators.


How can we Manage Asthma at home?


By giving a daily course of medical treatment in the form of syrup, granules, tablets, inhaler or nebulizer. There may be more than one inhaler according to the need. Some time one inhaler will be advised to continue for 3 - 6 months duration, till the child literally forgets about his disability. You will be asked to visit the Doctor monthly to check the effectiveness of treatment. You will also be advised to keep the added medicines at hand to tackle an acute attack of wheezing.


Will my child get Addicted to Inhalers?


It is a misconception and a worry of almost every parent. Even an educated parent will ask this question. Children at times seem to prefer the inhaler because it is the only way of having a good breathing. A child rarely complains that "I cannot breath". He/She will suffer in silence so his/her preference of using an inhaler is simply showing the need of it.


Do I have to keep a Nebulizer at home?

Not necessarily. But it is needed in the hospital setting. The drugs are given back to back by a nebulizer in acute condition. In very severe cases even continuous use of a nebulizer is recommended for a period of time. Mortality of Asthma is still high due to various reasons. Part of this could be related to drug complications, either too much or too little of it. When a child is not responding to usual medications at home, seeking medical help is advised to ensure proper dosing. Avoid decisions of escalating treatment without guidance. In that way, a nebulizer at home will give you overconfidence and delay in seeking help.


How to give Inhaler to a child?

Children need a Spacer for proper delivery of the medicine from an Inhaler. Children will not be able to control their breathing to ensure a good delivery of the medicine from an inhaler directly. At times even adults prefer a spacer for the same purpose. There are different sizes from 250 ml to 500 ml volume, according to the age. Inhaler given to a child without the spacer will give zero efficacy. The doctor will make sure the use of the spacer and check your efficiency of giving it on follow up. The medicine reaching to a child"s lungs are dependent upon proper delivery of the drugs. So try to meet the doctor on follow up with the inhalers and the spacer which you use.

Rules of giving medicine by a Spacer


First of all, shake the inhaler cartridge well prior to use at any time. If it is used for the first time, or after a long gap, discard one or two sprays before connecting to the spacer.

Connect the mouth and nose of the baby to the spacer, using a connecting mask for small babies. For bigger children they can use the mouthpiece directly.

Each puff in to the spacer should be singled out and should be kept for breathing for a period of 10 counts, roughly 7-8 breaths. Never put two puffs in to the chamber at the same time as it will be counted as one. The extra puff given will just sediment on the walls of the spacer.

Each cartridge of inhalers contain 100 inhalations so it should be kept for further use.

Clean the spacer as instructed, from time to time.

Why don't I give a Nebulizer instead?


Nebulizers are another equally useful alternative for delivery of the medicine. But the inhaler with a spacer is preferred for few practical reasons.

First of all the nebulizer will take 10-15 minutes for the delivery of medications to the child. A sick child may accept it in extreme condition but as the symptoms improve, child will refuse to sit that long. And the treatment will be incomplete. This is seen in almost all cases.

Secondly, the nebulizers carry water particles, which make some of the medicine particle size bigger and delivery into deep areas of lungs will be hindered.

Thirdly, carrying a nebulizer in travel is not as handy as an inhaler.

Fourthly, you may need an electrical point to use the nebulizer.

Fifthly, using a nebulizer outside home is a big display in public and may be embarrassing for the child.

Finally,  as I mentioned earlier,  it may delay in seeking further medical help.

If you are possessing one, it may be used temporarily in an acute rescue till you switch over to the other mode. It is an additional help rather than sole help.


Can I stop the Asthma Medications on my own?


Never. Most of the treatment failures are due to self decision. You have to follow the medical advice and let the doctor decide abut the duration. Some children need only a week of treatment. Some may need 3 months to 6 months. While others may need minimal treatment for a longer time to make him fit.

Controlling the symptoms are important; but maintaining a normal status with minimum treatment is the secret of a good long term control. Inappropriate stoppage of the medicine will reverse the status to zero level again.

In a child who needs the treatment for a longer time, the doctor will give you a treatment plan and guidance, enabling you to decide about the changes on your own; with necessary warnings. Further, monthly to 3 monthly follow up visits to check the progress may be all what is needed.



Having Good Breathing

Yes, having a good breathing is the birth right of every child. It will help him to do his daily normal activities, perform physical tasks, games, and grow up normally. It is very much needed for his personality and self esteem and to stand out in any performance among his peer groups.


 

This information is brought to you by Specialized doctors in Al Arif Heart and Children Medical Center, Al Mujarrah, Sharjah, UAE. Keep yourselves fit as a fiddle.


#Asthma #Inhaler #Spacer #Nebulizer #Breathing #Breathless #Oxygen #HealthAwareness

#AlArifHeartandChildrenMedicalCenter #DrSaieda

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