FOCUS on Asthma in Children


YOUR ALLERGY PARTNERS

Maria Patricia S. Abes, MD; Maria Remedios D. Ignacio MD; Nanneth T. Tiu, MD – a group of expert Filipino Allergists bond together as the H & L Allergy Team, whose aim is to give advice, help readers understand and find relief in dealing with common allergic disorders.

For comments, questions or queries, please email: hl.famepublishing@gmail.com


Asthma is a chronic disease involving the airways (bronchial tubes) in the lungs. These airways

allow air to come in and out of the lungs. If you have asthma, your airways are always inflamed

or swollen which restricts the airways and makes it hard to breathe.

During this period of a global pandemic, the COVID19 infection, it is important to distinguish it

from other respiratory diseases such as asthma.

Symptoms of asthma

  • Wheezing – most common symptom is a scratchy or whistling sound when you breathe.
  • Shortness of breath
  • Chest tightness or pain
  • Chronic cough – may be the only symptom in some children
  • Trouble sleeping due to coughing or wheezing Causes of asthma symptoms (asthma flare-ups or asthma attacks)
  • Allergic triggers: pet dander, dust mites, pollen or mold.
  • Non-allergic triggers include smoke, pollution or cold air or changes in weather

Diagnosis of asthma

  • Taking a thorough medical history

– Patterns in asthma symptoms that are important and can help your doctor make a diagnosis.

Pay attention to when symptoms occur:

  • At night or early morning
  • During or after exercise
  • During certain seasons
  • After laughing or crying
  • When exposed to common asthma triggers
  • Performing breathing tests to measure how well your lungs work.
  1. Spirometry – You will take a deep breath and blow into a sensor to measure the amount of air your lungs can hold and the speed of the air you inhale or exhale. This test diagnoses asthma severity and measures how well treatment is working.
  2. FeNO test or exhaled nitric oxide test – is a way to determine how much lung inflammation is present and how well inhaled steroids are suppressing this inflammation. With allergic or eosinophilic asthma, sometimes you may feel your breathing is fine, but when you measure your exhaled nitric oxide, it may still be significantly elevated, and you might do better in the long-term using slightly more of your inhaled steroid to suppress this inflammation.
  3. Peak flow test (you can do it yourself) Noting your peak flow reading every day can help you stay well with your asthma and reduce your asthma attack
  • Allergy testing -Treating the underlying allergic triggers for your asthma will help you avoid asthma symptoms. Testing for indoor allergens (certain molds, animal dander, house dust mites, and cockroach) is recommended for patients with persistent asthma and reported exposure to allergens. In addition, children with severe allergic rhinitis may benefit from subspecialist referral to an allergist for consideration of specific and targeted immunotherapy.

Management of asthma

There is no cure for asthma but symptoms can be controlled by medications and avoidance of triggers that cause your allergic asthma symptoms.

  1. Controller medications:
  • Inhaled corticosteroids are medications used to treat asthma. They are taken by using

an inhaler. This medication should be taken consistently so that it decreases inflammation in the airways of your lungs and prevents asthma flare-ups. Inhaled corticosteroids are considered the most effective long-term usage medication for control and management of asthma

  • LABAs are symptom-controllers that are helpful in opening yourairways. However,

LABAS should never be prescribed as the sole therapy for asthma. Current recommendations are for them to be used only along with inhaled corticosteroids

(Combination inhalers contain LABA + ICS)

  • Leukotriene modifiers are oral medications that counteract the effects of leukotrienes

leukotrienes that cause induction of asthmatic reactions – induces airway constriction, and induces airway inflammation

 

  1. Quick-relief or rescue medications are used to quickly relax and open the airways and relieve symptoms during an asthma flare-up, or are taken before exercising if prescribed. These include short-acting beta-agonists. Quick-relief medications do not take the place of controller medications. If you rely on rescue relief more than twice a week, it is time to see your allergist.

Oral and intravenous corticosteroids may be required for acute asthma flare-ups or for severe symptoms. Examples include prednisone and methylprednisolone. They can cause serious side effects if used on a long-term basis.

  1. Immunomodulatory medications, or biological agents are emerging treatments in children with moderate to severe asthma. If a child is taking medium- to high-dose ICS and long-acting inhaled β2-agonist and demonstrates poor control despite proper technique and good adherence (frequent exacerbations requiring systemic corticosteroids, intensive care, or intubation), he or she should be referred to a specialist for treatment of severe asthma. The specialist should evaluate for other diagnoses that mimic asthma before consideration of asthma treatment with biological agents (anti-IgE, anti–IL-5, or anti–IL-5α).

References:

  1. AAAAI (American Academy of Allergy, Asthma & Immunology)
  2. ACAAI (American College of Allergy, Asthma & Immunology)
  3. Pediatrics in Review

 

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