Best to explain asthma to a kid from the outset
Q: My daughter was recently diagnosed with asthma. What do I need to know?
A: Childhood asthma continues to be a leading cause of emergency department visits, hospitalizations and school days missed. Children with uncontrolled asthma have difficulty exercising, sleeping and participating in the normal activities of childhood. About 8% of U.S. children have asthma. About 50 percent of children with asthma experience an acute attack at some point. In their own words, children have described asthma attacks as “a pain in my side,” “I can’t stop coughing,” “my nose hurts,” “my mouth hurts,” “this cough is bothering me,” “my tummy hurts.”
It is helpful to try and explain what asthma is to your daughter, right from the beginning. You can start by talking about how normal lungs work. You might say, “Your lungs are in your chest. When your lungs are normal, the air goes in and out easily. The tubes inside your body that carry the air in and out of your lungs are round and open and clear.” Next, you might try to explain what is different during an asthma attack, “Because you have asthma, you have twitchy lungs. That means that when you breathe in certain things (child’s triggers), your lungs get all tight and make thick, sticky stuff called mucus. That’s why it’s hard to breathe and you feel like coughing.”
The diagnosis of asthma can be made by testing or by clinical symptoms. For older kids, usually older than 5, they can do tests called Spirometry and take measurements of airflow in the lungs. For younger children who cannot cooperate with that testing, the diagnosis can be made based on
clinical symptoms, such as nighttime coughing, chronic cough, wheezing and exercise intolerance. Chronic cough, especially at night, is something that deserves special mention. The number one cause in young children is post-nasal drip, followed by reflux and then asthma.
Asthma is assessed by Impairment and Risk. Impairment is categorized as Well-Controlled, Not Well Controlled and Poorly Controlled. WellControlled means having daytime symptoms less than twice a week, nighttime symptoms less than twice a month and no restrictions on activity. Not Well Controlled means daytime symptoms more than twice a week, nighttime symptoms more than twice a month and some limitation on physical activity. Poorly Controlled means daytime symptoms daily, nighttime symptoms more than twice a month and definite limitation of activity. There are other things to look at, such as how often the child needs to use rescue albuterol. For complete information, go to https://www. aap.org/en-us/Documents/medicalhome_ resources_ key points for asthma. pdf.
Asthma treatment is approached in steps. Step 1 is using a Short Acting Beta Agonist, such as Albuterol, on an as needed basis, infrequently. Step 2 is adding a low-dose Inhaled Corticosteroid (ICS), such as Flovent, when the child’s symptoms worsen. Step 3 is adding a Long Acting Beta Agonist (LABA), such as Serevent, or increasing the ICS to medium dose. Step 4 is using a medium dose ICS and a LABA. Step 5 is high-dose ICS plus a LABA. Step 6 is highdose ICS plus LABA, plus an Oral Corticosteroid. Your child should be referred to a Pediatric Pulmonologist at Step 3 or, at the latest, Step 4.
In addition to Impairment, we assess Risk — for severe respiratory distress or decreased oxygen saturation requiring hospitalization. There is also a rare, but scary, entity called Sudden Asphyxial Asthma, a sudden acute constriction of airways.