Asthma in Pediatrics

Asthma is the most common chronic disease of childhood affecting an estimated of seven million children, only in USA. It causes many visits to the doctor, emergency room and hospitalizations every day in North America and also around the world.

Asthma is a disease that produces narrowing of the airways secondary mainly to inflammation “swelling”. The most common form of presentation is chronic cough, which is usually dry, but could also be wet, especially when it is associated with respiratory infections.

An asthma exacerbation or asthma attack presents with shortness of breath, worsening cough, wheezing and fast breathing. There are many triggers for an asthma exacerbation but in pediatrics the most common is respiratory infections. Other triggers are: exercise (when your kid runs or plays); weather changes (cold weather, pollen); cigarette smoke, dustmites, animal dander, stress or even laughing.

If your child has chronic cough and wheezing that has required a nebulized medication called “albuterol” with or without a systemic corticosteroid called “prednisolone” or “prednisone” and this situation has happened in different occasions, your child most likely has asthma and may benefit from chronic daily therapy to control the disease and prevent exacerbations.

There are many kids that are underdiagnose, some patients only present with chronic cough and never wheeze. It is important to think about the possibility of having asthma, since it is the most common cause of chronic cough in pediatrics. Untreated asthma can lead into missing school days for kids and workdays for parents, not able to play as well as other kids and possible emotional problems; such as depression.

A common mistake is to think that asthma is only present when your child is sick with cough and wheezing. Asthma produces airway inflammation “swelling in the windpipes” that is always present and gets worse when your child gets sick with an asthma attack which is just the “peak of the iceberg”.

The cornerstone of therapy is inhaled corticosteroids, they help to control the airway inflammation and will help to improve your child’s breathing and prevent future exacerbations. The inhaled dose is much lower that the one prescribed orally and works mainly in the lungs, controlling the disease. The major side effect at regular doses is oral thrush, which is fully preventable with just brushing your child teeth after inhaling the medication.

In older kids it is important to measure a pulmonary function with a test called “spirometry”, this test can usually be done after 5 years of age. Spirometry will provide important information that is not present in the history or physical exam. It will tell us if there is airway obstruction or not and will help us to tailor the therapy.

Controlling the environment is also very important, you can also help your child doing frequent cleaning, removing books or stuffed animals from his/her bedroom, changing the air conditioning filter often, not smoking and covering with anti-allergic covers pillows and mattresses.

by Carlos Sabogal MD
Pulmonologist in Orlando