If your child has uncontrollable coughing, but doesn't have a cold,
it could be asthma. If you can hear a high-pitched sound (wheezing)
when your child breathes out (exhales), it could be asthma. If your
child complains of chest tightness or shortness of breath, it could
be asthma. If your child develops a cough anytime he or she runs
around a lot, it could be asthma.
Asthma is the most common chronic disease of childhood. In 2006,
more than 6.8 million children-1.2 million of them under 5-were
diagnosed with asthma and many others went undiagnosed. Asthma is
one of the most common causes of missed school days and is the
third leading cause of hospitalization among children under age
Asthma has become more common in recent years and now affects up
to one out of every four children in some urban areas.
To explain asthma, we first need a little anatomy lesson. We
have two lungs and each one is kind of like an upside-down oak
tree. The two oak trees attach to either side of a big breathing
tube called the trachea. After their attachment, they divide into
smaller and smaller branches. The air we breath enters the trachea,
then flows down each tree bough until it finally travels to the
smallest branches where oxygen travels from the lungs and enters
our blood. Asthma affects these tiny branches (bronchioles) and
causes them to become red and swollen (inflamed), to get smaller
(constrict) and to develop mucus.
To get an idea of how hard it can be to breathe with asthma, get
a straw and take a nice breath through it. Now pinch the straw in
the middle and try to take the same breath. That's what a child
feels when having an asthma attack-to many children it feels like
they are suffocating.
Asthma can range from mild to life threatening and though it
can't be cured, in most cases it is controllable with the proper
Many children have something that triggers their asthma. Common
triggers are exercise, cigarette smoke, allergies to pets, dust
mites, mold or something else in the environment, air pollution,
aerosol sprays and cold weather.
Many of these triggers, such as cigarette smoke, can be avoided.
For instance, many parents who smoke say they go into another room
so their child won't be affected. But because air circulates
throughout a home, the child will almost certainly be exposed
anyway. Even smelling smoke on a parent's clothing can be a trigger
for some children. Families of children with triggered allergies
will be given instructions on how to avoid the allergens. And it
may be necessary to stay inside on high ozone days or when it is
very cold. Children with asthma (and all children) should get a flu
shot yearly to help avoid the increased risk of an asthma attack
with the flu.
It's not always clear why a child gets asthma, but there are
some known risk factors. For example, children whose parents smoke
are twice as likely to develop asthma as children of non-smokers.
And babies born to women who smoked during pregnancy are at a
higher risk for getting asthma by age 7 than babies born to women
who didn't smoke.
Antibiotic use early in life may be linked to asthma by changing
the natural environment of the body and changing the immune system.
There is also something called "the hygiene hypothesis," which says
that asthma is caused by our increased use of antibiotics and
cleaning products. All of these things make our environments
cleaner than nature may have intended and, therefore, the immune
system isn't challenged adequately when children are young.
The good news about asthma is that the vast majority of children
can be treated. The goals of treatment are to eliminate symptoms,
avoid flare-ups, allow the child to participate in physical
activities and reduce the use of pump-style inhalers. There are
many treatment options, ranging from the use of an inhaler only
when symptoms arise to medications that must be taken several times
per day. Most general doctors are skilled in managing basic asthma,
but in some cases it is useful to enlist a pediatric allergist who
specializes in asthma.
It's also important to know that children may abuse their
inhaler by reaching for it several times a day. Overuse of inhalers
can cause the body to no longer respond to the medication and has
been linked to several asthma deaths.
Getting proper treatment and eliminating triggers that cause
wheezing can allow children with asthma to enjoy a full and active
Dr. Lisa Thornton, a mother of three, is director of pediatric
rehabilitation at Schwab Rehabilitation Hospital and LaRabida
Children's Hospital. She also is assistant professor of pediatrics
at the University of Chicago. E-mail her at firstname.lastname@example.org
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