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November 2011
Childhood Asthma
Some oft-asked questions answered…
Dr. Samiya Razvi
A child is almost always a bundle of energy; always curious to know more about the world around them, forever ready to try out new things. But when a child’s natural exuberance and free movement gets stalled because of something that appears to be breathlessness (by the look of it), the situation becomes worrisome and often tricky.

Very many concerns crop up, the child too starts feeling restless and bound, and parents are at their wits end about what to do to handle the situation properly.

If kids have asthma in their childhood, does it go away with time?
No. A child cannot “outgrow” his asthma as symptoms are due to the airways being intrinsically hyper-responsive to various triggers in the environment. In young children, the smaller size and diameter of their bronchial tubes/airways plays a role in developing asthma symptoms, as smaller sized airways are more easily obstructed and blocked due to inflammation and swelling of their lining, with viral illnesses and exposure to various triggers.

Interestingly, there are gender differences as well, with boys tending to have a smaller diameter of their airways in infancy as compared to girls, a difference that tends to even out as children get older. With lung and body growth, a child’s airways increase in size and diameter and hence are less likely to get obstructed with inflammation. This makes it appear as if the child’s asthma has gone away.

How do eczema and psoriasis relate to asthma?
Eczema and psoriasis are conditions in which the skin is itchy, red and inflamed. Both are thought to have an allergic component to their underlying disease mechanism. A similar process is thought to occur in asthma, in which allergens penetrate the airway mucosa (lining) giving rise to an allergic and inflammatory airway response. Individuals with eczema are likely to develop asthma symptoms suggesting an inherent common disease mechanism, and also a genetic connection as both these conditions tend to run in families.

Are children shy of being asthmatic?
A child with asthma, which is well controlled, should feel no different from any other child, and have no limitations in work or play except avoiding known triggers for their asthma. Although there is no reason for a child to feel shy about having asthma, this may vary from child to child depending on their nature, temperament and understanding of the problem. Here, the child’s physician plays an important role in helping a child to understand asthma, its symptoms and in taking a simplified and practical approach to managing asthma so that it is not on their minds or a source of worry/anxiety.

How do children manage their asthma at school?
If a child’s asthma is well controlled, he or she may be on preventive medications (inhaled or oral) that are taken daily at home and hence are not an issue at school. Children with exercise-induced symptoms however, will need to take a short-acting rescue inhaler about 15-20 minutes prior to exercise/play and as needed if there is cough or wheeze. This may make the child feel different from others. It is therefore extremely important to educate not only the child but also the teachers at school on the noncontagious nature of asthma, and the fact that several top athletes have asthma that they have controlled well. In fact, children with asthma are encouraged to participate in sports and exercise as this improves their cardiopulmonary conditioning.

What role should the school play in such cases?
Not all schools may have a trained nurse or nursing staff available, so it is essential that teachers know and are confident in administering rescue medications for asthma when a child needs help.

Parents should have a completed medical form in place at school for their child with asthma, which lists the medications in use as well as contact information for their child’s physician.

School authorities should ensure that parents sign a medication administration authorization form for their child with asthma, and provide a spacer and the appropriate rescue inhaler to be kept on the school premises that can be used in the event of an emergency.

The information provided should include instructions for stepwise medication administration when there is an acute onset of symptoms, until further help arrives.

About half the children, who have wheezing in their preschool years, may not have asthma symptoms after the age of 6 years. Children who are more likely to continue wheezing or have symptoms are those with a strong family history of asthma, particularly a maternal history of asthma, and a personal history of allergies and eczema.

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