Answers to common questions about Symptoms of Asthma are discussed here.
I'm very confused about what asthma really is. My 8 year old son, who has been coughing off and on for many years, was just diagnosed by an allergy specialist as having asthma. What is asthma?
Asthma is a chronic inflammatory condition of the bronchial tubes, which are pipes that take air from the mouth into the lungs. Think of it as a fire that doesn't go out. When you have asthma, these passageways become narrow or blocked by mucus, with swelling of the walls lining the bronchial tubes, and tightening of muscle around the outside of these tubes - all leading to narrowing of the space that brings air in and out of your lungs. This leads to symptoms of asthma, which include cough, chest tightness, shortness of breath, and wheezing. If your child has asthma and it's not treated, it could limit his activities, such as sports, sleep-overs and going to school. The symptoms of asthma can come and go even though the inflammation continues in the bronchial tubes. What makes asthma symptoms to occur are called triggers. The most common triggers in children include upper respiratory viral illnesses (the common cold), and allergens (dust mites, furry animals, pollens, mold, cockroaches, exercise, cold air, cigarette smoke, and even stress). Staying away from or eliminating triggers will help control your child's asthma. Your doctor should be very helpful in working with you to figure out what your child's asthma triggers are and how to get rid of them.
I have a 3 year old child with asthma and my doctor tells me he is concerned about three things: impairment, risk and control. I don't think I understand what he is saying, can you help me understand?
The latest NIH Expert Panel (EPR3) for diagnosis and management of asthma stresses the very three items your doctor mentioned. Impairment and risk are the components that can interfere with good asthma symptom control. Impairment involves the amount of daily symptoms, number of night time awakenings, the extent that asthma interferes with daily activities and the number of times your child has to use their short acting bronchodilator for relief of symptoms. If the numbers are small for each category then your child would be in good control.
Risk, on the other hand, involves the number of exacerbations (attacks) of asthma your child has over a 1 year period along with consideration concerning the possibility of loss of lung function over time because of persistent asthma. When you provide him/her this information it helps your child's physician decide on what tests they should consider doing, how long between visits and what medications your child should be taking. Risk also concerns any possible medication side effects that could occur.
All this sounds complicated but really by giving the above information to your child’s doctor they will, in a short period of time, move to make the best decision on how to keep your child in control of their asthma.
My husband and I were talking about our four-year-old son with asthma and I was wondering what are latest statistics about asthma in the United States?
The latest statistics are as follows:
- Almost 26 million Americans report having asthma. Asthma affects around 9 million children under the age of 18.
- Asthma rates in children under the age of five increased more than 220% between 1980 and 2010.
- More than 14 million school days are missed annually because of asthma. That means it could be up to 14 million work days are also missed by one or both parents.
- Approximately 60% of parents who have asthma will have children who develop asthma.
- Asthma is more prevalent in African American children than in white children.
- 60% people with asthma suffer also from allergies which contribute to asthma symptoms.
- About 5 million children had asthma exacerbations during the past 12 months that required them to either go to the emergency department or to go for an unscheduled visit to their physician.
- There are approximately two million emergency department visits per year in the United States for asthma and about 40% of them are children.
- Asthma is one of the leading causes of hospitalization for children with asthma.
- You should know the certain co-morbid conditions are associated with asthma including obesity, rhinosinusitis, gastroesophageal reflux, and they should always be addressed as possible reasons why children’s asthma are not under control.
I understand that the latest guidelines for asthma were released in 2007. What were the major changes in these guidelines?
Of special note is the emphasis on asthma control. For a patient to be well controlled, they would have no limitation of activities, no night time awakening or symptoms due to asthma, no exacerbations and normal lung function. They may have asthma symptoms and/or need for reliever medication up to 2 days out of the week and still be considered well controlled.
http://www.nhlbi.nih.gov/guidelines/asthma/index.htm
I have 2 children, both with asthma. One child began wheezing at 2 years of age and the other at 5 years of age. Does the age when their asthma began make any long term difference?
To provide this answer we turn to superb research by Dr. Martinez at the University of Arizona. Childhood asthma has been well studied by Dr. Martinez particularly from infancy to age 6.
- Asthma which begins before age 3 and is not present at age 6 is termed transient asthma and occurs in 20% of children. These children are usually born with smaller than normal lungs and as they and their lungs grow asthma halts in 60%.
- Children that do not have wheezing before age 3 but do have wheezing by age 6 (15%) are termed late onset asthma, and usually have evidence for allergic sensitization, and their asthma frequently continues.
So the child that began to wheeze before age 3 but halted before age 6 is much less likely to have further asthma later while the other child is more likely to be allergic and have asthma later. However, neither fits the category most likely to have persistent asthma which is when wheezing begins before age 3 and is also present at age 6. Asthma that is persistent from infancy thru age 6 frequently continues into adulthood.
My daughter’s physician has told me that she has moderate persistent asthma, can you explain exactly what this means.
The National Institutes of Health through the National Heart and Lung Institute has established a classification of asthma based primarily on asthma severity and control. The current classification takes into account the number of asthma episodes during the day as well as during the night, along with their lung function (particularly the amount of air emptied from the lung in a forced expiration of air over 1 second FEV1) and response to medication.
For instance some patients have very few episodes and in between episodes are free of asthma (= 2 days/week and = 2 nights awakening /month) coupled with FEV1 of 80% of a predicted normal FEV 1. These patients are classified as intermittent asthma.
When symptoms occur greater than 2/week but less than daily or they have more than 2 nights /month that they awake because of asthma they are classified as having mild persistent asthma. These patients also have an FEV1 of 80% or less than the predicted normal FEV1.
Your daughter being classified as moderate persistent asthma would indicate that she has essentially daily symptoms, probably awakens about 1 night a week with asthma and has an FEV1 of 60-80% of predicted. Severe persistent asthma is when symptoms are continuous and sleep at night is frequently disturbed by asthma. Their FEV1 would be 60% or less compared to what would be their normal FEV1.
My 20-month-old child was called a wheezer,or a happy wheezer, by her pediatrician the other day. What is the significance of that?
Infants with recurrent or chronic wheezing we call “wee wheezers.” These children have an increased risk of developing asthma. More than 80% of children who develop asthma begin having symptoms under age five. The most common trigger for wheezing in a child under five is an upper respiratory viral infection.
Many children (up to 60%) will have a viral illness, cough and wheeze with the virus and this may last for many months. After the initial episode after the virus is gone, the wheezing can last for many months without interfering with the child’s eating, growth and development, and general well being. In fact many asthma specialists wouldn’t even recommend treating this wheezing. This is the “happy wheezer.” You should discuss with your physician whether or not your child should be treated if they are just a “happy wheezer.”
My three children have either asthma or food allergy, and I have some concerns. Does having asthma mean you are less likely to outgrow a food allergy?
No. If one has asthma, it doesn’t appear to have any real effect on whether or not a patient will outgrow a certain food allergy or allergies. One can develop a tolerance, meaning being able to ingest a specific food without it having at all an effect on the outcome of asthma.
If my child has food allergy and no asthma, will asthma develop?
Very likely the child with food allergy that doesn’t have asthma has a much higher chance of developing asthma compared to a child who is not allergic. In essence, children with a history of food allergy are atopic; they have the ability to develop allergy, i.e. they are allergy prone.
My son is 9 years old and has had asthma since age two. Will he ever outgrow it? What are the odds?
Answer: In recent studies looking at children into adulthood, somewhere between 25-40% of children who had asthma as children will have asthma as adults. About half of them will lose their asthma with adolescence, and it will come back when they are adults.
A number of factors have been identified which may increase the likelihood of your son’s asthma continuing, and they include:
- Persistent nasal allergy.
- Frequent wheezing prior to puberty.
- Increased body weight, i.e. obesity.
- The presence of eczema and/or food allergy.
- Cigarette smoke in the environment.
- The possibility of having chronic sinusitis.
Some teenagers and young adults may seem symptom-free, yet they truly aren’t, i.e. they may have coughing or wheezing or chest tightness when they exercise or when there is high pollen exposure.
One theory as to why asthma can resurface later in life is that the inflammation that occurs in the bronchial tube during childhood asthma doesn’t always go away. A recent study found that some children who were symptoms free from asthma, when they looked at their bronchial tubes, had evidence of asthma being there, i.e. the inflammation is still present. Testing for exhaled nitric oxide may help determine if allergic inflammation is present.
Other factors that may affect remission include:
- Males seem to have a higher likelihood than females of becoming symptom-free as they get older.
- Genetic factors may play a role.
The message is to make sure that your child is followed appropriately by an asthma specialist, and that various interventions, such as environmental control measures are in place and allergy injections. In addition, your asthma specialist may have their patient use a peak flow meter to document if their asthma is in control and may obtain breathing tests every six to eight months which would help in deciding whether the asthma is still there in your son’s bronchial tubes.
My 7-year-old son has asthma, but I don’t know if it’s allergic asthma. I was wondering if you could help me in regard to this.
First you need to know all about allergic asthma. Allergic asthma occurs when a person’s asthma is triggered by exposure to a substance called an allergen. Around 70% of people with asthma have an allergic trigger.
Allergic asthma is different because symptoms are by triggered by exposure to that allergen. The allergens that trigger allergic asthma include:
- Grass, tree and weed pollen.
- Exposure to furry animals, such as cats and dogs, even pet mice or rabbits.
It’s also important to remember that besides allergens, there are other triggers of asthma, which are called irritants. These include:
- Cigarette smoke.
- Fumes and odors.
The person with allergic asthma has asthma because of an antibody (an immune globulin called IgE), and that’s the antibody that recognized allergens and triggers the immune system to get rid of the “invading allergen.”
If one has allergic asthma, it’s important to treat that component, such as:
- Avoiding indoor allergens, especially dust mite and furry animals.
- Considering allergy injections, which could be very effective for allergic asthma.
In addition, if your son has nasal allergy associated with the asthma, treating the nasal allergy appropriately could diminish the chance of having asthma due to allergy. See your allergy/asthma specialist for the right combination of treatments which may include medications, allergy injections, and definitely environmental control.
My child has a nasal allergy and recently noticed difficulty with her ears. When we took her to the doctor she told us that she had a middle ear infection with fluid behind her ear drum. Could this be connected to her nasal allergy?
Physicians have noted that middle ear infections with fluid present behind the ear drum seem to occur in association with nasal allergy. A scientific study has demonstrated that allergic children with this ear problem have the same allergic inflammation in the ear and the abnormal fluid collection that occurs as is seen in nasal allergy.
Allergist have begun to think in terms of upper and lower airways as being connected, not just by location, but also by allergic diseases such as nasal allergy (allergic rhinitis) and asthma, which of course, occurs in the lungs. Maybe now we will have to add the ears to that concept.
My daughter has just begun puberty and we have noticed that her asthma worsens at the time of her menstrual period, is this unusual?
Worsened asthma can occur at different times of the menstrual cycle. In one study almost 50% of emergency department asthma visits for females occurred at the time of their menstrual period (day 26-day 4 of menstrual cycle). Another study found only 13% of emergency department visits for asthma in women was related to reproductive factors. In this study the most frequent timing was not during the menstrual period but during days 5-11 of the menstrual cycle (preovulatory phase). This study also showed that there was no association between phase of the menstrual cycle and asthma severity.
How do I know if I have the flu and what should we do if we get it?
If you get the flu you should do the following:
- Rest
- Drink plenty of liquids
- Avoid using alcohol and tobacco
- Contact your physician for antiviral drugs
- Take medication to relieve the symptoms of flu
- Generally symptoms last 3-4 days
You can use the following chart to help understand the symptoms and differences between a cold and the flu.
AAAAI & CDC have detailed the differences between the symptoms and the Flu
SYMPTOMS | COLD | FLU |
Fever | Rare in adults and older children, but can be as high as 102° F in infants and small children | Usually 102° F, but can go up to 104° F and usually lasts 3 to 4 days |
Headache | Rare | Sudden onset and can be severe |
Muscle aches | Mild | Usual, and often severe |
Tiredness and Weakness | Mild | Can last two or more weeks |
Extreme exhaustion | Never | Sudden onset and can be severe |
Runny nose | Often | Sometimes |
Sneezing | Often | Sometimes |
Sore throat | Often | Sometimes |
Cough | Mild hacking cough | Usual, and can become severe |
AAAAI.ORG
http://www.cdc.gov/flu/protect/preventing.htm
My 11 month old son was very sick and hospitalized with RSV infection. I am told this could lead to asthma, is that true?
Almost all children have had infection with respiratory syncytial virus (RSV) by the first few years of life. Approximately 66% of children have been infected by the first year of life. It is the most important cause of chest infection in infants. The current question is: does RSV increases the risk for having asthma or uncovers a person who has the ability to have asthma because of other risk factors, such as their environment or genetic factors. It has been established that children with RSV broncholitis in infancy, particularly those requiring hospitalization, have an increased risk of future asthma like symptoms but its role in causing asthma is unknown.
My doctor tells me that my 12 year old son has vocal cord dysfunction and that his symptoms of wheezing and difficulty breathing are not asthma. Please explain what vocal cord dysfunction means.
With normal breathing the vocal cords open, as a person takes a breath, and fills their lungs with air. As the air leaves the lung the vocal cords close and get ready for the next breath to be taken into the lungs. With vocal dysfunction (VCD) there is a closure of the vocal cords during inspiration (taking air into the lungs) that allows only a very narrow passage for air to pass through on its way to the lungs. Ordinarily the vocal cords stay open for inspiration and close with expiration (movement of air out of the lungs).
This “paradoxical” closure of the vocal cords is termed “vocal cord dysfunction” or “paradoxical closure of the vocal cords”. Because air is traveling through this very narrow space there is a noise that is created that sounds a lot like wheezing. Although the noise can be heard at the neck it is also transmitted into the lungs and simulates the wheeze that is heard with asthma. This creates the idea that the person has asthma. Actually, many people who experience VCD may have asthma as well. This of course adds to the confusion, but usually the symptoms of VCD are greater than one would expect from the degree of asthma that the person has.
The cause of VCD is not known. It is not done by the person on purpose and is something like the reflex you would have if an object came close to your eye and you blinked.
Treatment involves first recognizing what is going on. Then by a visual examination of the vocal cords, during breathing, the diagnosis can be confirmed. Pulmonary functions studies, which should be done on anyone with asthma (unless they are too young i.e. less than age 4-5) may also demonstrate evidence of VCD.
The second step in treatment would be to see a speech therapist to learn ways to control the movement of the vocals cords. Since in some instances a person’s emotions may play a role in VCD consultation with a therapist may be considered.
My six year old daughter coughs a lot and has spells of difficult breathing. Could she have asthma?
She may very well have asthma. Untreated asthma can interfere with her daily living. It is extremely important that she see a doctor. The major symptoms of asthma are:
- Coughing is the most common asthma symptom. It occurs more commonly early in the morning, late at night, with weather changes, with exercise, and is prolonged after an upper respiratory infection.
- Wheezing, is another indication of asthma. Wheezing is a whistling sound, produced when air goes through narrowed bronchial tubes.
- Shortness of breath, is also an asthma symptom, It is hard for children to describe, which you will notice, it is the feeling of being winded, either for no reason or when she stops exercising, walks up a flight of stairs or up a hill.
- Chest tightness is another sign of asthma, but again, your daughter would find it hard to describe. What you would notice is her holding her chest as if it is uncomfortable, or she may complain that her chest hurts or feels funny.
Last week I went on a hayride with my friends and my asthma began to bother me during the hayride. My mom picked me up and I took my medication and it helped my asthma a lot, but now two weeks later I am still having asthma problems. Can you tell me what to do and why I am still bothered by my asthma?
First, with continued asthma you should talk with your doctor. After the doctor helps you with your current asthma difficulty ask if they will prepare an asthma action plan for you. Action plans outline the steps that you should follow when your asthma worsens. During the hayride your asthma could have been triggered by the exposure to dust, mold spores or even outdoor pollens. It is not unusual for a person to have continued asthma symptoms of wheezing, cough or just irritable (or twitchy) lungs after an exposure to an allergen. Even a single allergen exposure that causes an asthma episode can continue to cause symptoms for 3 weeks or even longer after the allergen exposure has occurred. It is always wiser to avoid allergen exposure, so next time it would be best to skip the hayride and maybe join you friends at the end of the ride.
My doctor says my asthma is in good control. I still have some asthma symptoms. What does he mean by good control?
It is important that your doctor knows all about the episodes of asthma you are having. The doctor will want to know what brings on the asthma, what time of the day they occur, if you are using your medication as your doctor asked you to use the asthma medication. Be sure to discuss your symptoms with your doctor. The National Guidelines issued by the National Institutes of Health sets the goals for asthma therapy as:
- Control chronic symptoms (including night-time symptoms)
- Maintain normal activity levels which also includes symptoms that might occur with exercise
- Maintain (near) normal pulmonary function
- Prevent acute episodes of asthma
- Avoid adverse effects of asthma medications.
These are goals that your doctor will want you to be able to reach.
What should my child do when he is teased at school about his asthma?
When others kids tease your child about their asthma it can be very hurtful. Children kid each other about a lot of things and they may not know how much it can hurt another’s feelings. They just don’t know that your child is a normal kid who just happens to have asthma. They also do not understand what asthma really is and that is why it is so easy to make fun of what they do not know. Your child should be encouraged to share their feelings with you and their school teacher. “Check-in” with your child and talk with them about their feelings. Make sure they know they are not alone and you will protect them. The school teacher can help by planning an activity for the class educating them about asthma or your child can bring their medication for a “show-n-tell”.
