Asthma symptoms often match those of routine childhood illnesses, and there is no test to diagnose asthma in children under age 5. Yet after reading the latest statistics on asthma in kids, you might think the disease would be on top of every pediatrician's list of suspects.
The leading serious chronic illness of children today, asthma affects 5 million Americans under age 18. It accounts for about one in six pediatric emergency-room visits. Between 1980 and 1994, there was a 160 percent increase in the number of asthma cases in newborn children through age 4. Even scarier, asthma deaths -- usually the result of too little treatment, too late -- also are on the rise.
That's the bad news. The good news is that with the right medication and awareness, asthmatic children can live with virtually no limitations on their activities.
To control asthma, you first have to recognize it. Children with asthma don't always wheeze or have obvious attacks. Recurrent nighttime or early-morning coughing can be a tip-off, as can rapid or noisy breathing or frequent bouts of bronchitis or pneumonia.
"Sometimes the only hint is that a child is unable to physically keep up with his peers," says Dr. Robert Holzhauer, a clinical assistant professor of pediatrics at the University of Rochester School of Medicine in Rochester, New York. "A large percentage of asthmatic kids have symptoms triggered by exercise."
A cough that disturbs your child every night can vanish just in time for a doctor's appointment. These elusive symptoms may be why asthma was once considered a psychosomatic illness linked to overprotective parenting.
Asthma is a physical disease in which the lungs' airways, or bronchial tubes, constrict. Inflammation and mucus obstruct the tubes, making breathing laborious. But some doctors -- perhaps because of asthma's outdated reputation as an illness without a remedy -- still shun the "a" word.
"I still see patients who come to me who are said to have bronchitis several times a year, and nobody has made the diagnosis of asthma when it's pretty apparent that's what's been going on all along," says Dr. Holzhauer. Meanwhile, the child loses out on lung-preserving medication. The message here: If your child shows signs of asthma, remain watchful even if a doctor rules out the disease. Seek another opinion should symptoms continue.
Any child can get asthma, but children with a family history of asthma or allergies appear most vulnerable.
There's definitely a genetic predisposition, says Dr. Holzhauer, though scientists don't know the genes involved or any exact way to determine susceptibility. "A child with one parent with asthma has about a 35 percent chance of developing asthma," Dr. Holzhauer says. "That goes up to 60 percent if both parents have asthma."
To get asthma, a susceptible person has to be exposed to some initial irritant or allergen. That exposure can "turn on" the asthma -- and apparently the earlier in life this happens, the more severe the asthma tends to be. Culprit irritants vary from person to person, but common ones include allergens such as animal dander and mold, and irritants such as respiratory viruses and tobacco smoke. Many asthmatic children are also allergic to cockroaches and dust mites.
Parents eager to evade asthma can try to limit their child's exposure to common irritants, especially early on. "In the first three to four years of life, if you can begin the avoidance measures, you may be able to turn off the (asthma) process, which can't be turned off later," says Dr. Gail Shapiro, a clinical professor of pediatrics at the University of Washington in Seattle.
For example, researchers know that if there's a cat in the home during the first year of life, a child of allergic parents is 10 times more likely to get asthma, says Dr. Martha White, director of research at the Institute for Asthma and Allergy in Washington, D.C. She adds, "If someone is smoking in the house, a susceptible child is four times more likely to get asthma."
Dr. Gary Rachelefsky, clinical professor of pediatrics at the University of California, Los Angeles, advises parents:
Once you know that your child has asthma, one of the first things to do is determine what triggers an attack. Exercise can activate attacks, as can allergens, viruses, cold air, and even laughing or crying.
Ideally, a doctor helps find the triggers. Then she or he explains how to medicate before exposure, or how to limit the exposure by battling germs or reducing allergens through cleaning and air filtration.
The doctor, whether a general practitioner, allergist, or pulmonologist (lung specialist), should be an energetic partner in asthma control. For example, he or she should demonstrate how to use a peak-flow meter, a small device that measures changes in airflow from the lungs, warning of an impending attack days in advance.
"You want to find a doctor who's going to explain how the different asthma medications work, teach you about what goes on in the lungs, and then provide a written treatment plan," says Dr. White.
Inflammation in the airway lining is the underlying cause of asthma. Untreated over many years, inflammation also leads to scarring. Asthma experts now recommend that anyone with more than mild asthma should take a daily anti-inflammatory, such as corticosteroids or cromolyn sodium, and then use a bronchodilator, often via an inhaler, for quick relief.
Whatever drugs an asthmatic child is prescribed, parents should make sure their children take them. Dr. White says parents need to get over any feelings of uneasiness about giving a child daily medicine. She calls the less-medication-is-better mentality "disastrous if you have asthma."