Childhood Asthma : Care of the Asthmatic Child

by Food and Drug Administration (FDA)

(Page 3 of 3)

Inhaled steroids may produce the good effects of oral corticosteroids and decrease some of the bad effects, and thus can be used daily as preventive medication.

Sander states: "Parents know about the side effects of oral steroids and are afraid to have their children use inhaled steroids. They shouldn't be. . . . Inhaled steroids go right where they're supposed to go."

However, the inhaler is difficult for small children to use, and continued use may also irritate the throat. Occasionally, inhaled corticosteroids cause a yeast infection called thrush to settle in the back of the throat. Rinsing the mouth and gargling with warm water after use should help prevent this infection.

Inhaled corticosteroids are not useful in severe or acute attacks of asthma, but they can reduce their frequency. For difficult-to-manage asthma, the more effective oral corticosteroids are probably the most valuable drugs.

Doctors rely on oral corticosteroids when allergy treatment and other medications — including adrenergic drugs, theophylline, inhaled steroids, and cromolyn — have been unable to control asthma symptoms. Occasional short-term use of oral corticosteroids — less than two weeks — may not result in significant side effects.

Finding the right doses of the right medicines that will benefit a child often takes a period of trial and error. The doctor will fine-tune the treatment as much as possible, taking into account the child's symptoms and the medications' adverse effects. With good management, a child with asthma should be able to lead a normal, active life.

Care of the Asthmatic Child

Many factors can trigger an asthma "flare" in a susceptible child, but the most common are allergens, colds, flu, and other respiratory infections. Exercise is also a common trigger in children, as well as adults.

Irritants such as perfumes, cigarette smoke, wood smoke, hair sprays, paint odors, cotton or wood dust, industrial chemicals and fumes, and outdoor pollution may also bring on an attack. Cold air and changes in the weather, in which winds sweep in from other areas carrying irritants, pollution or different pollens, often cause a flare. A cough, shout or laugh may stimulate the vagus nerve that leads to the lungs, and cause an attack.

Allergies play a part in triggering attacks in a large percentage of children with asthma. Some of the most common offenders are animal dander, pollen, mold, ragweed, house dust, bacteria, dust mites, fungi, and animal and human skin fragments. Certain foods, such as chocolate, shellfish, milk, orange juice, eggs, nuts and peanut butter, along with foods or drugs containing sulfites and other preservatives, can also trigger attacks. Some children may develop severe bronchospasm from aspirin and nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen and piroxicam.

A recent study performed at the National Jewish Center for Immunology and Respiratory Medicine, Denver, Colo., found that children with severe asthma suffer from depression and guilt feelings, often have problems in school, and limit their normal activities because of the disease. Asthma's damage extends to the family, whose lifestyles are often affected. When the cost of medication and devices is added in, it can be seen that severe chronic asthma can be a burden on the family.

Doctors advise parents of asthmatic children whose attacks are allergy- related to help the child avoid the allergen whenever possible, which means that sometimes the family pet must go or more rigorous dust-control measures must be instituted. With unavoidable allergens, allergy shots given year-round are helpful in most cases. Moving to another area to escape allergens is not recommended unless the new area is given a trial in all seasons of the year. It is quite possible that after a "honeymoon" period in the new area, the child may begin to react to local allergens.

Since asthma attacks can happen anytime, anywhere, parents of children with asthma need to communicate with school personnel if their children must take medicine at designated times or use devices such as inhalers. Unfortunately, many teenagers try to ignore asthma symptoms at school because they don't want to be seen using an inhaler, especially before sports activities. The result is often out-of-control asthma.

Parents should see that the child eats a nutritious diet, including plenty of fluids, has adequate rest and exercise, and is knowledgeable about factors that will set off an episode.

To avoid reliance on emergency rooms and hospitals, parents and child need to be alert to the early signs of asthma and have a definite medical regimen to follow when an attack begins. Medications should be taken exactly as prescribed. A supportive and sympathetic doctor, who can provide the parents with an asthma prevention plan as well as care for acute episodes, is a necessity.

Children with well-controlled asthma should be encouraged to take part in exercises or sports activities. Besides increasing lung capacity, exercise improves breathing and may eliminate or lessen the severity of asthma attacks. An added bonus: Doing what other children can do increases self-esteem. In 1984, 66 of the U.S. Olympic competitors had been diagnosed as having exercise-induced asthma. Forty-one of those athletes won medals in the games.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.