"We always hope for the easy fix: the one simple change that will
erase a problem in a stroke. But few things in life work this way.
Instead, success requires making a hundred small steps go right - one
after the other, no slipups, no goofs, everyone pitching in." - Atul
Gawande, surgeon and journalist
Since I have talked of colds and
allergies I guess it is natural to feel compelled to discuss the
challenges a paediatrician faces with managing asthma. My moment of
truth came when a close friend of mine broke down as I was nebulizing
her nephew. I knew that she had outgrown wheezing episodes as a child
and I expected her to be reassuring by virtue of her experience. When I
asked her to explain herself she said, "The fear you feel when it
becomes increasingly difficult to breathe, it's horrible... I know what
the child must be going through, can't help feeling bad for him." That's
when I guessed that it's this panic that actuates so much of absurd
behaviour and decision making. So let me share some facts to allay some
of it.
First of all being asthmatic means you have airways that
are hypersensitive and prone to becoming narrowed because the
surrounding tissues get bloated as a part of the rabble rousing response
of the immune system when it encounters some triggers. Asthma attacks
come and go, with wide variation in the symptoms at different times.
Many people with asthma have problems only occasionally but others
struggle with it every day. There is no cure, the focus should be on
control, and it can be achieved. What we aim for when we say control, is
generally an ability to live an active, normal life (which means
performing daily activities, play, and participation in sports without
difficulty)
- Prevention of chronic and troublesome symptoms
- Zero school absenteeism because of asthma related symptoms
- Avoidance of symptoms during the night
- Stopping the need for urgent visits to the doctor, emergency department, or hospital
- Prescription and adjustment of medications to control asthma with little or no side effects
Secondly,
not all wheezing is asthma. About half of infants and toddlers with
repeated episodes of wheezing with shortness of breath or cough (even
though these illnesses usually respond to asthma medications) will not
have asthma by the age of six. Because of this, many paediatricians use
terms like "reactive airways disease" or "bronchiolitis" when describing
such children instead of labelling them as asthmatic.
No one
really knows the exact reasons why more and more children are developing
asthma in recent times. Some experts suggest that children spend too
much time indoors and are exposed to more and more dust, air pollution,
and second-hand smoke. Some suspect that children are not exposed to
enough childhood illnesses to direct the attention of their immune
system to bacteria and viruses and therefore, develop allergies (the so
called "hygiene hypothesis").
We also find many parents hesitant
to give inhaled asthma drugs or liquid medications delivered with an
asthma nebulizer, also known as a breathing machine. I wish parents
would take the time to educate themselves (the resources being so
accessible) and have clear concepts in their minds because only then can
they motivate children to be regular with medications and not feel
self-conscious while taking them. This is very crucial.
Asthma in
children is handled using very specific guidelines, depending on the
severity and duration of symptoms. The medications given fall into two
categories. One category includes drugs taken daily that are meant to
control asthma in the long term and reduce the frequency of asthma
attacks (controller or maintenance medications). The other category is
medications that provide instant relief from symptoms (rescue
medications). Steroids are a vital part of the list too. Very short oral
courses (three or five days) or long term inhaled preparations seldom
cause alarming side effects and there is no need for trepidation. In
general, doctors start with a high level of therapy during an asthma
attack and then decrease treatment to the lowest possible level that
still prevents asthma flare-ups and allows your child to have a normal
life. Every child needs to follow a customized asthma management plan
based on the severity and triggering factors so do not compare it with
another.
So the essential parts to managing your child's asthma
are Identifying and Controlling Asthma Triggers, knowing when to
anticipate flare ups and having a clear plan of action to handle it,
being regular with medicines and periodically updating your knowledge
with your doctor. This can take time and energy to master, but it's worth the effort!
