November 11, 2004

Asthma in babies is increasing in our country at an alarming rate. Zara Maqbool writes about how this disease can be controlled

For many years asthma was considered to be a disease which was common in the West. But some years ago a research done in Pakistan revealed that asthma cases have been increasing day by day. In the first survey carried out in Karachi in 1996, nine per cent people of the sample survey were discovered with asthma. A survey done in 2001 showed 19 per cent to be suffering from asthma. It was also noted that asthma is equally prevalent in the other cities of Pakistan.

So what is asthma? “Asthma is an allergy that causes inflammation of the airways,” says Dr Naseerudin Mahmood, a pediatrician. It is a chronic condition in which a person’s airways tend to become inflamed and filled with mucus when they are exposed to respiratory infection, cigarette smoke or a known allergen. During an asthma attack the body reacts by coughing.

In an attempt to expel the mucus, the tiny branches of the lung bronchi known as the bronchioles, go into spasms and it becomes very difficult to breathe. In some cases, asthma attacks can be life threatening.

Most people think that asthma is only an ‘episode of attack’ where shortness of breath takes place. The breathlessness is a result of the illness itself which is irreversible and needs proper treatment to control the attack. “Asthma requires regular, sustained treatment,” adds Dr. Naseer.

Asthma begins at an early age. Even if your baby is wheezing a lot, it may not be possible to tell if he has asthma until he’s older and the wheezing has then become a chronic condition. In fact, many experts don’t even think it’s possible to diagnose asthma until a child is at least three- year-old. Colds and other respiratory infections tend to cause babies to wheeze a lot because their airways are very small.

However, if your baby also coughs frequently and seems to have allergies (including food allergies), and your family has a history of asthma and allergies, there’s a good chance he may develop asthma. If the baby seems to be having real trouble breathing and his nostrils flare; if the skin around his ribs sucks in with each breath; if he appears to be turning blue, or if he’s breathing too fast, take him to hospital immediately.

In older children a lung function test is administered but in children under five, clinical judgment determines asthma. It is important to administer these tests every three to four months in children already diagnosed with asthma.

Let’s try to determine the causes of asthma? Are the factors controllable? Some babies who come down with a severe case of respiratory syncytial virus (RSV), a common respiratory virus, have a higher risk for developing asthma. Colds and other respiratory infections can also trigger wheezing. Certain foods (especially eggs, shellfish, cow’s milk and nuts) can produce the same effect if your baby happens to be allergic to them. That’s why most pediatricians recommend that parents wait until a child is at least a year old before being introduced to these foods.

Environmental allergens don’t come into play as much until the toddler years. That’s because it takes six months of exposure to an allergen for a baby to become sensitized to it. So a baby who lives with a cat, for example, won’t start to have any allergy or asthma symptoms until he’s at least six months old. And seasonal allergies such as hay fever usually don’t show up until the child is four or five, since it takes at least that long for him to accumulate six months’ exposure to a particular pollen. Exercise-induced asthma isn’t really a problem for babies, but it can strike when a toddler begins running.

Children with a family history of asthma and skin and nasal allergies are more prone to getting this disease than others. At the same time social factors play a role, such as constant exposure to smoke is a risk factor, as is unhealthy food and unhygienic environment. It is important to remember that asthma is a chronic disease so prevention is better than cure. “Asthma can be controlled but not cured,” says Dr Naseer.

It is a common belief that as children grow up, most of them outgrow asthma. It is important to know that the symptoms of asthma disappear but the disease does not. And just because the patient is not having the “attacks” does not mean that he is not asthmatic anymore. “If a test is done, it will be seen that the patient is still asthmatic,” says Dr Naseer. “It’s only that he is not having attacks because of better care.”

The biggest fear parents have regarding asthma is the “attacks”.

They need to work with their child’s doctor to develop a strategy for preventing and dealing with asthma attacks. The first thing that has to be done is to find out what triggers the attacks. Some babies only get them when they get a cold or other upper respiratory infection, others have an attack when they come into contact with an allergen.

The doctor will then probably prescribe one or more drugs for the child. Drugs known as relievers may be used to stop an asthma attack quickly. These include fast-acting aerosol bronchodilators that relieve the spasm in the airway, making breathing easier. One can administer the medication using either a metered-dose inhaler with a spacer tube and a face mask or a device called a nebulizer, both of which vaporize the medicine so that the baby can inhale it.

Another group of drugs, known as controllers, is used to prevent the attacks. A child who wheezes frequently may benefit from controller drug therapy, which seeks to prevent the wheezing from occurring in the first place. Controllers include anti-inflammatories, such as corticosteroids. In most cases a baby will not need to take medication on a regular basis but only when exposed to an asthma trigger. If your baby’s asthma proves difficult to control, you should consult a pediatric pulmonologist. In acute cases of asthma steroids are also recommended for children. “The short-term use of these steroids is not dangerous for children,” says Dr Naseer.

There’s nothing you can do to fully prevent your baby from getting asthma if it’s in his genes. And you won’t know whether your child will be asthmatic until he shows consistent symptoms, such as wheezing and coughing. But if you and your spouse both have allergies and asthma, then your baby has a strong likelihood of having asthma as well. That said, you may be able to delay its onset until your baby is older (and his lungs are bigger and stronger) if you do the following:

* Limit his exposure to dust mites by encasing his crib mattress in an impermeable cover, removing carpeting and plush toys from his room, using blinds instead of heavy fabric drapes, and washing his bedding once a week in hot water.

* Keep him away from second-hand smoke. Cigarette smoke isn’t considered an allergen per se, but it does irritate the lungs.

* Avoid using a fireplace or wood stove. Although the warmth and coziness are inviting, the smoke may irritate your baby’s respiratory system.

* If it’s clear that your baby has developed an allergy to a pet, you’ll need to keep the pet outdoors or away from the baby as much as possible.

* Try to limit his exposure to viruses for as long as you can by practicing good hygiene.

* Delay giving your baby the foods that are the most likely to cause food allergies, such as eggs, nuts, shellfish, and cow’s milk.

The important thing to understand here is that asthma is not something to be feared about. With proper treatment and controlling of the factors, an asthmatic child can have a 100 per cent normal life. Stress in life can start the onset of asthmatic attacks but it is not common in all cases.

Asthma can be frightening for both you and your baby, but remember, you’re not alone. Although asthma is a disease that can’t be cured in the traditional sense, it can be effectively controlled. While many children outgrow their asthma, others learn how to manage their conditions and do what other kids do, such as running, swimming and playing. Either way, most children with asthma grow up to be healthy adults.

Please Visit our Sponsor (Ads open in separate window)