A WonderCare Guide to Asthma in Children!

Childhood Asthma

Around 1 in 5 of Irish children are affected by asthma with boys being more likely to suffer than girls.  Happily the odds get a bit better with age but still approximately 1 in 10 adults are asthma patients  (470,000 people!) in Ireland.

Asthma is a chronic respiratory disease which is often not diagnosed and unfortunately uncontrolled which can lead to ill health in children.  The early detection and treatment of asthma in kids is essential to reduce illness and complications and to increase the quality of life of those affected and their families. Illness from asthma can be mild and cause moderate inconvenience such as missed days from school, however it can also present in a more severe form which can be serious and potentially life threatening. Modern medicine makes asthma an extremely well controlled condition in those with appropriate action plans and I can’t stress enough how important it is to work with your child’s doctor to ensure you are keeping their condition as well controlled as possible – this proactive attitude will help your child to lead a ‘normal’ life and reduce the number of doctor and hospital visits necessary.

Asthma causes your child’s airways to tighten up and narrow in response to a ‘trigger’. Triggers vary from person to person but often include dust or cold air. Patients and their families should learn about asthma and what makes it worse for them.  When your child’s airways are tight it can be hard for them to breathe in and out normally.  Their lungs also produce a thick mucus which clogs up the airways – as you can imagine this doesn’t help with breathing and can leave your child’s lungs more susceptible to infection.

Asthma can run in families – so if your child has a parent or sibling with allergies, hay-fever or eczema they are more likely to be affected.  Other risk factors for asthma include viral infections, preterm birth, a mother smoking during pregnancy, obesity, and exposure to environmental irritants such as pollution.

Symptoms of asthma:

The symptoms of asthma can vary and aren’t always quite as dramatic as parents tend to expect.  Your child may have just one symptom or may have several.  Your child may have  similar symptoms and still not have asthma as unfortunately they are common with many other illnesses also. If you suspect asthma please do speak to your GP who will be able to further investigate their symptoms.

• Shortness of breath – with asthma this tends to start with exercise or excitement.
• A dry persistent night time cough – sometimes this cough is worse in the morning but usually results in your child’s sleep being disrupted – and that’s not easy for anyone!
• A dry cough which comes when exercising (or in children’s world – active playing!)
• Regular wheeze – A wheezing sound (like a whistling sound) which you can hear when your child is breathing in or out. Some children can be affected by wheeze and not asthma and often grow out of it by school going age. It can also be associated with a regular cough, cold or viral infection.
• A pain in the child’s chest caused by the tightening – they sometimes mistake this for a sore tummy and so this symptom can be a little confusing.

Obtaining a diagnosis of asthma can be a long process and good interaction with your child’s GP is essential.  It will often take several weeks or months and your doctor will use lots of information available to them to make the diagnosis for example age, symptoms, general health, presence of other allergies, family history etc.  Your doctor may decide to trial asthma medication to see how your child responds over a period of weeks or months.  Their response to the medication may be a helpful tool in their diagnosis.  Your child may be labelled with ‘suspected asthma’ for quite some time as it is difficult to perform all of the necessary tests, especially on children under five years of age.

Triggers

Triggers are anything that makes the symptoms of your child’s asthma worse.  Sometimes a trigger can make your child’s breathing instantly worse and sometimes it can take hours for their little bodies to react which makes it pretty difficult to always be sure of what the trigger was!  Triggers can include:

• Infections such as the common cold.
• Pollutants in the air such as tobacco smoke.
• Allergies to dust, pets , pollen or mould.
• Exercise (once under control exercise can and should continue like normal!)
• Changes in the weather – from hot to cold or vice versa.
• Fog or damp.

Medication for asthma

There are many different treatments for asthma in children.  Your Doctor will make their choice based on research and clinical guidelines in response to your  child’s specific symptoms – so not every child’s treatment will be the same!

Inhalers generally include a ‘preventer’ inhaler which are commonly thought of as brown in colour but can be different (red,orange, yellow etc!) and is taken regularly as directed by your child’s doctor. This is usually taken whether your child has symptoms or not – it’s important to keep going with it as directed as this inhaler reduces the inflammation of the lungs over time and prevents it from coming back.  I’d advise wiping your child’s skin around their mouth after giving this inhaler and rinsing their mouth out with water – even by encouraging them to have a good drink.  This helps to prevent irritation of the mouth.  This type of inhaler is also known as a ‘controller’ inhaler.

There is also a ‘reliever inhaler which is most commonly blue.  This is used to ease symptoms such as shortness of breath as they occur or when exposed to a known trigger.  The dose will vary according to your child’s age and the nature of their symptoms.  You ideally should not need to use this inhaler too often as symptoms occurring approximately more than twice per week should be readdressed by your child’s GP as their condition may not be under control.  Using your ‘preventer’ inhaler as prescribed should reduce the need for use for your ‘reliever’ inhaler.

Devices are recommended to make the administration of inhalers easier to children and can include soft masks or mouth pieces depending on the age of your child.  I will speak more about these when I discuss inhaler technique.

There are also different types of tablets available for use in children with asthma.  For severe symptoms steroids are often used – these can be dissolved in a little water before been given and work by reducing inflammation to alleviate symptoms.  These are only used for a few days (generally 3-5) to get the symptoms under control.  Other tablets are sometimes useful depending on the cause of your child’s asthma such as leukotrine receptor antagonists which work by preventing an asthmatic reaction to a particular trigger.
These are available in granules, chewable tablets or regular tablets depending on the age of your child.

WonderCare Tips:

• Keep a diary of your child’s symptoms – recording each day whether they have had a cough, shortness of breath, wheeze, or a pain in their chest. This sounds like a lot of work but is really really worth doing because it will allow your GP to get a clear picture of what is going on in day to day life – rather than just when you have to present at the surgery with a bad chest infection or flare up etc.  I’d advise having a little diary and in the front of the book write a code – ‘S’ for shortness of breath, ‘W’ for wheeze, ‘PIC’ for pain in chest, ‘C’ for cough.    If I’m being really nerdy….I’d score each symptom out of ten…so ‘S’ followed by the number 1 would be mild shortness of breath or 10 would be severe shortness of breath.
• Note your child’s activities and environment when symptoms occur – this helps to identify triggers – for example – you may notice your child’s symptoms get worse every time you visit your mother in laws….no, this does not mean you have an excuse to avoid your relations, but it does mean she may have a particular plant or fragrance etc in the house which is a ‘trigger’. In the interest of family diplomacy you should discuss this tactfully with them… I’m a Pharmacist though…not a politician!!
• Use my Medicines administration chart to ensure that your child’s medicine is being administered correctly – i.e. the right dose, at the right time, and in the right way. Follow the link to download the chart for free. 
• Inhaler technique is really important – click here to read my inhaler technique blog
• Encourage your children to have good hand hygiene to reduce the spread of infections which can trigger symptoms.
• Discuss the flu vaccine for your child with your doctor – it’s recommended for all children diagnosed with asthma.
• Breastfeeding exclusively can help to reduce your child’s chance of developing asthma. This is particularly important during the early months
• The preventative actions you should take should reflect the triggers your child is sensitive to. Each child’s asthma treatment plan will be different as triggers are different for everyone. For example if your child’s asthmatic symptoms are triggered by dust mites you will need to take action to reduce their exposure specifically to dust mites.  Some examples of how to do this include hoovering three times a week with a hoover which has a HEPA filter,  use dust mite covers on bedding, wash all bedding at 60 degrees once each week and regularly clean down surfaces with a damp cloth.     If your child is sensitive to certain temperatures or weather ensure your child uses their reliever inhaler when changing environment.  If your child has symptoms during exercise then encourage reliever inhaler use prior to exercise and if symptoms continue to get worse during exercise see the doctor as other medications will most likely get this under control.

I always compare asthma to eczema…. It’s one of those conditions which needs ongoing maintenance but unfortunately as humans we tend to forget about the importance of the maintenance once the symptoms have gone away – I’m not preaching – I’m guilty myself!!  It’s not a condition which really goes away but number of the flare ups and severe episodes (attacks) can go away with good maintenance.  To allow your child to live a ‘normal,’ and active life try to explain their condition to them as best as you can depending on their age.  Some children will understand that their chest is red and tight and by following the Doctors instructions and Pharmacists directions they can calm it down again to loosen it out and help their lungs to work properly.  Rather than engaging in a battle of medication administration encourage them to do it themselves under your supervision and even ask them to colour code their symptoms for you – ask them to tell you when their chest is red (when they are badly struggling to breath), its pink (when it’s a little but hard to breath) and its white (when its fine).  Giving them a simple colour code empowers them to communicate how they are feeling and they will be so happy that you understand how they are feeling and that you can treat them and make the red turn white again! Ok so maybe I’m a little bit enthusiastic due to my job but I truly feel that educating children at a level appropriate to them is the best way for parents to gain cooperation and for everyone to start feeling better sooner! My two girls currently think they have two ‘angry’ tonsils and they have to make the medicine to make them happy again.. It’s all about finding a way for them to understand and for you to explain why you are trying to push an ‘aero-chamber’ device into their faces when they are already struggling to breath! A willing patient is so much easier to treat!

For great support and information its worth checking out www.asthma.ie which is the website of the Asthma Society of Ireland who do great work supporting parents through the identification and diagnosis of asthma.  First and foremost contact your GP if you are at all concerned and know that I am happy to answer private queries on a one to one basis through the WonderCare facebook page – www.facebook.com/wonderbabacare

I will record a video demonstrating correct inhaler technique and all of the different devices that are available to make life easier over the coming weeks!  I have also included emergency treatment advice as per the HSE below – it’s no harm to be familiar with the current emergency treatment recommendations.

I hope you find this helpful and if you have any questions at all please don’t hesitate to contact me by sending a private message to the WonderCare facebook page (www.facebook.com/wonderbabacare) or by calling me (Sheena) at Milltown totalhealth Pharmacy in Dublin 6 on 012600262. I’m always happy to help!

In the case of a severe asthma attack please follow the following recommendation from the HSE:

“An Asthma Attack

Occasionally an asthma attack may occur no matter how careful you are about taking your asthma treatment and avoiding triggers. An asthma attack normally doesn’t occur suddenly; most people find that asthma attacks are the result of a gradual worsening of symptoms over a few days. If your symptoms are getting worse, do not ignore them. Quite often using your reliever may be all that is needed to get your asthma under control again. At other times symptoms are more severe and more urgent action is required.

 

The Five Step Rule

During an Asthma Attack – Follow the Five Step Rule

• Take two puffs of reliever inhaler (usually blue) immediately
• Sit upright and stay calm
• Take slow steady breaths
• If there is no immediate improvement take one puff of reliever inhaler every minute (You can take up to 10 puffs in ten minutes – Children under 6 years can take up to 6 puffs in ten minutes)
• Call 999 or 112 if symptoms do not improve after following steps 1 -4 OR if you are in worried
• If an ambulance does not arrive within 10 minutes repeat Step 4.

 

Don’t put your arm around me or lie me down – this will restrict my breathing.

Don’t worry about giving me too much reliever – during an asthma attack extra puffs of reliever medication are safe.

Do use a spacer device if one is available.

Do listen to what I am saying – I have had attacks before.

If you are admitted to hospital or an accident and emergency department because of your asthma, take details of your treatment with you. Bring your asthma management plan if you have one to the hospital.

You should also make an appointment with your doctor or nurse after you are discharged from hospital, so that you can review your asthma treatment to avoid the situation rising again.

Severe Asthma

Severe asthma is difficult to define. It is made more confusing because there are several other words people use to describe it (difficult, brittle) and people use the term severe asthma in different ways.

There is a widespread popular misconception that asthma is a mild disease that only affects children. Not many people are aware of the severe consequences it can have on a person’s quality of life.”

References

https://www.ncbi.nlm.nih.gov/pubmed/24727807

http://aje.oxfordjournals.org/content/179/10/1153.full

https://www.asthma.ie/https://www.asthma.ie/sites/default/files/files/document_bank/2014/May/Asthma%20and%20Your%20Child_final.pdf

https://www.hse.ie/eng/health/az/A/Asthma/Symptoms-of-asthma.html  (please review for any updates – current as of 2/11/16)