Asthma is a chronic condition with symptoms of cough, chest tightness, with or without difficulty in breathing. These symptoms occur periodically and are usually associated with certain triggering events.
People with asthma have a narrowed airway during the episodes of an attack, but the narrowing is reversible with use of asthma medications. In children with asthma, the airway of these children is very reactive to a variety of triggering agents such as; viral infection (commonly, the common cold), exercise, pollen, food to which the child is allergic to or other environmental changes.
Asthma is the most common chronic illness in children in developed countries, affecting about 12 per cent of the children below the age of 18 years. Asthma affects more males than females before the age of 15 years.
Asthma occurs when the small airways in the lungs become inflamed and narrowed, which limits the flow of air out of the lungs. This narrowing is almost always reversible in children with treatment. Many different genetic and environmental factors can increase the risk of developing asthma
Increased exposure to indoor and outdoor pollution, exposure to tobacco smoke during pregnancy and throughout childhood,increase the risk of developing asthma. Children with a family history of certain medical condition such as asthma, allergies, eczema are at an increased risk of developing asthma.
However, children without any of these identifiable risk factors can suffer from asthma and presence of the risk factors doesn’t always guarantee that one will suffer from asthma.
Symptoms of asthma in children commonly are cough and wheezing. The cough is usually dry and hacking, and is most noticeable when the child is sleeping and early morning hours and may also be triggered by exercise. Wheezing is a high pitched musical noise that is usually heard when the child breathes out. These symptoms tend to come and go during the day or night, depending on the degree of airway narrowing in the lungs. Breathlessness, chest tightness or pressure or chest pain may occur. The child may report that their chest or stomach hurts.
Asthma symptoms usually develop in children before the age of 5 years, although it can be difficult to diagnose asthma in infants.
Although, these symptoms of asthma can occur anytime, certain triggers are known to worsen asthma in many children. Asthma symptoms may worsen during certain environmental changes such as cold air, rainy seasons or dusty conditions. Viral respiratory infections are a common trigger of asthma in children. In some children, exercise can trigger asthma and this commonly happens in 5 to 10 minutes of relaxing after a vigorous exercise and tends to disappear after 20 to 45 minutes.
Indoor and outdoor agents are common trigger of asthma especially in children older than 3 years of age, and the commonest known triggering agents include; house dust (e.g. Dust mites, cockroaches, mice droppings) , animal exposure especially cats and dogs, pollens from flowers, molds, indoor pollutants (e.g. paint, perfume, cleaning products, gas stoves, etc.)
Diagnosis of asthma in children is done by taking the history of the child’s complaints usually from the mother/ guardian, doing a physical examination and further tests are carried out to diagnose asthma and rule out other causes of the symptoms. Many children with asthma appear and sound completely normal in absence of attacks.
Spirometry is a common test that is used to diagnose asthma. It measures the flow and volume of air the child generated after taking a very deep breath and then forcefully expels the air out of his lungs and if there is air obstruction such as in asthma, the test is repeated after the child has used an inhaler for asthma. The results are then interpreted by a clinician to confirm the diagnosis.
Children younger than 6 years are sometimes unable to follow instructions, and if there is high suspicion of asthma, a trial of medication for asthma can be given, and monitored for improvement.
If allergies are a possible cause of the symptoms of asthma, skin or blood testing can be done in some settings. These can help in identifying the triggers and the need to avoid these triggers at home.
Treatment for asthma in children depends on a number of factors such as age, severity and frequency of the asthma attacks. For most children, asthma medications can help children to live a normal life and participate in all activities and sports.
The pillar of successful asthma treatment lies in; identifying and avoiding asthma triggers, regularly monitoring for asthma symptoms with early treatment of these symptoms and understanding how to use these medications for asthma.
Dr Ian Shyaka is a General Practitioner based in Kigali.