The start of summer usually signifies a drop in viral respiratory infections. However, this is also the season for high humidity, thunderstorms and various environmental allergens, all of which can be especially hard on some people with asthma whose symptoms can strike at any time.
Asthma is a complex condition characterized by swollen and narrowed airways. According to the center for disease control, it affects about 22 million people in the United States and is caused by a combination of genetic and environmental factors. Onset is usually in early childhood and it may or may not be associated with eczema and/ or allergic rhinitis/ hay fever.
Diagnosing asthma, especially in a young child, can be challenging as there is no specific test available. Doctors might perform some studies (lung function testing, chest X-ray, etc.) to aid diagnosis. Asthma symptoms can be episodic or persistent. Symptoms include cough, shortness of breath, chest tightness, wheezing (whistling noise while breathing), exercise intolerance, fatigue, etc.
Various factors can trigger asthma, including tobacco smoke, seasonal allergies, viral upper respiratory infections, cold air, exercise, air pollution, etc. An asthma attack or exacerbation is when there is worsening of baseline symptoms and this can range in severity from mild to life threatening. A device called “peak flow meter” can be used to assess the severity of an exacerbation more objectively. Poorly controlled asthma can also affect a person’s quality of life. Fortunately, asthma can usually be managed by the following means:
There are two categories of medications for asthma:
▪ Rescue/quick-relief drugs (usually albuterol) – these are meant to be used during an acute asthma attack to provide immediate relief of symptoms. Rescue inhalers must be available at all times and should be started at the first sign of an exacerbation.
▪ Controllers – these are used to prevent exacerbations or decrease persistent symptoms. Most controllers only work if they are taken consistently on a daily basis for a long period of time. Some commonly used controllers are inhaled corticosteroid (ICS), Montelukast, combination inhalers, etc. Most of these medications have a low side effect profile and benefits of using them often outweigh any risks.
The most ideal method to deliver inhaled medications in children (and even most adults) is either via a nebulizer machine or by a Metered Dose Inhaler (MDI) with a spacer. It cannot be stressed enough that using MDI without a spacer is extremely ineffective. Placing an inhaler directly in the mouth will lead to deposition of the drug in the mouth and throat instead of delivering the drug to the lungs where it is required to act.
Avoidance of triggers
Avoidance of triggers is also equally important in asthma management. Triggers can vary for each individual and can even change for the same individual over time. Testing for environmental allergies can help pinpoint triggers guide treatment. Medical professionals should remember that there is no indication to routinely send extended food allergy panels as they are frequently falsely positive and therefore should only be performed if there are clear-cut clinical symptoms of allergy to specific food(s).
Exercise and asthma
In general, there should be no restrictions in activity for children with asthma, unless there are other reasons to do so, for example if a child has an acute asthma exacerbation or there are other coexisting medical conditions that require activity limitations. Premedication with Albuterol 10-15 minutes prior to intense physical activity might help in improving exercise tolerance.
Most people with asthma are provided with a personalized “asthma action plan” by their physician. This plan is intended to act as a guide for appropriate management of asthma at different stages (at baseline and during exacerbations). If an individual’s asthma is very difficult to control then various other diseases that mimic asthma must be taken into consideration and this might warrant referral to a pulmonary specialist.
Overall asthma is a challenging condition. Management requires close partnership with an experienced medical professional who can help in coming up with a customized management plan that works optimally for each individual.